Glial neuronal ratio: A novel index for differentiating injury type in patients with severe traumatic brain injury

Stefania Mondello, Andreas Jeromin, Andras Buki, Ross Bullock, Endre Czeiter, Noemi Kovacs, Pal Barzo, Kara Schmid, Frank Tortella, Kevin K. Wang, Ronald L. Hayes

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Neurobiochemical marker levels in blood after traumatic brain injury (TBI) may reflect structural changes detected by neuroimaging. This study evaluates whether correlations between neuronal (ubiquitin carboxy-terminal hydrolase-L1 [UCH-L1]) and glial (glial fibrillary acidic protein [GFAP]) biomarkers may be used as an indicator for differing intracranial pathologies after brain trauma. In 59 patients with severe TBI (Glasgow Coma Scale [GCS] score≤8) serum samples were obtained at the time of hospital admission and analyzed for UCH-L1 and GFAP. Glial neuronal ratio (GNR) was evaluated as the ratio between GFAP and UCH-L1 concentrations. A logistic regression analysis was used to identify variables associated with type of injury. GNR had a median of 0.85 and was positively correlated with age (R=0.45, p=0.003). Twenty-nine patients presented with diffuse injury and 30 with focal mass lesions as assessed by CT scan at admission and classified according to the Marshall Classification. GNR was significantly higher in the focal mass lesion group compared with the diffuse injury group (1.77 versus 0.48, respectively; p=0.003). Receiver operating characteristic curve analysis showed that GNR discriminated between types of injury (area under the curve [AUC]=0.72; p=0.003). GNR was more accurate earlier (≤12h after injury) than later (AUC=0.80; p=0.002). Increased GNR was independently associated with type of injury, but not age, gender, GCS score, or mechanism of injury. GNR was significantly higher in patients who died, but was not an independent predictor of death. The data from the present study indicate that GNR provides valuable information about different injury pathways, which may be of diagnostic significance. In addition, GNR may help to identify different pathophysiological mechanisms following different types of brain trauma, with implications for therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)1096-1104
Number of pages9
JournalJournal of neurotrauma
Issue number6
StatePublished - Apr 10 2012
Externally publishedYes


  • biomarkers
  • computed tomography
  • diagnostic
  • glial neuronal ratio
  • traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology


Dive into the research topics of 'Glial neuronal ratio: A novel index for differentiating injury type in patients with severe traumatic brain injury'. Together they form a unique fingerprint.

Cite this