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1. Evaluation of GFAP/UCH-L1 biomarkers for computed tomography exclusion in mild traumatic brain injury (mTBI)

Author

Jacopo M. Legramante, Marilena Minieri, Marzia Belli, Alfredo Giovannelli, Alessia Agnoli, Daniela Bajo, Lorenza Bellincampi, Anna Maria De Angelis, Alessandro Terrinoni, Massimo Pieri, Eleonora Nicolai, Vito N. Di Lecce, Carla Paganelli, Gianluigi Ferrazza, Susanna Longo, Marco Ciotti, and Sergio Bernardini

Subjects
Mild traumatic brain injury, Biomarkers, Head CT scan, Patient treatment turnaround time, Diagnostic accuracy, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Introduction Mild traumatic brain injury (mTBI) represents a major public health concern and affects millions of people worldwide every year. Diagnosis mainly relies on clinical criteria and computed tomography (CT) scans. GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) have been recently studied as potential biomarkers of mTBI. This study retrospectively evaluated the possible use of these combined biomarkers as negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department. Methods Adult patients (n = 130) enrolled at Tor Vergata University Hospital (Rome, Italy), consecutively registered at the triage of the emergency department between October 2022 and January 2023, with non-penetrating TBI and Glasgow Coma Scale (GCS) score of 13–15, were considered. All eligible patients underwent intracranial CT scans and blood tests, within 12 h after trauma, for GFAP and UCH-L1 serum concentrations. Results Intracranial CT detected injuries in only seven patients (5%); GFAP and UCH-L1 tested positive in 96 patients and negative in 34 patients (74% vs. 26%). Combined biomarkers had a sensitivity equal to 1.00 (95% CI 0.64-1.00) and a negative predictive value (NPV) of 1.00 (0.99-1.00) in mTBI diagnosis with a negative CT. Conclusions Combined laboratory tests for GFAP and UCH-L1 biomarkers might play a potential clinical role in avoiding unnecessary head CT scans after mTBI in emergency departments.

Published
2024
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2. Serum iPTH range in a reference population: From an integrated approach to vitamin D prevalence impact evaluation

Author

Vincenzo Rossi, Daniela Bajo, Alessia Agnoli, Sergio Bernardini, Anna Maria De Angelis, Alessandro Terrinoni, Lorenza Bellincampi, Massimo Pieri, Stefano Pignalosa, Francesco Equitani, Filippa Valente, Bruno Daniele Leoni, and Marilena Minieri

Subjects
0301 basic medicine, Vitamin, Male, medicine.medical_specialty, Percentile, iPTH, Clinical Biochemistry, Population, Biochemistry, Gastroenterology, vitamin D deficiency, Reference interval, LIMS data, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, medicine, Vitamin D and neurology, Prevalence, Humans, Vitamin D, education, education.field_of_study, Creatinine, business.industry, Settore BIO/12, Biochemistry (medical), General Medicine, medicine.disease, Vitamin D Deficiency, Secondary hyperparathyroidism, 030104 developmental biology, chemistry, Parathyroid Hormone, 030220 oncology & carcinogenesis, Cohort, Calcium, Female, business
Abstract

The iPTH upper reference limit (URL) reported by our laboratory provider (Abbott Laboratories) at Tor Vergata University Hospital was evaluated by internal verification procedures as not representative of our population and resulting as underestimated. In this study, a new reference interval has been investigated and established by comparing a direct and an indirect method based on a statistical reduction from results stored in the laboratory database.For reference interval calculation from the healthy population, we analyzed a cohort of 100 blood donors (84% males and 16% females) screened with no bone-related and malabsorption diseases. We analyzed a cohort of 495 patients retrieved from more than 800 iPTH results by excluding subjects with pathological measurement for calcium, phosphorus, and creatinine for the reference interval evaluation. Patients with vitamin D results were included in the analysis. Vitamin D sufficiency status during the period from January to September 2020 was also evaluated by investigating 3,050 patients.The iPTH reference interval of a healthy blood donor population was measured as 25.2-109.1 pg/mL (2.7-11.6 pmol/L) at 2.5 and 97.5 distribution percentile. The iPTH reference interval from data stored in the laboratory database was 19.3-112.5 pg/mL (2.0-11.9 pmol/L). Furthermore, 60% of the whole population had prevalently insufficient vitamin D concentration (30 ng/dL;75 nmol/L). The impact of vitamin D concentration on the iPTH reference interval was measured for insufficient vitamin D (30 ng/dL;75 nmol/L) as 15.2-127.7 pg/mL (1.6-13.5 pmol/L), desirable vitamin D (30-40 ng/ml; 75-100 nmol/L) as 25.6-105 pg/mL (2.7-10.7 pmol/L) and optimal vitamin D (40 ng/ml;100 nmol/L) as 26.2-89.2 pg/mL (2.8-9.4 pmol/L), respectively.The URL reported in manufacturer datasheets likely refers to a normal population with non-pathological vitamin D levels. On the contrary, the considered population was mostly vitamin D insufficient, resulting in a URL shift. On this basis, we suggest describing in medical reports the iPTH range for vitamin D deficiency for diagnosis of primary hyperparathyroidism even when a specific vitamin D request is lacking. On the other hand, reporting optimal vitamin D-based iPTH reference interval could be clinically relevant in supplemented patients as a marker of treatment efficacy.

Published
2021

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