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- Title
Plasma Biomarkers of Traumatic Brain Injury in Adolescents With Sport-Related Concussion.
- Authors
Tabor, Jason B.; Penner, Linden C.; Galarneau, Jean-Michel; Josafatow, Nik; Cooper, Jennifer; Ghodsi, Mohammad; Huang, Johnny; Fraser, Douglas D.; Smirl, Jonathan; Esser, Michael J.; Yeates, Keith Owen; Wellington, Cheryl L.; Debert, Chantel T.; Emery, Carolyn A.
- Abstract
This cohort study evaluates the association between sport-related concussion and plasma biomarkers in Canadian adolescents. Key Points: Question: Are blood-based levels of neurological biomarkers different between adolescents with sport-related concussion (SRC) and uninjured peers? Findings: This cohort study included 1023 plasma samples from 695 uninjured adolescents and 154 adolescents with concussion. Sex-specific post-SRC differences were found in multiple traumatic brain injury biomarkers at acute and subacute time points relative to healthy uninjured youths. Meaning: These findings highlight variations in biomarker levels in adolescents with SRC, suggesting their continued use in investigating concussion pathology in this understudied population. Importance: Blood-based biomarkers may clarify underlying neuropathology and potentially assist in clinical management of adolescents with sport-related concussion (SRC). Objective: To investigate the association between SRC and plasma biomarkers in adolescents. Design, Setting, and Participants: Prospective cohort study in Canadian sport and clinic settings (Surveillance in High Schools and Community Sport to Reduce Concussions and Their Consequences study; September 2019 to November 2022). Participants were a convenience sample of 849 adolescent (ages 10-18 years) sport participants with blood samples. Data were analyzed from February to September 2023. Exposures: Blood collection and clinical testing preseason (uninjured) and post-SRC follow-ups (ie, ≤72 hours, 1 week, and biweekly until medical clearance to return to play [RTP]). Main Outcomes and Measures: Plasma glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light (NfL), and total tau (t-tau) were assayed. Group-level comparisons of biomarker levels were conducted between uninjured and post-SRC intervals (postinjury day [PID] 0-3, 4-10, 11-28, and >28) considering age and sex as modifiers. Secondary analyses explored associations between biomarker concentrations and clinical outcomes (Sport Concussion Assessment Tool, Fifth Edition [SCAT5] symptom scores and time to RTP). Results: This study included 1023 plasma specimens from 695 uninjured participants (467 male participants [67.2%]; median [IQR] age, 15.90 [15.13-16.84] years) and 154 participants with concussion (78 male participants [51.0%]; median [IQR] age, 16.12 [15.31-17.11] years). Acute (PID 0-3) differences relative to uninjured levels were found for GFAP (female participants: 17.8% increase; β = 0.164; 95% CI, 0.064 to 0.263; P =.001; male participants: 17.1% increase; β = 0.157; 95% CI, 0.086 to 0.229; P <.001), UCH-L1 (female participants: 43.4% increase; β = 0.361; 95% CI, 0.125 to 0.596; P =.003), NfL (male participants: 19.0% increase; β = 0.174; 95% CI, 0.087 to 0.261; P <.001), and t-tau (female participants: −22.9%; β = −0.260; 95% CI, −0.391 to −0.130; P <.001; male participants: −18.4%; β = −0.203; 95% CI, −0.300 to −0.106; P <.001). Differences were observed for all biomarkers at PID 4 to 10, 11 to 28, and greater than 28 compared with uninjured groups. GFAP, NfL, and t-tau were associated with SCAT5 symptom scores across several PID intervals. Higher GFAP after 28 days post-SRC was associated with earlier clearance to RTP (hazard ratio, 4.78; 95% CI, 1.59 to 14.31; P =.01). Male participants exhibited lower GFAP (−9.7%), but higher UCH-L1 (21.3%) compared with female participants. Age was associated with lower GFAP (−5.4% per year) and t-tau (−5.3% per year). Conclusions and Relevance: In this cohort study of 849 adolescents, plasma biomarkers differed between uninjured participants and those with concussions, supporting their continued use to understand concussion neuropathology. Age and sex are critical considerations as these biomarkers progress toward clinical validation.
- Subjects
EFFECT sizes (Statistics); RESEARCH funding; SPORTS injuries; STATISTICAL sampling; BLOOD collection; SEX distribution; AGE distribution; MULTIVARIATE analysis; DESCRIPTIVE statistics; SPORTS re-entry; LONGITUDINAL method; BRAIN injuries; CONFIDENCE intervals; DATA analysis software; BIOMARKERS; BRAIN concussion; REGRESSION analysis; PROPORTIONAL hazards models; ADOLESCENCE
- Publication
JAMA Network Open, 2024, Vol 7, Issue 9, pe2431959
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.31959