pcij-2597-1777222050 20260426164730 PCIJ bmpublisher@bmpublisher.net Pathophysiology of Cell Injury Journal Pathophysiology of Cell Injury Journal 2378-5225 15 1 2026 4 21 Anurak Chaiyaporn MD PhD Nattaporn Srisawat MSc Kittisak Lertsinudom MD PhD Background: Acute brain insults, including traumatic brain injury, stroke, intracerebral hemorrhage, and hypoxic–ischemic encephalopathy, are major causes of morbidity and mortality in intensive care unit (ICU) settings. Early assessment of neuronal injury severity and prediction of clinical outcomes remain challenging. Circulating biomarkers of neuronal and glial injury have emerged as promising tools for improving diagnostic and prognostic accuracy. Objective: To evaluate the clinical utility of serum biomarkers of neuronal cell injury—neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP), and ubiquitin C-terminal hydrolase L1 (UCH-L1)—and to determine their correlation with clinical outcomes in ICU patients with acute brain insults. Methods: A prospective observational study was conducted in the ICU of Siriraj Hospital, Mahidol University, Thailand, including 70 adult patients with acute brain insults. Serum biomarker levels were measured at admission (T0), 48 hours (T1), and 72 hours (T2) using ELISA. Clinical data, Glasgow Coma Scale (GCS), and radiological findings were recorded. Outcomes were assessed using the Glasgow Outcome Scale (GOS) and ICU mortality. Statistical analysis included correlation testing and receiver operating characteristic (ROC) curve analysis. Results: All biomarkers were significantly elevated in patients with unfavorable outcomes (GOS 1–3) compared to favorable outcomes (GOS 4–5) (p < 0.001). GFAP demonstrated the strongest predictive performance (AUC = 0.91), followed by UCH-L1 (AUC = 0.89), NSE (AUC = 0.86), and S100B (AUC = 0.83). Biomarker levels showed significant inverse correlations with GCS scores (GFAP: r = −0.66, p < 0.001) and positive correlations with ICU length of stay. Elevated biomarker levels were also significantly associated with ICU mortality. Temporal analysis revealed early peak of UCH-L1 and sustained elevation of GFAP and NSE in severe cases. Conclusion: Serum biomarkers of neuronal cell injury, particularly GFAP and UCH-L1, demonstrate strong associations with clinical severity, functional outcomes, and mortality in ICU patients with acute brain insults. These findings support their potential role as reliable prognostic tools in neurocritical care and highlight their value in improving patient stratification and management in both high-resource and resource-limited settings. Keywords: Acute brain injury; biomarkers; GFAP; NSE; UCH-L1; S100B; intensive care unit; prognosis; neurocritical care 2026 4 21 10.18081/2378-5225/15.37 https://pcij.net/archives/2597