Biological Significance of Serum Biomarkers in Sports- Related Concussion Injury-A Systematic Review

AIM: To evaluate all serum biomarkers in sports-related concussion injury (SRC) to determine diagnostic validity, changes with symptom severity, and return to play, as well as detect early changes in serum concentration.MATERIAL and METHODS: Studies were searched in various electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, Scopus and Cochrane databases) from their commencement to May 2021. Studies were included if athletes aged 12 years and older were diagnosed with a concussion injury and evaluated using serum biomarkers. Studies including athletes with injuries other than concussion injuries were excluded. Articles with fewer than 20 concussed athletes were excluded. There were 1782 articles identified.RESULTS: After exclusion a total of 17 articles qualified for systematic review. S100 calcium binding protein beta (S-100 beta) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) showed promising results in distinguishing concussed athletes from contact sports and non-athlete controls. Most of the serum biomarkers increased within 6 hours of SRC. Serum neurofilament light protein (NFL) positively correlated with the severity of post-concussion symptoms. NFL, tau and Interleukins (IL-1 Ra and IL-6) have the potential to determine return to play.CONCLUSION: Serum biomarker measurement is an objective tool that aids in early diagnosis and predicts the severity and prognosis of injury.