Accuracy of Gfap and Uch-L1 in Predicting Brain Abnormalities on Ct Scans After Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis Publisher Pubmed



Karamian A¹ ; Farzaneh H² ; Khoshnoodi M³ ; Maleki N⁴ ; Rohatgi S⁵ ; Ford JN⁶ ; Romero JM⁵ Show Affiliations
Source: European Journal of Trauma and Emergency Surgery Published:2025

Abstract

Purpose: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In recent years, blood biomarkers including glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have shown a promising ability to detect head CT abnormalities following TBI. This review aims to combine the existing research on GFAP and UCH-L1 biomarkers and examine how well they can predict abnormal CT results after mild TBI. Methods: Our study protocol was registered in PROSPERO (CRD42024556264). PubMed, Google Scholar, and Cochrane electronic databases were searched. We reviewed 37 full-text articles for eligibility and included 14 in our systematic review and meta-analysis. Results: Thirteen studies reported data for GFAP. The optimal cutoff of GFAP was 65.1 pg/mL with a sensitivity of 76% (95% CI 37 ̶ 95) and a specificity of 74% (95% CI 39 ̶ 93). In patients with GCS 13 ̶ 15 the optimal cutoff was 68.5 pg/mL, showing a sensitivity of 75% (95% CI 17 ̶ 98), and a specificity of 73% (95% CI 20 ̶ 97). Seven studies provided data on UCH-L1. The optimal cutoff was 225 pg/mL, with a sensitivity of 86% (95% CI 50 ̶ 97) and a specificity of 51% (95% CI 19 ̶ 83). In patients with GCS 13 ̶ 15, the optimal cutoff was 237.7 pg/mL, with a sensitivity of 89% (95% CI 74 ̶ 96), and a specificity of 36% (95% CI 29 ̶ 44). Modeling the diagnostic performance of GFAP showed that in adult patients with GCS 13–15 for ruling out CT abnormalities, at the threshold of 4 pg/mL, the optimal diagnostic accuracy was achieved with a sensitivity of 98% (95% CI 94–99) and (negative predictive value) NPV of 97%. For UCH-L1, the optimal diagnostic accuracy for ruling out intracranial abnormalities in adults with GCS 13–15 was achieved at the threshold of 64 pg/mL, with a sensitivity of 99% (95% CI 92–100) and NPV of 99%. Conclusion: Present results suggest that GFAP and UCH-L1 have the clinical potential for screening mild TBI patients for intracranial abnormalities on head CT scans. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2025.