A study on the predictive value of glial fibrillary acidic protein for prediction of traumatic brain injury severity

Document Type : Original Article


1 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

2 Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran



Background and Objectives: Head injury is an increasing consequence of different kinds of trauma. It may result in release of substances such as glial fibrillary acidic protein (GFAP) within the cerebrospinal fluid or in serum, which can be used for the measurement of severity of damage. The aim of this study was to assess the predictive value of GFAP in prediction of trauma severity in head-injured patients. Methods: In this cross-sectional study, 98 patients with head injury admitted to Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS) enrolled in this study during 2020-2021. The GFAP serum level, the Extended Glasgow Coma Outcome Score (EGOS), Glasgow Coma Scale (GCS), and Rotterdam computed tomography score were assessed and then analyzed by SPSS V20. Results: The mean of GCS at the time of admission and discharge and EGOS and Rotterdam scores at a 3-month follow-up all were within a mild range. In addition, on the base of EGOS, all of the patients had recovered to a good state 3 months after their injury. Statistical analysis revealed a meaningful correlation between GFAP and GCS and EGOS (P < 0.05). GFAP with sensitivity of 80.8%, specificity of 65.3%, and area under the curve of 0.804 has appropriate strength for prediction of severity of head injury. Conclusions: The sensitivity and specificity of GFAP revealed acceptable strength for prediction of severity of head injury, even when confounding factors are considered. The mean of EGOS and GCS and Rotterdam score were all within the range of mild injury. However, further detailed and multicenter studies are recommended for better clarification of the role of GFAP as a biomarker of traumatic brain injury.


Masoumeh Abedzadeh-Kalahroudi [Pubmed] [Google Scholar]



Kiening K, Unterberg A. Trauma care in Germany: A European perspective. Clin Neurosurg 2007;54:206-8.  Back to cited text no. 1
Ansari M, Bayan L, Gorji A. The impact of road accidents on brain injury. Neurosci J Shefaye Khatam 2016;4:103-10.  Back to cited text no. 2
Ratan SK, Pandey RM, Kulsreshtha R, Ratan J. Risk factors for mortality within first 24 hours of head injury. Indian J Pediatr 2002;69:573-7.  Back to cited text no. 3
Fraser DD, Close TE, Rose KL, Ward R, Mehl M, Farrell C, et al. Severe traumatic brain injury in children elevates glial fibrillary acidic protein in cerebrospinal fluid and serum. Pediatr Crit Care Med 2011;12:319-24.  Back to cited text no. 4
Jones A, Jarvis P. Review of the potential use of blood neuro-biomarkers in the diagnosis of mild traumatic brain injury. Clin Exp Emerg Med 2017;4:121-7.  Back to cited text no. 5
Lei J, Gao G, Feng J, Jin Y, Wang C, Mao Q, et al. Glial fibrillary acidic protein as a biomarker in severe traumatic brain injury patients: A prospective cohort study. Crit Care 2015;19:362.  Back to cited text no. 6
Missler U, Wiesmann M, Wittmann G, Magerkurth O, Hagenström H. Measurement of glial fibrillary acidic protein in human blood: Analytical method and preliminary clinical results. Clin Chem 1999;45:138-41.  Back to cited text no. 7
Vos PE, Lamers KJ, Hendriks JC, van Haaren M, Beems T, Zimmerman C, et al. Glial and neuronal proteins in serum predict outcome after severe traumatic brain injury. Neurology 2004;62:1303-10.  Back to cited text no. 8
Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H. GFAP versus S100B in serum after traumatic brain injury: Relationship to brain damage and outcome. J Neurotrauma 2004;21:1553-61.  Back to cited text no. 9
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 2018;17:782-9.  Back to cited text no. 10
Wiesmann M, Steinmeier E, Magerkurth O, Linn J, Gottmann D, Missler U. Outcome prediction in traumatic brain injury: Comparison of neurological status, CT findings, and blood levels of S100B and GFAP. Acta Neurol Scand 2010;121:178-85.  Back to cited text no. 11
Luoto TM, Raj R, Posti JP, Gardner AJ, Panenka WJ, Iverson GL. A systematic review of the usefulness of glial fibrillary acidic protein for predicting acute intracranial lesions following head trauma. Front Neurol 2017;8:652.  Back to cited text no. 12
Aydin I, Algin A, Poyraz MK, Yumrutas O. Diagnostic value of serum glial fibrillary acidic protein and S100B serum levels in emergency medicine patients with traumatic versus nontraumatic intracerebral hemorrhage. Niger J Clin Pract 2018;21:1645-50.  Back to cited text no. 13
[PUBMED]  [Full text]  
Okonkwo DO, Yue JK, Puccio AM, Panczykowski DM, Inoue T, McMahon PJ, et al. GFAP-BDP as an acute diagnostic marker in traumatic brain injury: Results from the prospective transforming research and clinical knowledge in traumatic brain injury study. J Neurotrauma 2013;30:1490-7.  Back to cited text no. 14
McMahon PJ, Panczykowski DM, Yue JK, Puccio AM, Inoue T, Sorani MD, et al. Measurement of the glial fibrillary acidic protein and its breakdown products GFAP-BDP biomarker for the detection of traumatic brain injury compared to computed tomography and magnetic resonance imaging. J Neurotrauma 2015;32:527-33.  Back to cited text no. 15