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Mild traumatic brain injury is associated with increased levels of axonal injury biomarkers in blood
  1. Pashtun Shahim1,
  2. Kaj Blennow1,
  3. Henrik Zetterberg1,2,
  4. Yelverton Tegner3
  1. 1Clinical Neurochemistry Laboratory, nstitute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
  2. 2Department of Molecular Neuroscience and Reta Lila Weston Laboratories, UCL Institute of Neurology, London WC1N1PJ, UK
  3. 3Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden


Objective To investigate whether sports-related concussion is associated with elevated blood biomarkers reflecting axonal injury (total-tau [T-tau], [tau-A] and [tau-C]) and astroglial injury (S100B), as well as neurons-specific enolase (NSE).

Design and setting A multicenter prospective cohort study involving all 12 teams of the top professional ice hockey league in Sweden.

Participants A total of 288 players consented to participate in the study. Thirty-five players sustained concussions, of whom 28 underwent repeated blood samplings at 1, 12, 36, and 144 hours after the trauma, or when the player returned to play (7->90 days).

Outcome measures Concentrations of T-tau was, tau-A, tau-C, S100B and NSE in blood.

Results Players with sports-related concussion had increased levels of the axonal injury biomarker T-tau compared to preseason values. The highest biomarker concentrations of T-tau were measured immediately after a concussion and decreased during rehabilitation. There was no significant increase in the levels of tau-A in post-concussion samples compared with preseason values. However, serum levels of tau-C were significantly higher in post-concussion samples compared with preseason. The levels of the astroglial injury biomarker S100B were also increased in players with sports-related concussion compared to preseason values. No significant changes were measured in the levels of NSE.

Conclusions Sports-related concussion in professional ice hockey players is associated with acute axonal and injury. Plasma T-tau may be used both in the diagnosis and clinical decision-making when an athlete is declared fit to return to play.

Competing interests None.

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