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NEUROLOGY 2006;67:1600-1604
© 2006 American Academy of Neurology

Initial CSF total tau correlates with 1-year outcome in patients with traumatic brain injury

M. Öst, MD, K. Nylén, MD, L. Csajbok, MD, A. Olsson Öhrfelt, PhD, M. Tullberg, MD, PhD, C. Wikkelsö, MD, PhD, P. Nellgård, MD, PhD, L. Rosengren, MD, PhD, K. Blennow, MD, PhD and B. Nellgård, MD, PhD

From the Departments of Anesthesiology and Intensive Care Medicine (M.Ö., L.C., P.N., B.N.), Neurology (K.N., L.R.), and Neurochemistry (A.O.O., K.B.) and Institute of Clinical Neuroscience (M.T., C.W.), Sahlgrenska University Hospital, Gothenburg, Sweden.

Address correspondence and reprint requests to Dr. M. Öst, Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Storgatan, Göteborg, Sweden 41138; e-mail: martin.ost{at}vgregion.se

Objective: We investigated if tau, microtubular binding protein, in serum and ventricular CSF (vCSF) in patients with severe traumatic brain injury (TBI) during the initial posttraumatic days correlated to 1-year outcome.

Methods: Patients with severe TBI (n = 39, Glasgow Coma Scale score ≤8) were included. We measured serum and vCSF total tau on days 0 to 14, using ELISA. vCSF total tau correlated to 1-year Extended Glasgow Outcome Scale (GOSE), the NIH Stroke Scale (NIHSS) neurologic status, and the Bartel Daily Living Index. Patients (n = 20) with normal pressure hydrocephalus (NPH) served as reference.

Results: Higher levels of tau were found in TBI patients vs patients with NPH. A correlation was found between initial vCSF total tau and GOSE levels (R = 0.42, p < 0.001) but not between vCSF total tau and NIHSS or Bartel scores at 1 year. A vCSF total tau level of >2,126 pg/mL on days 2 to 3 discriminated between dead and alive (sensitivity of 100% and a specificity of 81%). A vCSF total tau level of >702 pg/mL on days 2 to 3 discriminated between bad (GOSE 1 to 4) and good (GOSE 5 to 8) outcome (sensitivity of 83% and a specificity of 69%). Patients with GOSE 1 (dead) had higher vCSF total tau levels on days 2 to 3 (p < 0.001) vs both surviving patients (GOSE 2 to 8) and those with NPH. Total tau was not detected in serum throughout the study.

Conclusion: The increase in ventricular CSF (vCSF) total tau probably reflects axonal damage, known to be a central pathologic mechanism in traumatic brain injury (TBI). These results suggest that vCSF total tau may be an important early biochemical neuromarker for predicting long-term outcome in patients with a severe TBI.

Supported by Laerdal Foundation, Swedish Medical Grant S-160 00, and Mattson's Memorial Foundation.

Disclosure: The authors report no conflicts of interest.

Received December 9, 2005. Accepted in final form July 5, 2006.