Role of Phosphorylated Neurofilament H as a diagnostic and prognostic marker in traumatic brain injury

One of the main drawbacks in the management of patients with traumatic brain injuries (TBI) is the absence of a widely available and rapid diagnostic test. The objective of our study was to assess whether Phosphorylated Neurofilament H (pNF-H) might provide useful diagnostic information as an indication of axonal injury in the early evaluation of such patients and whether levels of the pNF-H correlated with different clinical variables. A total of 30 patients presenting to the critical care department of Cairo University diagnosed with traumatic brain injury were prospectively studied. Blood samples for pNF-H were assayed on admission and after 7 days. Neurofilament levels correlated with Glasgow coma scale and CT findings on admission and after 7 days. Rankin score at 3 months was used to detect the degree of disability. Phosphorylated Neurofilament H levels showed a negative correlation with GCS on admission and after 7 days in traumatic brain injury; hence higher neuromarker levels were associated with lower GCS on admission and after 7 days. There was a negative correlation between neurofilament levels and Marshal CT scores on admission and after 7 days (r = 0.56.0.4) hence higher neurofilament levels correlated with worse CT findings. Patients who died or had the greatest Rankin 6 and 5 after 3 months had the highest levels of pNF-H on admission and after 7 days. The cut off level of pNF-H to detect death and disability was 35 pg/ml on admission (sensitivity 82%, specificity 78%) and was 11 pg/ml after 7 days (sensitivity87%, and specificity 92%). Phosphorylated Neurofilament H can be used as a diagnostic and prognostic marker in patients with TBI as seen by the presence of significant correlations between the marker levels and different clinical and radiological tools.