THE ROLE OF BIOMARKERS IN THE DIAGNOSIS AND PREDICTION OF OUTCOMES IN CIVILIAN COMBAT-RELATED TRAUMATIC BRAIN INJURY: RESULTS OF ROC ANALYSIS
DOI:
https://doi.org/10.32782/2411-9164.23.2-11Keywords:
combat traumatic brain injury, biomarkers, ROC analysis, GFAP, S100β, IL-6, NF-L, MBP, NSE, prognosisAbstract
Introduction. Combat-related traumatic brain injury (TBI) in civilian populations is associated with a high risk of early and long-term complications, while traditional clinical scales often lack sufficient prognostic accuracy. Neurospecific blood biomarkers may improve early diagnostic precision and risk stratification. Aim. To evaluate the diagnostic and prognostic significance of S100β, GFAP, NSE, MBP, IL-6, and NF-L in patients with combat TBI and to determine their predictive value based on ROC analysis depending on evacuation time. Results. Within the “early window” (≤3 hours), MBP (AUC≈0.90), IL-6 (≈0.84), and NF-L (≈0.84) demonstrated the highest predictive accuracy. In patients evacuated >3 hours after injury, GFAP (≈0.76), NSE (≈0.65), and S100β (≈0.64) became the leading predictors. IL-6 retained prognostic value across all time intervals. A multivariable model (AUC≈0.95) that incorporated biomarkers, APACHE II, and delayed evacuation significantly outperformed individual biomarkers. Conclusions. Integration of clinical scoring systems with a biomarker panel substantially enhances prediction of 30-day outcomes in civilians with combined combat- related TBI. Evacuation time determines the dominant injury mechanisms and the optimal biomarker profile for early risk stratification.
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