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High-Sensitivity C-Reactive Protein: Retrospective Study of Potential Blood Biomarker of Inflammation in Acute Mild Traumatic Brain Injury

Shetty, Teena MD, MPhil; Cogsil, Taylor BA; Dalal, Aashka BA; Kim, Esther MSc; Halvorsen, Kristin BA; Cummings, Kelianne BA; Nguyen, Joseph T. MPH

Author Information

Department of Neurology (Dr Shetty and Ms Cogsil, Kim, and Halvorsen) and Biostatistics Core (Mr Nguyen), Hospital for Special Surgery, New York, New York; New York Medical College, Valhalla (Ms Dalal); and SUNY Downstate Medical School, Brooklyn, New York (Ms Cummings).

Corresponding Author: Teena Shetty, MD, MPhil, Department of Neurology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 ([email protected]).

The authors acknowledge Davena Zhang, George Skulikidis, Virgen Gonzalez-Alakham, Lauren Langford-Fassanella, Raven Lin, Hospital for Special Surgery, for their contributions to the data collection and entry necessary to complete this project.Dr Teena Shetty has, or previously had, research grants from General Electric/National Football League, Chembio/Perseus, Abbott Diagnostics, Teva Pharmaceuticals, and ElMindA. She is also a member of the GE/NFL Medical Advisory Board and has a provisional patent filed on November 4, 2016, titled, “Inflammatory and Hormone Biomarkers for mild Traumatic Brain Injury.” Joseph T. Nguyen has received grant support from the National Center for Advancing Translational Services (NCATS).The authors declare no conflict of interest.

Journal of Head Trauma Rehabilitation 34(3):p E28-E36, May/June 2019. | DOI: 10.1097/HTR.0000000000000450

Abstract

Objective:

A panel of biomarkers is needed to definitively diagnose mild traumatic brain injury (mTBI). There is a clear role for the inclusion of an inflammatory biomarker. This study looked to find a relationship between high sensitivity C-reactive protein (hsCRP), an inflammatory biomarker, and mTBI.

Setting:

Neurology department of high-volume tertiary orthopedic hospital.

Participants:

Individuals diagnosed with mTBI (n = 311, age 21 ± 12 years, 53% female).

Design:

Retrospective cohort study.

Main Measures:

hsCRP levels; postconcussive symptoms; demographics.

Results:

Continuous hsCRP levels were transformed into quartiles, as defined by less than 0.200 mg/L for quartile 1 (Q1); 0.200 to 0.415 mg/L for quartile 2 (Q2); 0.415 to 1.100 mg/L for quartile 3 (Q3); and greater than 1.100 mg/L for quartile 4 (Q4). Mean hsCRP was elevated in the cohort of individuals who presented within 1 week of injury and was found to significantly decrease between the first visit and 4 weeks postinjury (P = .016). Initial hsCRP level was positively correlated with age (r = 0.163, P = .004), and age significantly increased between quartiles (P = .013). Patients with increased age (odds ratio: 3.48) and those who endorsed headache (odds ratio: 3.48) or fatigue (odds ratio: 2.16) were significantly associated with increased risk of having an hsCRP level in Q4.

Conclusion:

hsCRP may be a viable addition to acute and longitudinal biomarker panels for diagnosis and prognosis of mTBI.

Article Keywords

Keywords
acute care, blood biomarker panel, closed head injury, gender, Glasgow Coma Scale, high-sensitivity C-reactive protein, inflammation, mild traumatic brain injury

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High-Sensitivity C-Reactive Protein: Retrospective Study of Potential Blood Biomarker of Inflammation in Acute Mild Traumatic Brain Injury