TY  - JOUR
A1  - Zwirner, Johann
A1  - Anders, Sven
A1  - Bohnert, Simone
A1  - Burkhardt, Ralph
A1  - Da Broi, Ugo
A1  - Hammer, Niels
A1  - Pohlers, Dirk
A1  - Tse, Rexson
A1  - Ondruschka, Benjamin
T1  - Screening for fatal traumatic brain injuries in cerebrospinal fluid using blood-validated CK and CK−MB immunoassays
JF  - Biomolecules
N2  - A single, specific, sensitive biochemical biomarker that can reliably diagnose a traumatic brain injury (TBI) has not yet been found, but combining different biomarkers would be the most promising approach in clinical and postmortem settings. In addition, identifying new biomarkers and developing laboratory tests can be time-consuming and economically challenging. As such, it would be efficient to use established clinical diagnostic assays for postmortem biochemistry. In this study, postmortem cerebrospinal fluid samples from 45 lethal TBI cases and 47 controls were analyzed using commercially available blood-validated assays for creatine kinase (CK) activity and its heart-type isoenzyme (CK–MB). TBI cases with a survival time of up to two hours showed an increase in both CK and CK–MB with moderate (CK–MB: AUC = 0.788, p < 0.001) to high (CK: AUC = 0.811, p < 0.001) diagnostic accuracy. This reflected the excessive increase of the brain-type CK isoenzyme (CK–BB) following a TBI. The results provide evidence that CK immunoassays can be used as an adjunct quantitative test aid in diagnosing acute TBI-related fatalities.
KW  - cerebrospinal fluid
KW  - creatine kinase
KW  - fatal traumatic brain injury
KW  - postmortem biochemistry
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242769
SN  - 2218-273X
VL  - 11
IS  - 7
ER  - 
TY  - JOUR
A1  - Zwirner, Johann
A1  - Bohnert, Simone
A1  - Franke, Heike
A1  - Garland, Jack
A1  - Hammer, Niels
A1  - Möbius, Dustin
A1  - Tse, Rexson
A1  - Ondruschka, Benjamin
T1  - Assessing protein biomarkers to detect lethal acute traumatic brain injuries in cerebrospinal fluid
JF  - Biomolecules
N2  - Diagnosing traumatic brain injury (TBI) from body fluids in cases where there are no obvious external signs of impact would be useful for emergency physicians and forensic pathologists alike. None of the previous attempts has so far succeeded in establishing a single biomarker to reliably detect TBI with regards to the sensitivity: specificity ratio in a post mortem setting. This study investigated a combination of body fluid biomarkers (obtained post mortem), which may be a step towards increasing the accuracy of biochemical TBI detection. In this study, serum and cerebrospinal fluid (CSF) samples from 30 acute lethal TBI cases and 70 controls without a TBI-related cause of death were evaluated for the following eight TBI-related biomarkers: brain-derived neurotrophic factor (BDNF), ferritin, glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6), lactate dehydrogenase, neutrophil gelatinase-associated lipocalin (NGAL), neuron-specific enolase and S100 calcium-binding protein B. Correlations among the individual TBI biomarkers were assessed, and a specificity-accentuated threshold value analysis was conducted for all biomarkers. Based on these values, a decision tree modelling approach was performed to assess the most accurate biomarker combination to detect acute lethal TBIs. The results showed that 92.45% of acute lethal TBIs were able to be diagnosed using a combination of IL-6 and GFAP in CSF. The probability of detecting an acute lethal TBI was moderately increased by GFAP alone and considerably increased by the remaining biomarkers. BDNF and NGAL were almost perfectly correlated (p = 0.002; R\(^2\) = 0.944). This study provides evidence that acute lethal TBIs can be detected to a high degree of statistical accuracy using forensic biochemistry. The high inter-individual correlations of biomarkers may help to estimate the CSF concentration of an unknown biomarker, using extrapolation techniques.
KW  - biomarker combination
KW  - glial fibrillary acidic protein
KW  - interleukin-6
KW  - post mortem biochemistry
KW  - traumatic brain injury
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-248587
SN  - 2218-273X
VL  - 11
IS  - 11
ER  -