New research shows male patients with mild traumatic brain injury (TBI), or concussion, have a higher elevation of a biomarker used to detect the condition, compared to female patients with the injury. 

The study, led by researchers at Orlando Health Orlando Regional Medical Center (ORMC) and recently published in Nature Journal, is one of the largest studies to compare the two biomarkers between sexes among trauma patients at the time of diagnosis and over time, according to the researchers. The findings will help the diagnosis and treatment of patients with concussion.

The elevated biomarker, ubiquitin C-terminal hydrolase (UCH-L1), is one of two biomarkers already approved by the Food and Drug Administration to detect mild and moderate TBI. The second biomarker is glial fibrillary acidic protein (GFAP).

Although both GFAP and UCH-L1 were able to detect brain injuries on a computerized tomography (CT) scan, male patients had a significantly higher level of UCH-L1 compared to female patients. UCH-L1 concentrations were about 50 percent higher in male than female patients, particularly in those without brain injuries on CT scan. This difference was not found with GFAP.

The study enrolled male and female patients at the Level One Trauma Center at Orlando Health ORMC. Of the 584 patients, 362 were male and 222 were female.

Comparing biomarkers between males and females will help improve patient care – diagnosis and treatment.

“Since these biomarkers are now commercially available for clinical use it is important to assess their performance for any differences that may exist between male and female patients,” says Linda Papa, MD, lead author of the study and emergency medicine physician and director, Academic Clinical Research, Orlando Health ORMC. “We are in the early stages of introducing GFAP and UCH-L1 into clinical practice and these differences can help clinicians interpret the tests more accurately. Cutoff levels of UCH-L1 used to decide whether patients need a CT scan or have a concussion may need to be adjusted for male and female patients.”

Further reading: FDA Clears Abbott Blood Test to Evaluate Concussions

Understanding the ways medical conditions contrast among male and female patients has also proven beneficial in other areas of health care.

“Just as we’ve learned about recognizing the differences between male and female patients in the management of heart disease, these findings highlight the importance of a sex-specific approach for blood testing for mild traumatic brain injury,” says Papa.

Researchers at Orlando Health ORMC were leaders in identifying GFAP and UCH-L1 – the two FDA-approved biomarkers used in blood testing to detect brain injury and have continued to evaluate different aspects of the biomarkers through various studies.

Papa, who has over 20 years of experience in traumatic brain injury biomarkers research, has been the lead author of many studies published in various publications including JAMA Network Open, JAMA Neurology, BMJ Paediatrics Open, Annals of Emergency Medicine, Academic Emergency Medicine, and Journal of Trauma. Papa has published more than 200 articles related to traumatic brain injury.