Glial fibrillary acidic protein as a biomarker for periventricular white matter injury

Stewart, Amanda; Tekes, Aylin; Huisman, Thierry A.G.M.; Jennings, Jacky M.; Allen, Marilee C; Northington, Frances J.; Graham, Ernest M.

doi:10.1016/j.ajog.2013.02.049

Cited by 36 publications

(39 citation statements)

References 27 publications

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“…Assays were c arried out in duplicate using an electrochemiluminescent sandwich immunoassay platform (MesoScale Discovery [MSD], Gaithersburg, MD) and were analyzed on a Sector Imager 2400 (MSD) according to the manufacturer’s protocol. (24, 25) The lower limit of detection for GFAP, assay was 0.011 ng/mL.…”

Section: Methodsmentioning

confidence: 99%

Rewarming Rate During Cardiopulmonary Bypass Is Associated With Release of Glial Fibrillary Acidic Protein

Hori

Lee

Ono

et al. 2015

The Annals of Thoracic Surgery

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Background Rewarming from hypothermia during cardiopulmonary bypass (CPB) may compromise cerebral oxygen balance potentially resulting in cerebral ischemia. The purpose of this study was to evaluate whether CPB rewarming rate is associated with cerebral ischemia assessed by the release of the brain injury biomarker glial fibrillary acidic protein (GFAP). Methods Blood samples were collected from 152 patients after anesthesia induction and after CPB for the measurement of plasma GFAP levels. Nasal temperatures were recorded every 15 minutes. A multivariate estimation model for post-operative plasma GFAP level was determined that included the baseline GFAP levels, rewarming rate, CPB duration, and patient age. Results The mean rewarming rate during CPB was 0.21±0.11°C/min; the maximum temperature was 36.5±1.0°C (range, 33.1-38.0°C). Plasma GFAP levels increased after compared with before CPB (median, 0.022 ng/ml vs. 0.035 ng/ml, p<0.001). Rewarming rate (p=0.001), but not maximum temperature (p=0.77), was associated with higher plasma GFAP levels after CPB. In the adjusted estimation model, rewarming rate was positively associated with postoperative plasma log GFAP levels (Coef, 0.261; 95% Confidence Intervals, 0.132 to 0.390; p<0.001). Six (3.9%) patients experienced a post-operative stroke. Rewarming rate was higher (0.3±0.09°C/min vs. 0.2±0.11°C/min, p=0.049) in the patients with stroke compared with those without a stroke. Conclusions Rewarming rate during CPB was correlated with evidence of brain cellular injury documented with plasma GFAP levels. Modifying current practices of patient rewarming might provide a strategy to reduce the frequency of neurological complications after cardiac surgery.

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Section: Methodsmentioning

confidence: 99%

Rewarming Rate During Cardiopulmonary Bypass Is Associated With Release of Glial Fibrillary Acidic Protein

Hori

Lee

Ono

et al. 2015

The Annals of Thoracic Surgery

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“…Stewart et al [9] extended this work and compared GFAP levels in 21 low-birth-weight infants (<2.5 kg) with a gestational age 27.4 AE 3.3 weeks with periventricular white matter injury (PVMI) noted on head ultrasound at 6 weeks with 42 control infants. GFAP was not significantly different between the groups in the cord blood or at neonatal ICU admission but was significantly elevated on day 1.…”

Section: Surgical Conduct and Specific Proceduresmentioning

confidence: 99%

New concepts in predicting, evaluating, and managing neurodevelopmental outcomes in children with congenital heart disease

Marino

2013

Current Opinion in Pediatrics

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The literature reviewed reveals new intervention opportunities to improve neurodevelopmental outcome in the fetus (cerebrovascular resistance), during the perioperative period (brain biomarkers and EEG), and through the utilization of new stratification schemata. The new AHA/AAP guidelines on the evaluation and management of neurodevelopmental outcomes create the opportunity to identify and treat a significant population of survivors with neurodevelopmental deficits with novel interventions.

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“…Assays were performed in duplicate serum samples with the electrochemiluminescent sandwich immunoassay platform (MesoScale Discovery [MSD], Gaithersburg, MD) and were analyzed on a Sector Imager 2400 (MSD) according to the manufacturer’s protocol. 25,26 The lower limit of detection for the GFAP assay is 0.011 ng/mL, and the interassay variance is 2.4%.…”

Section: Methodsmentioning

confidence: 99%

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

Laflam¹,

Joshi

Brady

et al. 2015

Anesthesia &Amp; Analgesia

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Background Although controversial, failing to consider the gravitational effects of head elevation on cerebral perfusion is speculated to increase susceptibility to rare, but devastating, neurologic complications after shoulder surgery in the beach chair position (BCP). We hypothesized that patients in the BCP have diminished cerebral blood flow autoregulation than those who undergo surgery in the lateral decubitus position (LDP). A secondary aim was to examine whether there is a relationship between patient positioning during surgery and postoperative cognition or serum brain injury biomarker levels. Methods Patients undergoing shoulder surgery in the BCP (n=109) or LDP (n=109) had mean arterial blood pressure (MAP) and regional cerebral oxygen saturation (rScO2) monitored with near-infrared spectroscopy. A continuous, moving Pearson’s correlation coefficient was calculated between MAP and rScO2, generating the variable cerebral oximetry index (COx). When MAP is in the autoregulated range, COx approaches zero because there is no correlation between cerebral blood flow and arterial blood pressure. In contrast, when MAP is below the limit of autoregulation, COx is higher because there is a direct relationship between lower arterial blood pressure and lower cerebral blood flow. Thus, diminished autoregulation would be manifest as higher COx. Psychometric testing was performed before surgery and then 7–10 days and 4–6 weeks after surgery. A composite cognitive outcome was determined as the Z-score. Serum S100β, neuron-specific enolase, and glial fibrillary acidic protein were measured at baseline, after surgery, and on postoperative day 1. Results After adjusting for age and history of hypertension, COx (p=0.035) was higher and rScO2 lower (p<0.0001) in the BCP group than in the LDP group. After adjusting for baseline composite cognitive outcome, there was no difference in Z-score 7 to 10 day (p=0.530) or 4 to 6 weeks (p=0.202) after surgery between the BCP and the LDP groups. There was no difference in serum biomarker levels between the 2 position groups Conclusions Compared with patients in the LDP, patients undergoing shoulder surgery in the BCP are more likely to have higher COx indicating diminished cerebral autoregulation and lower rScO2. There were no differences in the composite cognitive outcome between the BCP and LDP groups after surgery after accounting for baseline Z-score.

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Glial fibrillary acidic protein as a biomarker for periventricular white matter injury

Cited by 36 publications

References 27 publications

Rewarming Rate During Cardiopulmonary Bypass Is Associated With Release of Glial Fibrillary Acidic Protein

Rewarming Rate During Cardiopulmonary Bypass Is Associated With Release of Glial Fibrillary Acidic Protein

New concepts in predicting, evaluating, and managing neurodevelopmental outcomes in children with congenital heart disease

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

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