Background Despite the use of validated guidelines in the management of mild traumatic brain injury (mTBI), processes to limit unnecessary brain scans are still not sufficient and need to be improved. The use of blood biomarkers represents a relevant adjunct to identify patients at risk for intracranial injury requiring computed tomography (CT) scan. Content Biomarkers currently recommended in the management of mTBI in adults and children are discussed in this review. Protein S100 beta (S100B) is the best-documented blood biomarker due to its validation in large observational and interventional studies. Glial fibrillary acidic protein (GFAP) and ubiquitin carboxyterminal hydrolase L-1 (UCH-L1) have also recently demonstrated their usefulness in patients with mTBI. Preanalytical, analytical, and postanalytical performance are presented to aid in their interpretation in clinical practice. Finally, new perspectives on biomarkers and mTBI are discussed. Summary In adults, the inclusion of S100B in Scandinavian and French guidelines has reduced the need for CT scans by at least 30%. S100B has significant potential as a diagnostic biomarker, but limitations include its rapid half-life, which requires blood collection within 3 h of trauma, and its lack of neurospecificity. In 2018, the FDA approved the use of combined determination of GFAP and UCH-L1 to aid in the assessment of mTBI. Since 2022, new French guidelines also recommend the determination of GFAP and UCH-L1 in order to target a larger number of patients (sampling within 12 h post-injury) and optimize the reduction of CT scans. In the future, new cut-offs related to age and promising new biomarkers are expected for both diagnostic and prognostic applications.

中文翻译：

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临床实践中治疗轻度创伤性脑损伤的血液生物标志物


背景 尽管在轻度创伤性脑损伤 （mTBI） 的管理中使用了经过验证的指南，但限制不必要的脑部扫描的过程仍然不够，需要改进。使用血液生物标志物是识别需要计算机断层扫描 （CT） 扫描的颅内损伤风险患者的相关辅助手段。内容 本综述讨论了目前推荐用于成人和儿童 mTBI 管理的生物标志物。蛋白 S100 β （S100B） 是文献记录最广的血液生物标志物，因为它在大型观察和介入研究中得到了验证。神经胶质纤维酸性蛋白 （GFAP） 和泛素羧基末端水解酶 L-1 （UCH-L1） 最近也证明了它们在 mTBI 患者中的有效性。介绍了分析前、分析和分析后性能，以帮助在临床实践中解释它们。最后，讨论了生物标志物和 mTBI 的新观点。摘要 在成人中，斯堪的纳维亚和法国指南中包括 S100B 已将 CT 扫描的需求减少了至少 30%。S100B 作为诊断生物标志物具有巨大潜力，但局限性包括其快速半衰期，需要在创伤后 3 小时内采集血液，以及缺乏神经特异性。2018 年，FDA 批准使用 GFAP 和 UCH-L1 的联合测定来帮助评估 mTBI。自 2022 年以来，新的法国指南还建议测定 GFAP 和 UCH-L1，以便针对更多患者（受伤后 12 小时内采样）并优化减少 CT 扫描。未来，预计与年龄相关的新临界值和有前景的新生物标志物将用于诊断和预后应用。