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Serum SNTF Increases in Concussed Professional Ice Hockey Players and Relates to the Severity of Post-Concussion Symptoms.

Journal article
Authors Robert Siman
Pashtun Shahim
Yelverton Tegner
Kaj Blennow
Henrik Zetterberg
Douglas H Smith
Published in Journal of neurotrauma
Volume 32
Issue 17
Pages 1294-1300
ISSN 1557-9042
Publication year 2015
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Pages 1294-1300
Language en
Links dx.doi.org/10.1089/neu.2014.3698
Subject categories Neurochemistry

Abstract

Abstract Biomarkers for diffuse axonal injury could have utilities for the acute diagnosis and clinical care of concussion, including those related to sports. The calpain-derived alpha-spectrin N-terminal fragment SNTF accumulates in axons after traumatic injury, and increases in human blood following mild traumatic brain injury (mTBI) in relation to white matter abnormalities and persistent cognitive dysfunction. However, SNTF has never been evaluated as a biomarker for sports-related concussion. Here, we conducted longitudinal analysis of serum SNTF in professional ice hockey players, 28 of whom had a concussion, along with 45 players evaluated during the preseason, 17 of whom were also tested after a concussion-free training game. Compared to preseason levels, serum SNTF increased at 1 hour after concussion and remained significantly elevated from 12 hours to 6 days, before declining to preseason baseline. In contrast, serum SNTF levels were unchanged after training. In eight players, post-concussion symptoms resolved within a few days, and in these cases serum SNTF levels were at baseline. On the other hand, for the 20 players withheld from play for 6 days or longer, serum SNTF levels rose from 1 hour to 6 days post-concussion, and at 12-36 hours differed significantly from the less severe concussions (p=.004). Serum SNTF exhibited diagnostic accuracy for concussion, especially so with delayed return to play (AUC = 0.87). Multivariate analyses of serum SNTF and tau improved the diagnostic accuracy, the relationship with the delay in return to play, and the temporal window beyond tau alone. These results provide evidence that blood SNTF, a biomarker for axonal injury after mTBI, may be useful for diagnosis and prognosis of sports-related concussion, and for guiding neurobiologically-informed decisions on return to play.

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