1. Diagnostic accuracy of plasma glial fibrillary acidic protein for differentiating intracerebral hemorrhage and cerebral ischemia in patients with symptoms of acute stroke
- Author
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Christian, Foerch, Marion, Niessner, Tobias, Back, Michael, Bauerle, Gian Marco, De Marchis, Andreas, Ferbert, Holger, Grehl, Gerhard F, Hamann, Andreas, Jacobs, Andreas, Kastrup, Sven, Klimpe, Frederick, Palm, Götz, Thomalla, Hans, Worthmann, Matthias, Sitzer, and Helmuth, Steinmetz
- Subjects
Adult ,Male ,medicine.medical_specialty ,Clinical Biochemistry ,Ischemia ,Brain Ischemia ,Diagnosis, Differential ,Interquartile range ,Internal medicine ,Glial Fibrillary Acidic Protein ,medicine ,Humans ,In patient ,cardiovascular diseases ,Prospective Studies ,Prospective cohort study ,Stroke ,Aged ,Cerebral Hemorrhage ,Intracerebral hemorrhage ,Immunoassay ,Autoanalysis ,Glial fibrillary acidic protein ,biology ,business.industry ,Biochemistry (medical) ,Electrochemical Techniques ,Middle Aged ,medicine.disease ,Surgery ,Acute Disease ,Luminescent Measurements ,Cardiology ,biology.protein ,Biomarker (medicine) ,Female ,business ,Biomarkers - 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 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.
- Published
- 2011