Predictive value of serum neuronal injury biomarkers combined with GCS-P score for the prognosis of patients with traumatic brain injury
JI Xiangyu
LI Dachuan
ZHANG Jinwen
WANG Zengwu
Abstract：Objective To investigate the predictive value of serum neuronal injury biomarkers combined with Glasgow Coma Scale-pupil(GCS-P)score on the prognosis of patients with traumatic brain injury(TBI).Methods A to-tal of 234 TBI patients were enrolled.Their prognosis at 28 days after admission was assessed using the Glasgow Outcome Scale.Prognosis-related data on admission were collected.Serum levels of neuronal injury biomarkers,including phos-phorylated tau181(p-tau181),neurofilament light chain(NfL),ubiquitin carboxyl-terminal hydrolase L1(UCH-L1),gli-al fibrillary acidic protein(GFAP),and S-100 calcium-binding protein B(S-100B),were measured using enzyme-linked immunosorbent assay.The GCS-P score was calculated based on the Glasgow Coma Scale(GCS)score and the Pupil(P)score.The least absolute shrinkage and selection operator(LASSO)regression was used to screen factors influencing the prognosis of TBI patients.Subsequently,multivariate Logistic regression analysis was performed to analyze the impact of serum neuronal injury biomarkers and the GCS-P score on TBI patient prognosis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was used to analyze the predictive value of the combination of se-rum neuronal injury biomarkers and the GCS-P score.Results Among the 234 TBI patients,93 cases(39.74%)had an unfavorable prognosis at 28 days,while 141 cases(60.26%)had a favorable prognosis.Brain herniation(OR=8.328,95%CI:2.941-23.577),midline shift≥5 mm(OR=2.918,95%CI:1.177-7.232),and elevated levels of p-tau181(OR=1.453,95%CI:1.225-1.722),NfL(OR=1.039,95%CI:1.020-1.057),UCH-L1(OR=1.026,95%CI:1.008-1.043),GFAP(OR=1.042,95%CI:1.006-1.079),and S-100B(OR=1.102,95%CI:1.039-1.170)were identified as independent risk factors for the poor prognosis in TBI patients(all P<0.05).An increased GCS-P score(OR=0.808,95%CI:0.716-0.913)was an independent protective factor(P<0.05).The probability of predicting prognosis in TBI patients by combining serum neuronal injury biomarkers with the GCS-P score was fitted using Logistic regression:Logit(P)=-4.534+0.317×p-tau181+0.036×NfL+0.025×UCH-L1+0.041×GFAP+0.098×S-100B-0.237×GCS-P score.The AUCs for predicting the poor prognosis in TBI patients using p-tau181,NfL,UCH-L1,GFAP,S-100B,GCS-P score alone,and the combination of them were 0.740,0.714,0.678,0.648,0.682,0.756,and 0.919,respectively.The AUC of the combined prediction was significantly greater than that of each individual indicator(Z=5.693,5.962,6.778,7.289,6.917,5.660,respectively;all P<0.05).Conclusions TBI patients with elevat-ed serum levels of neuronal injury biomarkers(p-tau181,NfL,UCH-L1,GFAP,S-100B)and a decreased GCS-P score tend to have an unfavorable prognosis.The combination of these indicators demonstrates high predictive value for the prog-nosis of TBI patients.
Keywords：traumatic brain injuryneuronal injury biomarkersGlasgow Coma Scale-pupil scorephosphorylated tau181neurofilament light chainubiquitin carboxyl-terminal hydrolase L1glial fibrillary acidic proteinS-100 calci-um-binding protein Bprognosis
Publication Date：2026-02-25
Online Publishing Date：2026-03-19(First online date of this platform, not the publication date of the document)
Pages：6( 75-79,83 )