Elevated cerebrospinal fluid concentrations of N-acetylaspartate correlate with poor outcome in a pilot study of severe brain trauma.
Nicole D Osier, Melody Ziari, Ava M Puccio and 5 others
PMID 31305157WHAT IT FOUND
In 28 patients with severe brain trauma, higher levels of N-acetylaspartate (NAA) in spinal fluid during the first few days after injury were linked to worse functional outcomes up to two years later.
Lower NAA levels tended to occur in patients who recovered better.
Key findings
01Higher average NAA levels in cerebrospinal fluid during the acute phase were significantly associated with greater disability on the Disability Rating Scale and poorer outcomes on the Glasgow Outcome Scale.
02NAA levels on days 2 and 4 after injury showed significant correlations with long-term functional outcomes, while day 1 and day 3 levels showed weaker or no associations with disability.
03The study was exploratory and underpowered, with no correction for multiple testing, meaning these associations require replication in larger studies before clinical use.
STILL TO COME
How it was doneWhat they found
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What it does not show
Very small sample size (n=28) limits generalizability and statistical power. No correction for multiple testing was performed, increasing the risk of false-positive findings. The sample excluded pediatric patients and was predominantly male and Caucasian from a single geographic region. The study only included patients with severe TBI (GCS ≤ 8), so findings do not apply to mild or moderate injuries. Outcome measures were limited to gross functional scales (GOS, DRS) due to the severity of injury, lacking detailed neuropsychological or cognitive metrics. The study design is observational and cannot determine causality or the mechanism behind NAA changes.
Declared interests
The authors declare that they have no conflicts of interest to report.
The easy way to misread this
Do not use these NAA levels to predict individual patient prognosis in clinical practice. This was a small pilot study with no correction for multiple testing, and the authors explicitly state the findings need replication in larger, adequately powered studies before any prognostic value can be confirmed.