Plasma Biomarkers of Traumatic Brain Injury in Adolescents With Sport-Related Concussion.
JAMA Netw Open
; 7(9): e2431959, 2024 Sep 03.
Article
em En
| MEDLINE
| ID: mdl-39235809
ABSTRACT
Importance Blood-based biomarkers may clarify underlying neuropathology and potentially assist in clinical management of adolescents with sport-related concussion (SRC). Objective:
To investigate the association between SRC and plasma biomarkers in adolescents. Design, Setting, andParticipants:
Prospective cohort study in Canadian sport and clinic settings (Surveillance in High Schools and Community Sport to Reduce Concussions and Their Consequences study; September 2019 to November 2022). Participants were a convenience sample of 849 adolescent (ages 10-18 years) sport participants with blood samples. Data were analyzed from February to September 2023. Exposures Blood collection and clinical testing preseason (uninjured) and post-SRC follow-ups (ie, ≤72 hours, 1 week, and biweekly until medical clearance to return to play [RTP]). Main Outcomes andMeasures:
Plasma glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light (NfL), and total tau (t-tau) were assayed. Group-level comparisons of biomarker levels were conducted between uninjured and post-SRC intervals (postinjury day [PID] 0-3, 4-10, 11-28, and >28) considering age and sex as modifiers. Secondary analyses explored associations between biomarker concentrations and clinical outcomes (Sport Concussion Assessment Tool, Fifth Edition [SCAT5] symptom scores and time to RTP).Results:
This study included 1023 plasma specimens from 695 uninjured participants (467 male participants [67.2%]; median [IQR] age, 15.90 [15.13-16.84] years) and 154 participants with concussion (78 male participants [51.0%]; median [IQR] age, 16.12 [15.31-17.11] years). Acute (PID 0-3) differences relative to uninjured levels were found for GFAP (femaleparticipants:
17.8% increase; ß = 0.164; 95% CI, 0.064 to 0.263; P = .001; maleparticipants:
17.1% increase; ß = 0.157; 95% CI, 0.086 to 0.229; P < .001), UCH-L1 (femaleparticipants:
43.4% increase; ß = 0.361; 95% CI, 0.125 to 0.596; P = .003), NfL (maleparticipants:
19.0% increase; ß = 0.174; 95% CI, 0.087 to 0.261; P < .001), and t-tau (femaleparticipants:
-22.9%; ß = -0.260; 95% CI, -0.391 to -0.130; P < .001; maleparticipants:
-18.4%; ß = -0.203; 95% CI, -0.300 to -0.106; P < .001). Differences were observed for all biomarkers at PID 4 to 10, 11 to 28, and greater than 28 compared with uninjured groups. GFAP, NfL, and t-tau were associated with SCAT5 symptom scores across several PID intervals. Higher GFAP after 28 days post-SRC was associated with earlier clearance to RTP (hazard ratio, 4.78; 95% CI, 1.59 to 14.31; P = .01). Male participants exhibited lower GFAP (-9.7%), but higher UCH-L1 (21.3%) compared with female participants. Age was associated with lower GFAP (-5.4% per year) and t-tau (-5.3% per year). Conclusions and Relevance In this cohort study of 849 adolescents, plasma biomarkers differed between uninjured participants and those with concussions, supporting their continued use to understand concussion neuropathology. Age and sex are critical considerations as these biomarkers progress toward clinical validation.
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Base de dados:
MEDLINE
Assunto principal:
Traumatismos em Atletas
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Concussão Encefálica
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Biomarcadores
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Proteínas tau
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article