Ubiquitin C-Terminal Hydrolase-L1 (UCH-L1) in Predic-tion of Computed Tomography Findings in TraumaticBrain Injury; a Meta-Analysis

Ubiquitin C-terminal hydrolase-L1 (UCH-L1) is one of the promising candidates, with an accept-able diagnostic value for predicting head computed tomography (CT) scan findings. However, there has beena controversy between studies and still, there is no general overview on this. Therefore, the current system-atic review and meta-analysis attempted to estimate the value of UCH-L1 in predicting intracranial lesions intraumatic brain injury (TBI).


Two independent reviewers screened records from the search of fourdatabases Medline, Embase, Scopus and Web of Science. The data were analyzed in the STATA 14.0 statisticalprogram and the findings were reported as a standardized mean difference (SMD), summary receiver perfor-mance characteristics curve (SROC), sensitivity, specificity, and diagnostic odds ratio with 95% confidence in-terval (95% CI).


Finally, the data of 13 articles were entered into the meta-analysis. The mean serumlevel of UCH-L1 was significantly higher in patients with CT-positive than in TBI patients with CT negative (SMD= 1.67, 95% CI: 1.12 to 2.23, I2 = 98.1%; p <0.0001). The area under the SROC curve for UCH-L1 in the predic-tion of intracranial lesions after mild TBI was 0.83 (95% CI: 0.80 to 0.86). Sensitivity, specificity and diagnosticodds ratio of serum UCH-L1 was 0.97 (95% CI: 0.92 to 0.99), 0.40 (95% CI: 0.30 to 0.51) and 19.37 (95% CI: 7.25to 51.75), respectively. When the analysis was limited to assessing the serum level of UCH-L1 within the first 6hours after mild TBI, its sensitivity and specificity increased to 0.99 (95% CI: 0.94 to 1.0) and 0.44 (95% CI: 0.38to 0.052), respectively. In addition, the diagnostic odds ratio of 6-hour serum level of UCH-L1 in the predictionof intracranial lesions was 680.87 (95% CI: 50.50 to 9197.97).


Moderate level of evidence suggeststhat serum/plasma levels of UCH-L1 have good value in prediction of head CT findings. It was also found thatevaluation of serum/plasma level of UCH-L1 within the first 6 hours following TBI would increase its predictivevalue. However, there is a controversy about the best cutoffs of the UCH-L1.

Article Type:
Review Article
Archives of Academic Emergency Medicine, Volume:6 Issue: 1, 2018
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