Association of blood-based glial fibrillary acidic protein level with depression and suicidal ideation following traumatic brain injury with Glasgow coma scale score 13 to 15: a TRACK-TBI study
Shawn R Eagle, Raquel C Gardner, Sonia Jain, Xiaoying Sun, Ava Puccio, David Brent, Lindsay D Nelson, Michael A McCrea, Joseph T Giacino, David O Okonkwo, John K Yue, Geoffrey T Manley, Murray B Stein, , Ann-Christine Duhaime, Adam R Ferguson, Shankar Gopinath, Ramesh Grandhi, C Dirk Keene, Christine Mac Donald, Amy Markowitz, Randall Merchant, Pratik Mukherjee, Laura B Ngwenya, Claudia Robertson, Andrea Schneider, David Schnyer, Sabrina R Taylor, Kevin Wang, Ross ZafonteAbstract
Blood-based glial fibrillary acidic protein (GFAP) level within 24 hours of traumatic brain injury (TBI) has been inversely associated with post-traumatic stress disorder at 6-months in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. We sought to assess the relationship between day-of-injury GFAP and cumulative prevalence (CI) of depression or suicidal ideation (SI) in the first year after injury among patients presenting with Glasgow Coma Scale (GCS) 13-15 who participated in TRACK-TBI (n=1,511). Multivariable logistic regression models were used to assess the association of day-of-injury GFAP levels with year 1 CI of depression or SI adjusting for age, sex, prior TBI, psychiatric history, and acute intracranial trauma on head computed tomography scan (CT). Subgroup analyses categorized into “high” and “low” risk for mental health problems based upon a history of psychiatric disorder or TBI. Overall, 20.4% reported depression and 11.3% reported SI in the first year. Participants with depression had significantly lower GFAP compared to participants without depression overall (median = 149.9pg/mL vs 306.9pg/mL, p<0.001) and CT-negative high risk and CT-negative low risk subgroups. Participants with SI had lower GFAP in the overall sample (155.8pg/mL vs. 299.1pg/mL, p=0.001). We found an interaction between GFAP and CT status, reflecting an inverse association of GFAP with cumulative depression among CT- subjects (aOR=0.84, 95%CI: 0.77-0.92), but not among CT+ subjects. Blood biomarkers may warrant future investigation as potential predictors of depression following TBI in patients without evidence of acute intracranial trauma on CT scan.