UCH-L1 and GFAP in Determining the Severity of Head Injuries in a National Referral Hospital in Indonesia

Background Accurate assessment of traumatic brain injury (TBI) severity remains challenging. Blood-based biomarkers, including Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) and Glial Fibrillary Acidic Protein (GFAP), have emerged as potential tools for refining TBI classification. This study investigated differences in serum UCH-L1 and GFAP between mild and moderate-to-severe head injuries, and their predictive value for injury severity. Methods This cross-sectional study was conducted at Dr. M. Djamil General Central Hospital, Padang, Indonesia (March–August 2024), enrolling 98 patients aged >18 years with TBI onset within 48 hours. Serum levels were measured via ELISA, and severity was classified using the Glasgow Coma Scale (GCS). Group differences were analyzed using the Mann-Whitney U test, and discriminatory performance was assessed via Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC). Results Serum UCH-L1 was significantly higher in moderate-to-severe (median 6364.5 ng/mL) than mild injuries (median 5684.5 ng/mL, P<0.05), with an optimal cut-off of 6085.5 ng/mL (60.5% sensitivity, 61.7% specificity). GFAP showed no significant difference (P>0.05); its cut-off was 2.17 ng/mL (63.2% sensitivity, 65.0% specificity). UCH-L1 yielded an AUC of 61.2% (95% CI 49.4–73.0%) and GFAP an AUC of 62.1% (95% CI 50.6–73.7%), both indicating poor-to-fair discrimination, overlapping confidence intervals indicate no meaningful difference between the two biomarkers. Conclusions Serum UCH-L1 and GFAP show potential diagnostic value for TBI severity. UCH-L1 significantly differentiated severity levels, while GFAP did not reach significance. Both biomarkers may serve as adjuncts to GCS scoring in acute TBI management.