Glial Fibrillary Acidic Protein in Blood as a Diagnostic Method for Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Authors

DOI:

https://doi.org/10.56294/hl2024.352

Keywords:

Traumatic brain injury, biomarkers, GFAP, diagnosis, meta-analysis

Abstract

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Glial fibrillary acidic protein (GFAP) has been proposed as a blood-based diagnostic biomarker for TBI, but its clinical utility remains uncertain. This meta-analysis assessed the diagnostic accuracy of GFAP in identifying TBI. Methods: A systematic search was conducted in biomedical databases for studies published between 2019 and 2024. Clinical trials with adequate sample sizes and standardized GFAP detection methods were included. Sensitivity, specificity, and predictive values were analyzed using statistical models to evaluate diagnostic accuracy. Results: Seven studies with a total of 3,209 patients were included. The overall sensitivity of GFAP was 0.91 (95% CI: 0.83–0.96), demonstrating a high capacity to detect TBI. However, specificity was moderate (0.61, 95% CI: 0.48–0.73), indicating a higher rate of false positives. The summary ROC curve confirmed a good general diagnostic performance but highlighted limitations in differentiating TBI from other neurological conditions. Conclusions: GFAP exhibited high sensitivity as a diagnostic biomarker for TBI, making it a useful tool for early detection. However, its low specificity suggests the need for combination with other biomarkers to improve diagnostic accuracy.

References

1. TBI Data | Concussion | Traumatic Brain Injury | CDC Injury Center [Internet]. [cited 2024 Apr 9]. Available from: https://www.cdc.gov/traumaticbraininjury/data/index.html

2. Suárez Barreiros CP, Saltos Bazurto GE. Abordaje Prehospitalario del Traumatismo Craneoencefálico para una Atención Eficiente y Efectiva. Ciencia Latina Revista Científica Multidisciplinar. 2024 Apr 9;8(1):10569–86.

3. González Echeverría KE, Hidalgo Acosta JA, López Alcívar GN, Ruiz Sorroza HL, Alvear Robalino AS, Salcedo Mite JL, et al. Traumatismo craneoencefálico en adultos jóvenes: una serie de casos y análisis de su pronóstico. Mediciencias UTA. 2023 Apr 1;7(2):27–34.

4. FDA authorizes marketing of first blood test to aid in the evaluation of concussion in adults | FDA [Internet]. [cited 2024 Apr 9]. Available from: https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-first-blood-test-aid-evaluation-concussion-adults

5. Gutierrez Gomez JI, Gutierrez Gomez JI. Valor predictivo negativo del recuento leucocitario en pacientes con lesión intracraneal secundario a traumatismo craneocefálico. Exploraciones, intercambios y relaciones entre el diseño y la tecnología [Internet]. 2024 [cited 2025 Jan 21];57–79. Available from: https://risisbi.uqroo.mx/handle/20.500.12249/4401

6. Gardner RC, Rubenstein R, Wang KKW, Korley FK, Yue JK, Yuh EL, et al. Age-Related Differences in Diagnostic Accuracy of Plasma Glial Fibrillary Acidic Protein and Tau for Identifying Acute Intracranial Trauma on Computed Tomography: A TRACK-TBI Study. https://home.liebertpub.com/neu [Internet]. 2018 Oct 1 [cited 2024 Nov 28];35(20):2341–50. Available from: https://www.liebertpub.com/doi/10.1089/neu.2018.5694

7. Posti JP, Takala RSK, Lagerstedt L, Dickens AM, Hossain I, Mohammadian M, et al. Correlation of Blood Biomarkers and Biomarker Panels with Traumatic Findings on Computed Tomography after Traumatic Brain Injury. https://home.liebertpub.com/neu [Internet]. 2019 Jan 1 [cited 2024 Nov 28];36(14):2178–89. Available from: https://www.liebertpub.com/doi/10.1089/neu.2018.6254

8. Bazarian JJ, Biberthaler P, Welch RD, Lewis LM, Barzo P, Bogner-Flatz V, et al. Serum GFAP and UCH-L1 for prediction of absence of intracranial injuries on head CT (ALERT-TBI): a multicentre observational study. Lancet Neurol [Internet]. 2018 Sep 1 [cited 2024 Nov 28];17(9):782–9. Available from: http://www.thelancet.com/article/S147444221830231X/fulltext

9. Correlation between serum markers GFAP-BDPs, UCH-L1, and NSE levels and prognosis in patients with mild craniocerebral injury [Internet]. [cited 2024 Nov 28]. Available from: https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zglnxzz201813002

10. Gill J, Latour L, Diaz-Arrastia R, Motamedi V, Turtzo C, Shahim P, et al. Glial fibrillary acidic protein elevations relate to neuroimaging abnormalities after mild TBI. Neurology. 2018 Oct 9;91(15):E1385–9.

11. Lagerstedt L, Egea-Guerrero JJ, Bustamante A, Rodríguez-Rodríguez A, Rahal A El, Quintana-Diaz M, et al. Combining H-FABP and GFAP increases the capacity to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury. PLoS One [Internet]. 2018 Jul 1 [cited 2024 Nov 28];13(7):e0200394. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200394

12. Frankel M, Fan L, Yeatts SD, Jeromin A, Vos PE, Wagner AK, et al. Association of Very Early Serum Levels of S100B, Glial Fibrillary Acidic Protein, Ubiquitin C-Terminal Hydrolase-L1, and Spectrin Breakdown Product with Outcome in ProTECT III. J Neurotrauma [Internet]. 2019 Oct 15 [cited 2024 Nov 28];36(20):2863–71. Available from: https://pubmed.ncbi.nlm.nih.gov/30794101/

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Published

2024-12-31

How to Cite

1.
Riofrio Ponce EJ, Salazar Garcés LF. Glial Fibrillary Acidic Protein in Blood as a Diagnostic Method for Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Health Leadership and Quality of Life [Internet]. 2024 Dec. 31 [cited 2025 Aug. 24];3:.352. Available from: https://hl.ageditor.ar/index.php/hl/article/view/352