Association of day-of-injury plasma glial fibrillary acidic protein concentration and six-month posttraumatic stress disorder in patients with mild traumatic brain injury
Jacqueline R. Kulbe, Sonia Jain, Lindsay D. Nelson, Frederick K. Korley, Pratik Mukherjee, Xiaoying Sun, David O. Okonkwo, Joseph T. Giacino, Mary J. Vassar, Claudia S. Robertson, Michael McCrea, Kevin Wang, Nancy Temkin, Christine L. Mac Donald, Sabrina R. Taylor, Adam R. Ferguson, Amy J. Markowitz, Ramon Diaz‐Arrastia, Geoffrey T. Manley, Murray B. Stein, TRACK-TBI Investigators, Neeraj Badjatia, Ann-Christine Duhaime, V. Ramana Feeser, C. Dirk Keene, Christopher Madden, Randall E. Merchant, Ava M. Puccio, David M. Schnyer, Sabrina R. Taylor, Alex B. Valadka, John K. Yue, Esther L. Yuh, Ross Zafonte
Abstract
Several proteins have proven useful as blood-based biomarkers to assist in evaluation and management of traumatic brain injury (TBI). The objective of this study was to determine whether two day-of-injury blood-based biomarkers are predictive of posttraumatic stress disorder (PTSD). We used data from 1143 individuals with mild TBI (mTBI; defined as admission Glasgow Coma Scale [GCS] score 13-15) enrolled in TRACK-TBI, a prospective longitudinal study of level 1 trauma center patients. Plasma glial fibrillary acidic protein (GFAP) and serum high sensitivity C-reactive protein (hsCRP) were measured from blood collected within 24 h of injury. Two hundred and twenty-seven (19.9% of) patients had probable PTSD (PCL-5 score ≥ 33) at 6 months post-injury. GFAP levels were positively associated (Spearman's rho = 0.35, p < 0.001) with duration of posttraumatic amnesia (PTA). There was an inverse association between PTSD and (log)GFAP (adjusted OR = 0.85, 95% CI 0.77-0.95 per log unit increase) levels, but no significant association with (log)hsCRP (adjusted OR = 1.11, 95% CI 0.98-1.25 per log unit increase) levels. Elevated day-of-injury plasma GFAP, a biomarker of glial reactivity, is associated with reduced risk of PTSD after mTBI. This finding merits replication and additional studies to determine a possible neurocognitive basis for this relationship.