{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:55:02Z","timestamp":1791579302718,"version":"4.3.4"},"reference-count":39,"publisher":"Walter de Gruyter GmbH","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2025-1129_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the diagnostic performances of GFAP and UCH-L1 with S100B in detecting intracranial injury, while investigating the impact of confounding factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1129_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a large prospective cohort of 1,010 patients with mild traumatic brain injury, we first evaluated the clinical performances of S100B and the GFAP\/UCH-L1 combination. To explore the impact of pre-analytical interferences on GFAP and UCH-L1 levels, HIL indices (hemolysis, icterus, lipemia) were measured using the Atellica\n                      <jats:sup>\u00ae<\/jats:sup>\n                      analyzer, and spiking experiments were performed with increasing concentrations of hemolysate, bilirubin, and Intralipid\n                      <jats:sup>\u00ae<\/jats:sup>\n                      . We then assessed the influence of four confounders on biomarker specificity: age over 80\u00a0years, hemolysis, neurodegenerative diseases, and extracranial fractures. Finally, we evaluated the ability of the biomarkers to predict clinical outcomes at one\u00a0month.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1129_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>S100B and the GFAP\/UCH-L1 combination showed sensitivities of 96 and 100\u202f%, and specificities of 25 and 27\u202f%, respectively. False positives were significantly associated with age &gt;80 and extracranial fractures for S100B; with age &gt;80 and neurodegenerative diseases for GFAP; and with age &gt;80, hemolysis, and extracranial fractures for UCH-L1. UCH-L1 levels were markedly increased by hemolysis, starting at 400\u202fmg\/L of hemoglobin. Age was the only confounding factor to significantly affect specificity. Using age-adjusted thresholds in patients over 80 increased specificity to 30\u202f% for S100B and 33\u202f% for GFAP\/UCH-L1. Overall, the biomarkers exhibited limited predictive value and performed poorly for one-month clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2025-1129_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>S100B and the GFAP\/UCH-L1 combination demonstrated very high sensitivities, close to 100\u202f%, with specificities of approximately 30\u202f% for the diagnosis of intracranial lesions. Age-adjusted thresholds improve specificity in older patients, supporting their clinical implementation. This study also provides the first evidence that hemolysis significantly elevates UCH-L1 concentrations from 400\u202fmg\/L of hemoglobin.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2025-1129","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T15:55:48Z","timestamp":1759938948000},"page":"368-378","source":"Crossref","is-referenced-by-count":5,"title":["Performance of GFAP and UCH-L1 compared to S100B in detecting intracranial injury: influence of age, hemolysis, neurodegenerative diseases, and extracranial fractures in a prospective cohort of over 1,000 patients"],"prefix":"10.1515","volume":"64","author":[{"given":"Antoine","family":"Puravet","sequence":"first","affiliation":[{"name":"Biochemistry and Molecular Genetic Department , 55174 CHU Clermont-Ferrand , Clermont-Ferrand , France"},{"name":"Faculty of Medicine , CNRS 6293, INSERM 1103, iGReD, Universit\u00e9 Clermont Auvergne , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7452-315X","authenticated-orcid":false,"given":"Vincent","family":"Sapin","sequence":"additional","affiliation":[{"name":"Biochemistry and Molecular Genetic Department , 55174 CHU Clermont-Ferrand , Clermont-Ferrand , France"},{"name":"Faculty of Medicine , CNRS 6293, INSERM 1103, iGReD, Universit\u00e9 Clermont Auvergne , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Baptiste","family":"Bouillon-Minois","sequence":"additional","affiliation":[{"name":"Adult Emergency Department , CHU Clermont-Ferrand , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Pereira","sequence":"additional","affiliation":[{"name":"Biostatistics Unit (DRCI), CHU Clermont-Ferrand , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Durif","sequence":"additional","affiliation":[{"name":"Biochemistry and Molecular Genetic Department , 55174 CHU Clermont-Ferrand , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Bouthors","sequence":"additional","affiliation":[{"name":"Biochemistry and Molecular Genetic Department , 55174 CHU Clermont-Ferrand , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Far\u00e8s","family":"Moustafa","sequence":"additional","affiliation":[{"name":"Adult Emergency Department , CHU Clermont-Ferrand , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannot","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Adult Emergency Department , CHU Clermont-Ferrand , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Bouvier","sequence":"additional","affiliation":[{"name":"Biochemistry and Molecular Genetic Department , 55174 CHU Clermont-Ferrand , Clermont-Ferrand , France"},{"name":"Faculty of Medicine , CNRS 6293, INSERM 1103, iGReD, Universit\u00e9 Clermont Auvergne , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Oris","sequence":"additional","affiliation":[{"name":"Biochemistry and Molecular Genetic Department , 55174 CHU Clermont-Ferrand , Clermont-Ferrand , France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"2026031918102561493_j_cclm-2025-1129_ref_001","doi-asserted-by":"crossref","unstructured":"Maas, AIR, Menon, DK, Manley, GT, Abrams, M, \u00c5kerlund, C, Andelic, N, et al.. 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