Serum Glial Fibrillary Acidic Protein Is Related to Focal Brain Injury and Outcome After Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose— Aneurysmal subarachnoid hemorrhage (aSAH) stands out from other subtypes of stroke because of the high early mortality and the risk of complications. Serum glial fibrillary acidic protein (s-GFAP) concentrations are increased after stroke. The aim of this study was to investigate whether s-GFAP could be used as a marker of brain damage and outcome after aSAH. Methods— Serum samples were obtained on a regular basis from 116 adults during a 2-week period after aSAH and analyzed using an enzyme-linked immunosorbent assay. The World Federation of Neurological Surgeons scale was used for neurological evaluation. Outcome was assessed after 1 year and categorized according to the Extended Glasgow Outcome Scale. Results— Increased s-GFAP levels were seen in 81 of the 116 patients. Maximum s-GFAP correlated with World Federation of Neurological Surgeons scale on arrival and on days 10 to 15 ( r =0.37, P <0.001 and r =0.47, P <0.001, respectively). Furthermore, maximum s-GFAP levels were increased in the patient group with radiological signs of focal lesions acute or at 1 year, compared with the group without focal lesions ( P <0.001 in both comparisons). Patients with secondary events (re-bleeding or ischemia) reached maximum levels later in the series and both maximum and final s-GFAP levels increased compared with the levels in patients without secondary events ( P <0.001 in all 3 comparisons). Finally, maximum s-GFAP correlated with outcome ( r =−0.48, P <0.001) and s-GFAP was an independent predictor of dichotomized outcome. Conclusions— s-GFAP provides information about brain injury severity and outcome after aSAH, which can be useful as a complement to clinical data.

Potential blood biomarkers for stroke

“…During a 2-week period after SAH, higher s-GFAP levels in the patient groups with radiological signs of focal lesions and patients with secondary events were observed. Their results indicate that s-GFAP provides information about injury severity and outcome after SAH and demonstrate its potential to refl ect the brain damage [81] .…”

A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia

“…Possible candidates include glial fibrillary-associated protein and brain-and heart-type fatty acid binding protein. Glial fibrillary-associated protein levels are related to severity of injury and adverse outcomes after traumatic brain injury [107], and to neurological outcome after stroke [108] and subarachnoid haemorrhage [109]. Brain-and heart-type fatty acid binding protein show higher sensitivities and specificities than protein S100B and neuron specific enolase in the rapid detection of brain injury in stroke, trauma and neurodegenerative diseases [110].…”

Serum glial fibrillary acidic protein as a marker of brain damage in patients after carotid endarterectomy

“…Moreover, any increase in the level of serum GFAP can depend on the magnitude of brain damage and its duration. It was observed that serum GFAP level was increased in different neurological diseases with characteristic persistent and chronic brain damage, including multiple sclerosis, glioblastoma, Parkinson disease, traumatic brain injury, and subarachnoid haemorrhage [13][14][15][16][17][18].…”