Discriminative value of glial fibrillar acidic protein (GFAP) as a diagnostic tool in acute stroke. Individual patient data meta-analysis

Glial fibrillar acidic protein (GFAP) in serum has been evaluated as a promising biomarker to differentiate between intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS). We assessed its value as diagnostic and prognostic tool for ICH through a literature systematic review and individual patient data (IPD) meta-analysis.We performed a systematic search in PubMed database until November 2018 for publications that evaluated GFAP to differentiate AIS and ICH within 4.5 hours after symptoms onset. Thereafter, we invited authors of selected studies to participate in this work by providing IPD from their cohorts. We used standardized individual subject’s data to evaluate the association of GFAP concentrations with stroke subtype, demographics, stroke characteristics and factors related with GFAP measurement.From 4 selected studies, we collected data of 340 patients (236 AIS and 104 ICH). Standardized GFAP blood levels were significantly elevated in ICH compared with those with AIS (median and IQR: 0.84 (0.781–1.24), 0.79 (0.74–0.81); p<0.0001). In both stroke types, GFAP concentrations correlated with baseline stroke severity (r=0.27, p<0.0001; r=0.36, p<0.001; for AIS and ICH, respectively) but no correlation was found regarding time to sampling. Limited data precluded the evaluation of GFAP levels and functional outcome.These findings demonstrate substantially different levels of GFAP in the blood of patients with ICH compared with patients with AIS soon after the event, while no association was found with outcome. In summary, GFAP could be a valuable diagnostic tool to assist in medical decision-making and to optimize management of stroke in the acute setting.

Download Full-text

Faculty Opinions recommendation of Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718525168.793499033 ◽

2014 ◽

Author(s):

Eivind Berge

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Individual Patient Data ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Treatment Delay ◽

Patient Data ◽

Stroke Severity ◽

Randomised Trials ◽

Effect Of Treatment

Download Full-text

Effect of Treatment Delay, Age, and Stroke Severity on the Effects of Intravenous Thrombolysis with Alteplase for Acute Ischaemic Stroke: A Meta-analysis of Individual Patient Data from Randomized Trials

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2015.03.037 ◽

2015 ◽

Vol 48 (5) ◽

pp. 650

Author(s):

Graham Ingalsbe

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Randomized Trials ◽

Individual Patient Data ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Treatment Delay ◽

Patient Data ◽

Stroke Severity ◽

Effect Of Treatment

Download Full-text

Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

The Lancet ◽

10.1016/s0140-6736(14)60584-5 ◽

2014 ◽

Vol 384 (9958) ◽

pp. 1929-1935 ◽

Cited By ~ 1020

Author(s):

Jonathan Emberson ◽

Kennedy R Lees ◽

Patrick Lyden ◽

Lisa Blackwell ◽

Gregory Albers ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Individual Patient Data ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Treatment Delay ◽

Patient Data ◽

Stroke Severity ◽

Randomised Trials ◽

Effect Of Treatment

Download Full-text

Abstract TMP40: Pharyngeal Electrical Stimulation for Early Decannulation in Tracheotomised Stroke Patients With Dysphagia: A Meta-analysis of Individual Patient Data From Randomised Controlled Trials

Stroke ◽

10.1161/str.51.suppl_1.tmp40 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Philip M Bath ◽

Lisa J Woodhouse ◽

Sonja Suntrup-Krueger ◽

Shaheen Hamdy ◽

Rainer Dziewas

Keyword(s):

Electrical Stimulation ◽

Randomised Controlled Trials ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Hospital Length Of Stay ◽

Controlled Trials ◽

Stroke Severity ◽

Stroke Patients ◽

Randomised Controlled

Background: Dysphagia is common after stroke and associated with a poor outcome. Pharyngeal electrical stimulation (PES) increased decannulation rates in tracheotomised stroke patients with dysphagia following ventilation in two trials. We report the results of an individual patient data meta-analysis assessing PES in severely dysphagic tracheotomised stroke patients. Methods: We searched for randomised controlled trials of PES in dysphagic tracheotomised stroke patients and obtained individual patient data for demographic and clinical (stroke severity, NIHSS; functional oral intake scale, FOIS; decannulation) variables from trialists. Data are number (%), median [interquartile range], mean (standard deviation) and mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CI). Results: Two completed trials were identified (n=30, PHAST-TRAC n=69 [funded by Phagenesis Ltd]), with data for 99 participants (PES 55, 56%; sham 44, 44%). Mean age 64 (13) years, female 40 (40%), NIHSS 18 [14-21], time from onset to randomisation 27 days [20-38], and FOIS=1 (nil by mouth). As compared with sham, PES was associated with an increased proportion of patients who were ready for early decannulation, 59% versus 11% (OR 11.4, 95% CI 3.86-33.33; p<0.001) and improved FOIS score at discharge (MD 1.13, 95% CI 0.25-2.00; p=0.011). Treated participants who were ready for decannulation tended to have a shorter hospital length of stay: 23 vs 41 days (p=0.070) than those who were not ready. No device-related serious adverse events were reported. Conclusions: PES was associated with an increased proportion of stroke patients who were ready for decannulation and less dysphagia, in two randomised trials.

Download Full-text