Abstract Details

Inflammatory biomarkers have been associated with poorer longitudinal outcomes following mTBI. hsCRP is a validated biomarker for inflammation. Previous studies have established relationships between CRP levels and TBI, but the utility of hsCRP in assessing mTBI requires further exploration.

To investigate the utility of hsCRP as a blood biomarker for the diagnosis and prognosis of acute mTBI.

Retrospective review of 311 acute mTBI patients (GCS ≥13; mean age 21±12 years, 53% female) seen within 30 days of injury. Patients with any comorbid diagnosis known to cause elevation of inflammatory proteins were excluded. Serum hsCRP levels were collected routinely. hsCRP levels were transformed into quartiles: <0.200mg/L (Q1); 0.200-0.415mg/L (Q2); 0.415-1.100mg/L (Q3); and ≥1.100mg/L (Q4). Multivariable binary logistic regression modeling identified potential factors for elevated hsCRP at first visit. Cox regression analysis identified potential factors for delayed recovery.

Mean hsCRP was elevated in patients presenting within 1 week of injury and decreased significantly between first visit and 4 weeks post-injury (p=0.016). Initial hsCRP level was positively correlated with age (r=0.163, p=0.004). Age significantly increased between quartiles (p=0.013).  Patients in Q4 were more likely to have endorsed headache (p=0.036) or fatigue (p=0.030). Increased age (OR: 3.48) and patients presenting with headache (OR: 3.48) or fatigue (OR: 2.16) were significantly associated with increased risk of being in Q4. Females (HR: 0.32) and increased age (HR: 0.95) were associated with delayed recovery.

Recent studies have proposed acute measurement of hsCRP as a potential prognostic biomarker for poor outcomes 6 months post-TBI, and have suggested that elevated levels can help identify mTBI patients at risk of developing psychological comorbidities like depression. In this context, our data suggests that hsCRP may be a viable addition to acute and longitudinal biomarker panels for mTBI, as well as stratification of subjects into treatments.