Diagnostic Accuracy of Glial Fibrillary Acidic Protein and Ubiquitin Carboxy-Terminal Hydrolase-L1 Serum Concentrations for Differentiating Acute Intracerebral Hemorrhage from Ischemic Stroke

2020 ◽  
Vol 33 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Sebastian Luger ◽  
◽  
Henriette S. Jæger ◽  
Joanna Dixon ◽  
Ferdinand O. Bohmann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glial Fibrillary Acidic Protein ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Acidic Protein ◽  
Serum Concentrations ◽  
Acute Intracerebral Hemorrhage ◽  
Carboxy Terminal

scholarly journals Diagnostic Accuracy of Plasma Glial Fibrillary Acidic Protein for Differentiating Intracerebral Hemorrhage and Cerebral Ischemia in Patients with Symptoms of Acute Stroke

2012 ◽  
Vol 58 (1) ◽  
pp. 237-245 ◽  
Author(s):  
Christian Foerch ◽  
Marion Niessner ◽  
Tobias Back ◽  
Michael Bauerle ◽  
Gian Marco De Marchis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glial Fibrillary Acidic Protein ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Acute Stroke ◽  
Symptom Onset ◽  
Point Of Care ◽  
Area Under The Curve ◽  
Acidic Protein ◽  
Stroke Mimic

Abstract BACKGROUND Glial fibrillary acidic protein (GFAP) is a biomarker candidate indicative of intracerebral hemorrhage (ICH) in patients with symptoms of acute stroke. GFAP is released rapidly in the presence of expanding intracerebral bleeding, whereas a more gradual release occurs in ischemic stroke. In this study the diagnostic accuracy of plasma GFAP was determined in a prospective multicenter approach. METHODS Within a 1-year recruitment period, patients suspected of having acute (symptom onset <4.5 h before admission) hemispheric stroke were prospectively included into the study in 14 stroke centers in Germany and Switzerland. A blood sample was collected at admission, and plasma GFAP was measured by use of an electrochemiluminometric immunoassay. The final diagnosis, established at hospital discharge, was classified as ICH, ischemic stroke, or stroke mimic. RESULTS The study included 205 patients (39 ICH, 163 ischemic stroke, 3 stroke mimic). GFAP concentrations were increased in patients with ICH compared with patients with ischemic stroke [median (interquartile range) 1.91 μg/L (0.41–17.66) vs 0.08 μg/L (0.02–0.14), P < 0.001]. Diagnostic accuracy of GFAP for differentiating ICH from ischemic stroke and stroke mimic was high [area under the curve 0.915 (95% CI 0.847–0.982), P < 0.001]. A GFAP cutoff of 0.29 μg/L provided diagnostic sensitivity of 84.2% and diagnostic specificity of 96.3% for differentiating ICH from ischemic stroke and stroke mimic. CONCLUSIONS Plasma GFAP analysis performed within 4.5 h of symptom onset can differentiate ICH and ischemic stroke. Studies are needed to evaluate a GFAP point-of-care system that may help optimize the prehospital triage and management of patients with symptoms of acute stroke.

scholarly journals Plasmatic retinol-binding protein 4 and glial fibrillary acidic protein as biomarkers to differentiate ischemic stroke and intracerebral hemorrhage

2015 ◽  
Vol 136 (2) ◽  
pp. 416-424 ◽  
Author(s):  
Víctor Llombart ◽  
Teresa García-Berrocoso ◽  
Alejandro Bustamante ◽  
Dolors Giralt ◽  
David Rodriguez-Luna ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glial Fibrillary Acidic Protein ◽  
Intracerebral Hemorrhage ◽  
Binding Protein ◽  
Acidic Protein ◽  
Retinol Binding Protein ◽  
Retinol Binding Protein 4

Glial fibrillary acidic protein for the early diagnosis of intracerebral hemorrhage: Systematic review and meta-analysis of diagnostic test accuracy

2018 ◽  
Vol 14 (4) ◽  
pp. 390-399 ◽  
Author(s):  
Luke A Perry ◽  
Tom Lucarelli ◽  
Jahan C Penny-Dimri ◽  
Matthew DF McInnes ◽  
Stefania Mondello ◽  
...  
Keyword(s):  
Glial Fibrillary Acidic Protein ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Symptom Onset ◽  
Hospital Setting ◽  
Acidic Protein ◽  
Test Accuracy ◽  
Primary Analysis ◽  
Significant Difference ◽  
Study Heterogeneity

Background and aims Glial fibrillary acidic protein (GFAP) has shown promise in several studies for its ability to diagnose intracerebral hemorrhage (ICH). We evaluated the diagnostic accuracy of blood GFAP level to differentiate (ICH) from acute ischemic stroke (AIS) and stroke mimics, both overall, and in the first three hours after symptom onset. Methods We searched multiple databases, without language restriction, from inception until December 2017. Hierarchical summary receiver operating characteristic (HSROC) modeling was used to meta-analyze results. We conducted subgroup analyses restricted to blood samples collected within 0–60, 60–120, and 120–180 min time groups after symptom onset, to evaluate diagnostic accuracy in the early pre-hospital phase. Between and within study heterogeneity was explored using meta-regression. Results The search identified 199 potentially relevant citations from which 11 studies involving 1297 participants (350 ICH, 947 AIS, or mimic) were included. The pooled sensitivity, specificity, and area under the HSROC curve were 0.756 (95% CI 0.630–0.849), 0.945 (95% CI 0.858–0.980), and 0.904 (95% CI 0.878–0.931), respectively. Differences in assays used, but not the other covariates, partially explained between-study heterogeneity ( p = 0.034). The summary estimates for the 0–60, 60–120, and 120–180 min subgroups were comparable to the primary analysis and there was no statistically significant difference in diagnostic accuracy between subgroups. Conclusions GFAP is a promising diagnostic biomarker for ICH diagnosis in the early pre-hospital phase. Test accuracy is affected by assay subtype, but there are still unexplained sources of heterogeneity. High quality, international multi-center trials are warranted to develop and validate a point-of-care GFAP assay for the rapid triage and evaluation of acute stroke in the pre-hospital setting.

Glial Fibrillary Acidic Protein Serum Levels Distinguish between Intracerebral Hemorrhage and Cerebral Ischemia in the Early Phase of Stroke

2017 ◽  
Vol 63 (1) ◽  
pp. 377-385 ◽  
Author(s):  
Sebastian Luger ◽  
Jens Witsch ◽  
Andreas Dietz ◽  
Gerhard F Hamann ◽  
Jens Minnerup ◽  
...  
Keyword(s):  
Glial Fibrillary Acidic Protein ◽  
Intracerebral Hemorrhage ◽  
Symptom Onset ◽  
Area Under The Curve ◽  
Quantitative Relationship ◽  
Final Diagnosis ◽  
Acidic Protein ◽  
Serum Concentrations ◽  
Tissue Destruction ◽  
Stroke Mimics

Abstract BACKGROUND Recent studies have suggested that glial fibrillary acidic protein (GFAP) serum concentrations distinguish between intracerebral hemorrhage (ICH) and ischemic stroke (IS) shortly after symptom onset. In this prospective multicenter trial we validated GFAP in an independent patient cohort and assessed the quantitative relationship between GFAP release, bleeding size, and localization. METHODS We included patients with a persistent neurological deficit (NIH Stroke Scale ≥4) suggestive of stroke within 6 h of symptom onset. Blood samples were drawn at hospital admission. GFAP serum concentrations were measured using an electrochemiluminometric immunoassay. Primary endpoint was the final diagnosis established at hospital discharge (ICH, IS, or stroke mimic). RESULTS 202 patients were included (45 with ICH, 146 with IS, 11 stroke mimics). GFAP concentrations were significantly higher in ICH than in IS patients [median (interquartile range) 0.16 μg/L (0.04–3.27) vs 0.01 μg/L (0.01–0.01), P <0.001]. A GFAP cutoff of 0.03 μg/L provided a sensitivity of 77.8% and a specificity of 94.2% in distinguishing ICH from IS and stroke mimics [ROC analysis area under the curve 0.872 (95% CI, 0.802–0.942), P <0.001]. GFAP serum concentrations were positively correlated with ICH volume. Lobar ICH volumes were larger and thus associated with higher GFAP concentrations as compared to deep ICH. CONCLUSIONS Serum GFAP was confirmed to be a biomarker indicating ICH in patients presenting with acute stroke symptoms. Very small ICH may be missed owing to less tissue destruction.

scholarly journals Serum glial fibrillary acidic protein and S100 calcium-binding protein B correlates cerebral vessel reactivity following carotid artery stenting

2021 ◽  
Author(s):  
Xiaofan Yuan ◽  
Lei Guo ◽  
Jianhong Wang ◽  
Duozi Wang ◽  
Shu Yang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Glial Fibrillary Acidic Protein ◽  
Calcium Binding ◽  
Carotid Artery Stenting ◽  
Acidic Protein ◽  
Serum Concentrations ◽  
Mean Flow ◽  
Cerebral Vessel ◽  
Post Operation

Abstract Using detection markers in serum has the advantages of simplicity, repeatability and the capability. This study combined the use of serum glial fibrillary acidic protein (GFAP) and S100B protein (S100B) with imaging tools to confirm the role of serum biomarkers in evaluating the cerebral vessel reactivity after carotid artery stenting (CAS). After CAS, the serum concentrations of GFAP and S100B increased to the peak at 24 hours after operation, and then gradually decreased. The mean flow velocity (MFV) (pre-operation, post-operation, 30 days follow-up: 47.65 ± 17.24 cm/s, 62.37 ± 18.25 cm/s, 70.29 ± 16.89 cm/s; P < 0.05) and pulsatility index (PI) (pre-operation, post-operation, 30 days follow-up: 0.78 ± 0.21, 0.98 ± 0.19, 1.02 ± 0.20; P < 0.05) increased significantly in the ipsilateral middle cerebral artery after CAS. At the 30-day follow-up, the cerebrovascular reserve (CVR) (post-operation, 30 days follow-up: 27.47 ± 12.13 cm/s, 31.92 ± 10.94 cm/s; P < 0.05) improved significantly. In patients with different degrees of stenosis, the more severe the stenosis in the carotid artery, the more obvious the improvement of CVR at the 30 days of follow-up (CVR changes: 11.08 ± 7.95 cm/s, Kendall’s tau-b = 0.645, P < 0.001). And the serum concentrations of GFAP (r = – 0.629, P < 0.0001) and S100B (r = − 0.604, P < 0.0001) correlated negatively with CVR at 30 days after CAS. Therefore, we recommend using the biomarkers GFAP and S100B associated with imaging tools such as transcranial Doppler (TCD) and Magnetic resonance imaging (MRI) to evaluate the cerebral vessel reactivity following CAS.

scholarly journals Age-Related Differences in Diagnostic Accuracy of Plasma Glial Fibrillary Acidic Protein and Tau for Identifying Acute Intracranial Trauma on Computed Tomography: A TRACK-TBI Study

2018 ◽  
Vol 35 (20) ◽  
pp. 2341-2350 ◽  
Author(s):  
Raquel C. Gardner ◽  
Richard Rubenstein ◽  
Kevin K. W. Wang ◽  
Frederick K. Korley ◽  
John K. Yue ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Glial Fibrillary Acidic Protein ◽  
Diagnostic Accuracy ◽  
Acidic Protein ◽  
Age Related
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