By Marilynn Larkin
NEW YORK—A diagnostic panel of 28 biomarkers confirmed a post-traumatic stress disorder (PTSD) diagnosis in male combat veterans with 77% accuracy, a phase 2 study revealed.
"PTSD impacts many veterans and active duty soldiers, but diagnosis can be problematic due to biases in self-disclosure of symptoms, stigma within military populations, and limitations identifying those at risk," Dr. Charles Marmar of NYU Langone Health and NYU School of Medicine in New York City and colleagues write in their report of the study.
"Prior studies suggest that PTSD may be a systemic illness, affecting not just the brain, but the entire body," they continue. "Therefore, disease signals likely span multiple biological domains, including genes, proteins, cells, tissues, and organism-level physiological change."
Dr. Marmar added in an email to Reuters Health, "We need to make it easier and more objective for physicians to diagnose PTSD so that treatment can be administered earlier, when it has greater effectiveness. We feel that our study moves the medical community in the right direction, and lays the groundwork for one day having an objective blood test for PTSD."
"But until we get to that moment in time, we have to remain vigilant in using our current assessment tools to better and more timely diagnose PTSD," he said.
As reported online September 10 in Molecular Psychiatry, Dr. Marmar and colleagues studied three cohorts of male combat veterans recruited as part of a larger study designed to identify biomarkers for PTSD diagnosis. All participants completed clinical interviews and blood draws.
The discovery cohort consisted of 83 veterans with PTSD and 82 veterans similarly warzone-exposed but without PTSD. After assessment of data quality, 77 PTSD and 74 trauma-exposed control samples had complete blood marker assays.
Participants from the discovery cohort were invited back for clinical re-evaluation and a blood draw approximately three years after their initial evaluation. The recall cohort included 55 participants, categorized at that point as PTSD (15), subthreshold PTSD (11), and controls (29).
The third cohort, an independent group of 26 PTSD and 26 control participants, became the validation cohort for the final set of PTSD biomarkers.
The team ascertained more than one million molecular, cellular, physiological and clinical features from the three cohorts. A set of 343 candidate markers were identified from the discovery cohort; these were refined to a set of 28 after assessment of the recall cohort, based on their performance and ability to track phenotypic changes over time.
The final diagnostic panel of 28 features achieved good performance in the validation cohort: area under the curve, 0.80; 81% accuracy; 85% sensitivity; and 77% specificity.
"Our next steps will be to take what we have learned from this study and expand it to the examination of PTSD in other groups, such as a larger male veteran cohort, as well as female veterans and civilian victims of trauma," Dr. Marmar said. "We also are going to work closely with the FDA to determine if what we have discovered in this study can have some early application to the clinical setting."
Dr. Alan Schatzberg, a professor of psychiatry and behavioral sciences at Stanford University School of Medicine in California, commented in an email to Reuters Health, "Psychiatry is in need of biomarkers to confirm diagnosis, to assist in treatment selection, and to help assess adequacy of treatment. This is true for all of our disorders and is particularly needed in PTSD, where treatments are highly variable in efficacy, especially in combat veterans."
"This study is an important step forward to developing a multiplex test to aid in diagnosis," he said. "The study was conducted by leaders in our field and the data are cogent. They will require further study in larger samples patients."
Mol Psychiatry 2019.
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