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The following is a summary of “Effect of blood alcohol on the diagnostic accuracy of glial fibrillary acidic protein and ubiquitin carboxy-terminal hydrolase L1 for traumatic intracranial hemorrhage: A TRACK-TBI study,” published in the February 2025 issue of Academic Emergency Medicine by Harris et al. 

Researchers conducted a retrospective study to examine how elevated blood alcohol levels (BALs) affected the diagnostic accuracy of FDA-cleared biomarkers, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), for detecting traumatic brain injury (TBI) on computed tomography (CT) scans.  

They examined the impact of significantly elevated (>300 mg/dL) and modestly elevated BAL (81–300 mg/dL) on the diagnostic accuracy of GFAP and UCH-L1 for predicting positive CT findings in individuals evaluated within 24 hours of TBI at 18 U.S. Level I trauma centers as part of the prospective Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. The UCH-L1 and Plasma GFAP levels were analyzed using Abbott i-STAT Alinity and ARCHITECT assays. Discrimination was evaluated via the area under the receiver operating characteristic curve (AUC).  

The results showed that among 2,320 participants with TRACK-TBI, 54 (2.3%) had significantly elevated (BAL >300 mg/dL), 332 (14.3%) had modestly elevated BAL (81–300 mg/dL), 1,209 (52.1%) had nonelevated BAL (0–80 mg/dL), and 725 (31.3%) had no BAL available. A positive brain CT scan was found in 48.3% with higher rates in those with significantly elevated (61.1%) and modestly elevated BAL (60.5%) compared to nonelevated BAL (46.9%) and no BAL available (44.0%). Plasma GFAP and UCH-L1 levels were higher in individuals with modestly elevated BAL. The AUC for GFAP and UCH-L1 combined was 0.949 in those with elevated BAL, 0.858 in modestly elevated BAL, 0.849 in nonelevated BAL, and 0.883 in those without BAL data.  

Investigators concluded that moderately elevated BALs did not diminish the diagnostic effectiveness of GFAP and UCH-L1 in identifying TBI on CT scans. 

Source: onlinelibrary.wiley.com/doi/10.1111/acem.15109