Circulating brain-derived neurotrophic factor has diagnostic and prognostic value in traumatic brain injury

Frederick K. Korley, Ramon Diaz-Arrastia, Alan H.B. Wu, John K. Yue, Geoffrey T. Manley, Haris I. Sair, Jennifer Van Eyk, Allen D. Everett, David O. Okonkwo, Alex B. Valadka, Wayne A. Gordon, Andrew I.R. Maas, Pratik Mukherjee, Esther L. Yuh, Hester F. Lingsma, Ava M. Puccio, David M. Schnyer

Research output: Contribution to journalArticle

Abstract

Brain-derived neurotrophic factor (BDNF) is important for neuronal survival and regeneration. We investigated the diagnostic and prognostic values of serum BDNF in traumatic brain injury (TBI). We examined serum BDNF in two independent cohorts of TBI cases presenting to the emergency departments (EDs) of the Johns Hopkins Hospital (JHH; n = 76) and San Francisco General Hospital (SFGH, n = 80), and a control group of JHH ED patients without TBI (n = 150). Findings were subsequently validated in the prospective, multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study (n = 159). We investigated the association between BDNF, glial fibrillary acidic protein (GFAP), and ubiquitin C-terminal hydrolase-L1 (UCH-L1) and recovery from TBI at 6 months in the TRACK-TBI Pilot cohort. Incomplete recovery was defined as having either post-concussive syndrome or a Glasgow Outcome Scale Extended score <8 at 6 months. Median day-of-injury BDNF concentrations (ng/mL) were lower among TBI cases (JHH TBI, 17.5 and SFGH TBI, 13.8) than in JHH controls (60.3; p = 0.0001). Among TRACK-TBI Pilot subjects, median BDNF concentrations (ng/mL) were higher in mild (8.3) than in moderate (4.3) or severe TBI (4.0; p = 0.004. In the TRACK-TBI cohort, the 75 (71.4%) subjects with very low BDNF values (i.e., <the 1st percentile for non-TBI controls, <14.2 ng/mL) had higher odds of incomplete recovery than those who did not have very low values (odds ratio, 4.0; 95% confidence interval [CI]: 1.5-11.0). The area under the receiver operator curve for discriminating complete and incomplete recovery was 0.65 (95% CI: 0.52-0.78) for BDNF, 0.61 (95% CI: 0.49-0.73) for GFAP, and 0.55 (95% CI: 0.43-0.66) for UCH-L1. The addition of GFAP/UCH-L1 to BDNF did not improve outcome prediction significantly. Day-of-injury serum BDNF is associated with TBI diagnosis and also provides 6-month prognostic information regarding recovery from TBI. Thus, day-of-injury BDNF values may aid in TBI risk stratification.

Original languageEnglish (US)
Pages (from-to)215-225
Number of pages11
JournalJournal of neurotrauma
Volume33
Issue number2
DOIs
StatePublished - Jan 15 2016

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Keywords

  • biomarkers
  • brain-derived neurotrophic factor
  • glial fibrillary acidic protein
  • traumatic brain injury
  • ubiquitin C-terminal hydrolase-L1

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Korley, F. K., Diaz-Arrastia, R., Wu, A. H. B., Yue, J. K., Manley, G. T., Sair, H. I., Van Eyk, J., Everett, A. D., Okonkwo, D. O., Valadka, A. B., Gordon, W. A., Maas, A. I. R., Mukherjee, P., Yuh, E. L., Lingsma, H. F., Puccio, A. M., & Schnyer, D. M. (2016). Circulating brain-derived neurotrophic factor has diagnostic and prognostic value in traumatic brain injury. Journal of neurotrauma, 33(2), 215-225. https://doi.org/10.1089/neu.2015.3949