Serum levels of GFAP and NfL are related to the neurological impairment and spinal edema after traumatic spinal cord injury.

Neurological examination in the acute phase after spinal cord injury (SCI) is often impossible and severely confounded by pharmacological sedation, or concomitant injuries. Therefore, diagnostic biomarkers that objectively characterize severity, or the presence of SCI are urgently needed to facilitate clinical decision-making. This study aimed to determine if serum markers of neural origin are related to i) presence and severity of SCI, and ii) magnetic resonance imaging (MRI) parameters in the very acute post-injury phase. We performed a secondary analysis of serological parameters, as well as MRI findings in patients with acute SCI (n=38). Blood samples were collected between days 1-4 post-injury. Serum protein levels of Glial Fibrillary Acidic Protein (GFAP), Neuron-Specific Enolase (NSE), and Neurofilament light protein (NfL) were determined. A group of 41 age- and sex-matched healthy individuals served as control group. In the group of individuals with SCI, pre-operative sagittal and axial T2-weighted and sagittal T1-weighted MRI scans were available for 21 patients. Serum markers of neural origin are different among individuals who sustained traumatic SCI depending on injury severity, and the extent of the lesion according to MRI in the acute injury phase. URP-CTREE produced preliminary cut-off values for NfL (75.217 pg/ml) and GFAP (73.121 pg/ml) allowing a differentiation between individuals with SCI and healthy controls within the first four days after SCI. Serum proteins NfL and GFAP qualify as diagnostic biomarkers for the presence and severity of SCI in the acute post-injury phase, where the reliability of clinical exams is limited.