Elevated cerebrospinal fluid concentrations of N-acetylaspartate correlate with poor outcome in a pilot study of severe brain trauma

Nicole Osier, Melody Ziari, Ava M. Puccio, Samuel Poloyac, David O. Okonkwo, Margaret B. Minnigh, Sue R. Beers, Yvette P. Conley

Research output: Contribution to journalArticle

Abstract

Primary objective: Examine the correlation between acute cerebrospinal fluid (CSF) levels of N-acetylaspartate (NAA) and injury severity upon admission in addition to long-term functional outcomes of severe traumatic brain injury (TBI). Design and rationale: This exploratory study assessed CSF NAA levels in the first four days after severe TBI, and correlated these findings with Glasgow Coma Scale (GCS) score and long-term outcomes at 3, 6, 12, and 24 months post-injury. Methods: CSF was collected after passive drainage via an indwelling ventriculostomy placed as standard of care in a total of 28 people with severe TBI. NAA levels were assayed using triple quadrupole mass spectrometry. Functional outcomes were assessed using the Glasgow Outcomes Scale (GOS) and Disability Rating Scale (DRS). Results: In this pilot study, better functional outcomes, assessed using the GOS and DRS, were found in individuals with lower acute CSF NAA levels after TBI. Key findings were that average NAA level was associated with GCS (p =.02), and GOS at 3 (p =.01), 6 (p =.04), 12 (p =.007), and 24 months (p =.002). Implications: The results of this study add to a growing body of neuroimaging evidence that raw NAA values are reduced and variable after TBI, potentially impacting patient outcomes, warranting additional exploration into this finding. This line of inquiry could lead to improved diagnosis and prognosis in patients with TBI.

Original languageEnglish (US)
Pages (from-to)1364-1371
Number of pages8
JournalBrain Injury
Volume33
Issue number10
DOIs
StatePublished - Aug 24 2019

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Cerebrospinal Fluid
Glasgow Outcome Scale
Glasgow Coma Scale
Ventriculostomy
Wounds and Injuries
Standard of Care
Neuroimaging
N-acetylaspartate
Traumatic Brain Injury
Drainage
Mass Spectrometry

Keywords

  • N-acetylaspartate (NAA)
  • Traumatic brain injury (TBI)
  • biomarker
  • brain trauma
  • severe TBI

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Developmental and Educational Psychology
  • Clinical Neurology

Cite this

Elevated cerebrospinal fluid concentrations of N-acetylaspartate correlate with poor outcome in a pilot study of severe brain trauma. / Osier, Nicole; Ziari, Melody; Puccio, Ava M.; Poloyac, Samuel; Okonkwo, David O.; Minnigh, Margaret B.; Beers, Sue R.; Conley, Yvette P.

In: Brain Injury, Vol. 33, No. 10, 24.08.2019, p. 1364-1371.

Research output: Contribution to journalArticle

Osier, Nicole ; Ziari, Melody ; Puccio, Ava M. ; Poloyac, Samuel ; Okonkwo, David O. ; Minnigh, Margaret B. ; Beers, Sue R. ; Conley, Yvette P. / Elevated cerebrospinal fluid concentrations of N-acetylaspartate correlate with poor outcome in a pilot study of severe brain trauma. In: Brain Injury. 2019 ; Vol. 33, No. 10. pp. 1364-1371.
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