ROLE OF INFLAMMATORY AND NEURONAL CSF BIOMARKERS IN PREDICTING THE ONSET OF INTRACRANIAL HYPERTENSION AFTER TRAUMATIC BRAIN INJURY juliopaza98@gmail.com

PW05-01

ROLE OF INFLAMMATORY AND NEURONAL CSF BIOMARKERS IN PREDICTING THE ONSET OF INTRACRANIAL HYPERTENSION AFTER TRAUMATIC BRAIN INJURY

6

Mexico

Oral or Poster

Intracranial hypertension (ICH) is a major determinant of poor outcomes in moderate to severe traumatic brain injury (TBI). Cerebrospinal fluid (CSF) biomarkers reflecting neuroinflammation and neuronal damage may offer predictive value for early ICH detection.This study aimed to assess whether early post-injury CSF levels of Glial Fibrillary Acidic Protein(GFAP), S100B, IL-6, and Neuron-Specific Enolase(NSE) can predict the onset of intracranial hypertension and correlate with key clinical outcomes in moderate to severe TBI.

We conducted a retrospective analysis of 60 adult TBI patients (GCS 4–12) admitted to a neurosurgical ICU between 2019 and 2023, all of whom required external ventricular drainage within 6 hours of injury. Archived CSF samples were analyzed for GFAP, S100B, IL-6, and NSE using ELISA. Intracranial hypertension (ICH) was defined as sustained ICP ≥22 mmHg. Primary outcomes included biomarker predictive value for ICH; secondary outcomes were 30-day mortality and ICU length of stay. Statistical analysis included ROC curves, AUC comparison, Youden’s Index for cutoff determination, and Pearson correlation. A p < 0.05 was considered statistically significant.

Total 60 patients analyzed based on our inclusion ceiteria among them 32 (53.3%) developed intracranial hypertension (ICP ≥22 mmHg).GFAP demonstrated the highest predictive accuracy (AUC = 0.89, p < 0.001), followed by S100B (AUC = 0.84), IL-6 (AUC = 0.80), and NSE (AUC = 0.72). The optimal GFAP cutoff (>8.1 ng/mL) yielded 90% sensitivity and 86% specificity which showed it's highly reliable biomarker for early risk stratification in moderate-to-severe TBI. Combined GFAP + S100B improved AUC to 0.92. Elevated biomarker levels significantly correlated with longer ICU stay (r = 0.64, p = 0.002) and higher 30-day mortality (OR = 3.7, 95% CI: 1.4–9.6, p = 0.01). No significant associations were found with age, sex, or mechanism of injury.

Early CSF biomarkers of neuroinflammation and neuronal injury, particularly GFAP and S100B, effectively predict the onset of ICH in TBI. Their integration into clinical protocols could minimize dependence on invasive ICP monitoring and enable timely therapeutic decisions.