- Poster presentation
- Open access
- Published:
Predictive value of glial fibrillary acidic protein for prognosis in patients with moderate and severe traumatic brain injury: a systematic review and meta-analysis
Critical Care volume 16, Article number: P298 (2012)
Introduction
Biomarkers have been proposed as potential prognostic indicators following a traumatic brain injury (TBI). Among those, glial fibrillary acidic protein (GFAP) has been one of the most studied. The objective of this study was to assess the prognostic value of GFAP levels in patients with moderate to severe TBI.
Methods
We systematically searched Medline, Embase, Cochrane Central, Scopus, BIOSIS, TRIP, conference abstracts, bibliography of selected studies and narrative reviews. Cohort studies including ≥4 patients with moderate or severe TBI and reporting GFAP levels (sampled within the first 24 hours of care) from any biological tissue or fluid, and mortality or Glasgow Outcome Scale (GOS), were eligible. Two independent reviewers screened all citations, selected eligible studies and extracted data using a standardized data extraction form. Pooled results from random effect models are presented using geometric mean ratios (GMRs). I2 tests were used to measure statistical heterogeneity.
Results
We retrieved 4,709 citations and eight studies were deemed potentially eligible. Among those, one was found to be a duplicate publication. Seven studies were thus included (n = 404). Four studies presented data on mortality (3 or 6 months) and four studies used the GOS (6 or 12 months) as an outcome measure. We found significant associations between serum GFAP levels and mortality in pooled analysis of three studies (GMR 14.73 (95% CI 5.93 to 34.12); I2 = 79%), and between GFAP and GOS ≤3 in three studies (GMR 8.80 (95% CI 3.94 to 19.66); I2 = 77%). Two studies could not be used in pooled analyses: one presented means of GFAP levels from multiple samplings over time (GMR 1.98 (95% CI 1.06 to 3.70)) while the other presented the highest peak levels of GFAP during the acute phase of care (GMR 3.20 (95% CI 1.82 to 5.65)).
Conclusion
Serum GFAP levels following TBI were significantly higher in patients showing an unfavourable prognosis (death or GOS ≤3). The small number of studies included precluded further exploration of statistical heterogeneity. More investigations of the association between serum GFAP levels and prognosis following TBI are needed before recommending for routine use for neuroprognostication.
Author information
Authors and Affiliations
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Laroche, E., Turgeon, A., Boutin, A. et al. Predictive value of glial fibrillary acidic protein for prognosis in patients with moderate and severe traumatic brain injury: a systematic review and meta-analysis. Crit Care 16 (Suppl 1), P298 (2012). https://doi.org/10.1186/cc10905
Published:
DOI: https://doi.org/10.1186/cc10905