Abstract Details

Title High-sensitivity C-reactive protein as a prognostic biomarker for traumatic brain injury (TBI): A TRACK-TBI Study

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S48 - Neurocritical Care: Traumatic Brain Injury and Goals-of-care Decision-making (1:12 PM-1:24 PM)

Poster/Presentation
Number 002

Objective To estimate the accuracy of high sensitivity assays of CRP (hsCRP) as a prognostic biomarker for TBI.

Background The effect of the systemic inflammatory response on recovery after TBI has received relatively little attention. C-reactive protein (CRP) is a clinically useful and non-specific biomarker of systemic inflammation.

Design/Methods TRACK-TBI enrolled adult subjects with TBI who presented to eighteen Level I trauma centers within 24 hours of injury (n=308), as well as orthopedic control subjects who suffered extracranial injuries but no TBI (n=19). Analysis included participants with samples drawn at day 1, 14, and either day 3 or 5 after injury. hsCRP was measured on the Abbott Architect c8000, MULTIGENT CRP Vario assay. Unfavorable outcome was defined as Glasgow Outcome Scale-Extended (GOSE) <5 at 6 months post-injury.

Results hsCRP levels were particularly elevated on days 3 and 5 after injury (median (IQR): 31.6 (7.3–70.6) mg/L on day 1, 99.3 (39.3–183.0) on day 3, 107.9 (46.5–185.6) on day 5, and 11.0 (3.4–42.6) on day 14). There was no significant difference in hsCRP between TBI subjects and orthopedic controls at any time point. TBI subjects with intracranial findings on CT had significantly higher hsCRP at every time point compared to those with negative CT scans (p=0.0237 on day 1, p<0.0001 on days 3, 5, and 14). Subjects with unfavorable recovery had significantly higher hsCRP at every time point in the first two weeks after injury compared to those with favorable recovery (p=0.024 on day 1, p<0.0001 on days 3, 5, and 14). hsCRP demonstrated good to excellent discriminative ability (C-statistic 0.789 on day 3, 0.769 on day 5, and 0.880 on day 14) for identifying subjects with unfavorable recovery.

Conclusions hsCRP is a promising prognostic biomarker for TBI. hsCRP, measured in the first two weeks post-injury, predicted unfavorable recovery at 6 months following TBI.

Authors/Disclosures
Linda Xu, MD (Penn Medicine) PRESENTER	No disclosure on file
	No disclosure on file
Ava Puccio, PhD, RN (University of Pittsburgh)	Dr. Puccio has nothing to disclose.
Adam Ferguson	The institution of Adam Ferguson has received research support from NIH. The institution of Adam Ferguson has received research support from VA. The institution of Adam Ferguson has received research support from DoD. The institution of Adam Ferguson has received research support from Wings for Life Foundation. The institution of Adam Ferguson has received research support from Craig H Neilsen Foundation. Adam Ferguson has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
David C. Okonkwo, MD	No disclosure on file
Geoffrey Manley, MD, PhD (UCSF Med Ctr/Dept of Neurosurgery)	The institution of Dr. Manley has received research support from NIH-NINDS. The institution of Dr. Manley has received research support from US Department of Defense. The institution of Dr. Manley has received research support from US Department of Defense/MTEC. The institution of Dr. Manley has received research support from One Mind. The institution of Dr. Manley has received research support from Neurotrauma Sciences, LLC. The institution of Dr. Manley has received research support from NFL Scientific Advisory Board.
	No disclosure on file
Ramon R. Diaz-Arrastia, MD, PhD, FAAN (University of Pennsylvania)	Dr. Diaz-Arrastia has stock in BrainBox, LLC. Dr. Diaz-Arrastia has stock in Nia Therpeutics. The institution of Dr. Diaz-Arrastia has received research support from National Institutes of Health. The institution of Dr. Diaz-Arrastia has received research support from Department of Defense.

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