The use of serum glial fibrillary acidic protein test as a promising tool for intracerebral hemorrhage diagnosis in Chinese patients and prediction of the short-term functional outcomes

Abstract

The objective of this study was to explore the efficacy of glial fibrillary acidic protein (GFAP) in differentiating intracerebral hemorrhage (ICH) from ischemic stroke (IS). Suspicious patients of acute stroke were screened and finally diagnosed by computed tomography and magnetic resonance imaging. Blood samples were collected within 2-6 h after onset of symptoms, and serum GFAP level was determined by ELISA assay. The functional outcome for the patients was determined by modified Rankin Scale (mRS) 90 days after onset of symptoms. 43 ICH patients and 65 IS patients were enrolled. GFAP concentration in ICH group was significantly higher than in IS group (p < 0.001). Significant correlation was found when comparing GFAP with National Institutes of Health Stroke Scale (NIHSS) (r = 0.418, p = 0.005) and hemorrhage volume (r = 0.840, p < 0.001) in ICH group, while such correlation was not observed in IS group. ROC analysis indicated that GFAP level at the cut-point of 0.7 ng/ml yielded an AUC of 0.901 (95 % CI 0.828-0.950) with high sensitivity (86.0 %) and specificity (76.9 %) to differentiate ICH from IS. Patients with higher serum GFAP concentration in ICH group experienced poorer functional disability (r = 0.755, p < 0.001), while this phenomenon was not observed in IS group (r = -0.114, p = 0.368). ROC curve analysis found that GFAP level at the cut-point of 1.04 ng/ml yielded an AUC of 0.936 (95 % CI 0.817-0.988) in identifying patients with poor functional outcome, at the sensitivity and specificity of 95.7 and 80.0 %, respectively. GFAP test is a promising technique for diagnosis of ICH from IS and prediction of short-term functional outcomes.

Blood‐based protein biomarkers for stroke differentiation: A systematic review

“…Figure gives the schematic representation of the systematic review. After scanning through the title and abstract of each article, 37 full text studies were assessed for eligibility; out of which 18 articles from 2004 to 2017 were found relevant and were included in our systematic review. The review highlights the role of 10 single biomarkers (ApoC‐1, ApoC‐III, GFAP, RBP4, hs‐CRP, APC‐PCI, Apo‐AI, Paraoxonase‐1, BNP, S100B) and seven panels consisting of several different biomarkers for distinguishing the two stroke types.…”

Biomarkers for acute diagnosis and management of stroke in neurointensive care units

“…A blood GFAP level at the cut point of 0.7 ng/mL yielded an AUC of 0.901 (95% CI 0.828-0.950) with high sensitivity (86.0%) and specificity (76.9%) to differentiate ICH from ischemic stroke. [ 47 ] In addition, in the ICH group, a significant correlation was observed between GFAP levels and neurological deficits assessed by NIHSS, and between GFAP levels and hemorrhage volume, and the highest GFAP levels were predictive of poor short-term functional outcomes. [ 47 ] Furthermore, a recent study suggested that GFAP used in combination with NR2 can differentiate between ischemic stroke and ICH at a time point extended to 12 h after the ictus with a sensitivity of 94% and specificity of 91%.…”

“…[ 47 ] In addition, in the ICH group, a significant correlation was observed between GFAP levels and neurological deficits assessed by NIHSS, and between GFAP levels and hemorrhage volume, and the highest GFAP levels were predictive of poor short-term functional outcomes. [ 47 ] Furthermore, a recent study suggested that GFAP used in combination with NR2 can differentiate between ischemic stroke and ICH at a time point extended to 12 h after the ictus with a sensitivity of 94% and specificity of 91%. [ 46 ] Another study showed that plasma concentrations of retinol binding protein 4 and GFAP at concentrations >61 μg/mL and <0.07 ng/mL, respectively, demonstrated 100% specificity, and these biomarkers might be independent predictors to discriminate stroke subtype, improving discrimination by 29% ( P < 0.0001).…”

A 24 h Delay in the Redox Response Distinguishes the most Severe Stroke Patients from Less Severe Stroke Patients

“…Biomarkers, GFAP, CRP, cortisol and glucose, are all unbiased measures that have been used to predict post-hospital (30-90 days) mortality [3][4][5] rather than more acute, in-hospital outcomes. Since 8-10% of stroke patients will die in-hospital [1,2] and 84% of hospice patients die with a median length of stay of 13 days [35] we felt that predicting early mortality was an important event.…”

“…Several stroke biomarkers have been used to predict 30-90 day outcomes based on serum levels of glial fibrillary acidic protein (GFAP), C-reactive protein (CRP), cortisol and glucose [3][4][5]. Only one study reported predictive values using in-hospital death as an end-point [6].…”