Virginia Research Day 2025

Medical Student Research Clinical

01 IGF-1 as a Biomarker for Symptom Severity in Adolescents with Traumatic Brain Injury

Varun Mishra, MSIII; Kimberly Rosenthal, MD; Emily Hillaker, DO; Melissa Martinez, NP; Jennifer Bath, DNP; William Ide, MD; Joshua Stodghill, DO; Tonja Locklear, PhD; Justin Weppner, DO Corresponding author: jlweppner@carilionclinic.org

Carilion Clinic Brain Injury Center Virginia Tech Carilion School of Medicine Eastern Virginia Medical School Edward Via College of Osteopathic Medicine Kennedy Krieger Institute University of Virginia Health System

correlated to IGF-1 z-scores using Kendall’s Tau analysis.

In contrast, only the msTBI group demonstrated a significant negative correlation between IGF-1 z-score and PHQ-9 score (tau=-0.82, p<0.0001), while the mild TBI group did not reach statistical significance (tau=-0.14, p=.3104). Conclusions: In this study, the msTBI group had higher RPQ-13 and GAD-7 scores, suggesting that in adolescents, brain injury severity may affect the degree of post-injury symptom severity and anxiety experienced as compared to those with mTBI. Results further suggest that a low IGF-1 level post-injury correlates to greater degree of post-injury symptom severity and anxiety in both mTBI and msTBI. Only the msTBI group showed a similar strong and negative correlation between IGF-1 z-score and degree of post-injury depression. This study presents compelling support for IGF-1 as a potential biomarker in adolescent TBI, particularly for post injury symptom severity and neuropsychiatric impact, though additional investigation is needed. Approved by the Carilion Clinic IRB, protocol number 24-1771.

Objective: The purpose of this study was to assess the relationship between insulin-like growth factor 1 (IGF-1) level and symptom severity in adolescents. Specifically, the study evaluates whether IGF-1 levels correlate with post-injury symptom severity, depression, and anxiety. Design: This retrospective observational study included adolescents aged 13-17 years (n=52) with mild TBI (mTBI, n=30) or moderate/severe TBI (msTBI, n=22), based on Glasgow Coma Scale scores. Participants were 3-12 months post-TBI and had available IGF-1 values along with complete Rivermead Post Concussion Symptoms Questionnaire (RPQ-13), Generalized Anxiety Disorder-7 (GAD 7), and Patient Health Questionnaire-9 (PHQ-9) responses. Age and gender were standardized using IGF-1 z-scores. Demographic and clinical characteristics including age, sex, BMI, race, mechanism of injury, psychiatric history, time to clinic presentation, and lab draw were compared between the mTBI and msTBI groups using either Fisher’s Exact Test or the Median Two-Sample Test. Outcome measures included intergroup comparison of RPQ 13, PHQ-9, and GAD-8 scores, which were then

Results: The msTBI group mean age was one year younger than those with mTBI (p=0.0179). Differences between participant BMI, sex distribution, race, mechanism of injury, psychiatric history, time to clinic presentation, or time to lab draw were nonsignificant between mTBI and msTBI. Median post-injury RPQ-13 and GAD-7 scores were significantly higher in the msTBI group compared to mTBI (p=0.0472 and p=0.0085, respectively), while PHQ-9 scores approached but did not reach significance (p=0.0762). Kendall’s Tau analysis demonstrated significant negative correlations between IGF-1 z-scores and RPQ-13, PHQ-9, and GAD-7 scores. IGF-1 z-scores were strongly and negatively correlated with RPQ-13 scores in both mild (tau=-0.65, p<0.0001) and moderate-to-severe (tau=- 0.85, p<0.0001) adolescent TBI groups, suggesting that higher IGF-1 levels were associated with lower post-injury symptom severity. Similarly, a negative correlation was observed between IGF-1 z-score and GAD-7 score in both mild (tau=-0.30, p=0.0302) and moderate-to-severe (tau=-0.39, p=0.0144) TBI.

129 2025 Research Recognition Day