Sport-related concussion: serum biomarkers of limited value

  • Neurology

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Serum biomarkers may aid diagnosis in collegiate athletes with sport-related concussion but do not predict clinical outcomes.

Why this matters

  • Unmet need for reliable diagnostic, prognostic markers in sport-related concussion.

Key results

  • In first part, nonconcussed athletes:
    • Males, females differed on UCH-L1, S100B, CNPase (P<.001 for all>
    • Blacks, whites differed on UCH-L1, Aβ42, CNPase (P≤.005 for all);
    • Test-retest reliability over 6-12 months generally poor (−0.02 to 0.40).
  • In second part, nonconcussed athletes:
    • More concussions, higher baseline Aβ42 (ρ, 0.140; P=.005);
    • No biomarkers correlated with cumulative collision sport exposure;
    • Correlations of S100B, UCH-L1, Aβ42 with cognitive scores mediated by race.
  • In third part, case-control:
    • S100B elevated postconcussion (P=.003), especially at
    • Differences between cases, controls only at
    • 42 (area under curve, 0.75),
    • Total tau (0.74),
    • S100B (0.82).
  • Specificity 79.1%-89.3%, sensitivity
  • No association of biomarkers with clinical outcomes.

Expert comment

  • In an editorial, Dr. Erin D. Bigler and Dr. Ellen Deibert write, “…ultimately, because of the complexities of concussion, the serum biomarker in and of itself cannot be the Holy Grail, but instead another tool in guiding the clinical management of concussion and return to play decisions.”

Study design

  • Observational cohort studies: 415 nonconcussed collegiate athletes without recent head impacts.
  • Case-control study: 36 collegiate athletes sustaining sport-related concussion, 86 matched nonconcussed control athletes.
  • Main outcomes: biomarker levels, clinical outcomes.
  • Funding: Head Health Initiative; others.

Limitations

  • Limited sampling.
  • Events between blood draws unknown.
  • Unclear generalizability.

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