Assessment of Serum UCH-L1 and GFAP in Acute Stroke Patients

Ren, Chang­hong; Kobeissy, Firas; Alawieh, Ali; Li, Na; Li, Ning; Zibara, Kazem; Zoltewicz, Susie; Guingab‐Cagmat, Joy; Larner, Stephen F.; Ding, Yuchuan; Hayes, Ronald L.; Ji, Xunming; Mondello, Stefania

doi:10.1038/srep24588

Cited by 90 publications

(94 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the 2 biomarkers were taken at 12 h after stroke, which is clearly too late for making treatment decisions in the hyperacute phase. Ren et al [30] analysed UCH-L1 levels together with GFAP within 4.5 h of onset but could not find added discriminatory value of UCH-L1.…”

Section: Discussionmentioning

confidence: 99%

Glial Fibrillary Acidic Protein for Prehospital Diagnosis of Intracerebral Hemorrhage

Różański¹,

Waldschmidt

Kunz³

et al. 2016

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: Both, acute ischemic stroke (AIS) and hemorrhage stroke (intracerebral hemorrhage, ICH) require early attention but different treatment strategies. Plasma glial fibrillary acidic protein (GFAP) levels were found to be elevated in ICH patients after they arrived in the hospital. Because treatment options differed, we sought to determine whether GFAP can be used to accurately differentiate between of AIS and ICH in the prehospital setting. Methods: We assessed acute stroke patients in the Stroke Emergency Mobile (STEMO). STEMO is a stroke ambulance staffed by a specialized team including a neurologist and equipped with a computed tomography scanner plus a point-of-care laboratory. The STEMO ambulance is integrated in the emergency medical system of Berlin, Germany. Following prehospital stroke diagnosis, blood was drawn and subsequently analysed using research assays from Roche diagnostics. The clinical accuracy of plasma GFAP was tested using a cut-off value of 0.29 ng/ml. Results: Blood samples of 74 patients were analysed. Twenty-five patients had ICH (mean age 69 ± 11 years, median National Institutes of Health Stroke Scale (NIHSS) 15) and 49 IS (mean age 75 ± 10 years, median NIHSS 6). Nine ICH (0 IS patients) had GFAP-levels above 0.29 ng/ml. The sensitivity and specificity of GFAP for differentiating between ICH and AIS were 36.0 and 100%. The sensitivity for ICH volume >15 ml was 61.5%. ICH patients without GFAP elevation had significantly smaller hemorrhage volumes (median 4.5 vs. 37.6 ml, p = 0.004) and were less likely to deteriorate (19 vs. 56%, p = 0.087). Conclusions: GFAP levels >0.29 ng/ml were seen only in ICH, thus confirming the diagnosis of ICH during prehospital care. However, sensitivity is low particularly in smaller hemorrhages.

show abstract

Section: Discussionmentioning

confidence: 99%

Glial Fibrillary Acidic Protein for Prehospital Diagnosis of Intracerebral Hemorrhage

Różański¹,

Waldschmidt

Kunz³

et al. 2016

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…23 UCH-L1 is a soluble protein localized in the cell body of neurons in the central nervous system that has important roles in the regulation of synaptic plasticity and learning and memory. 24 Circulating UCH-L1 has been identified as a biomarker specific to neuronal injury 16,25 as it is released into the circulation when the integrity of the blood-brain barrier (BBB) is disrupted. 26,27 In a piglet model, serum UCH-L1 predicted neuronal apoptosis induced by deep hypothermic circulatory arrest.…”

Section: Baseline Characteristics Of the Study Patientsmentioning

confidence: 99%

“…12 Increasingly, UCH-L1 is recognized as a biomarker of brain injury. Circulating UCH-L1 levels are significantly increased after acute neurological insults such as traumatic brain injury, subarachnoid hemorrhage, ischemic stroke, hypoxic-ischemic encephalopathy, and cardiac arrest, [13][14][15][16][17][18] and altered UCH-L1 expression is an indicator of brain injury severity and a predictor of neurological outcomes. 17,19 To the authors' knowledge, no studies have investigated the utility of serum UCH-L1 level as a predictor of cognitive impairment after AOPP.…”

Section: Introductionmentioning

confidence: 99%

Serum ubiquitin C‐terminal hydrolase L1 predicts cognitive impairment in patients with acute organophosphorus pesticide poisoning

Pang

Liu

et al. 2019

Clinical Laboratory Analysis

View full text Add to dashboard Cite

BackgroundTo assess the usefulness of serum C‐terminal hydrolase L1 (UCH‐L1) level as a biomarker for predicting cognitive impairment in patients with acute organophosphorus pesticide poisoning (AOPP).MethodsTwo hundred and seven adult patients with AOPP were included in this study. Serum UCH‐L1 levels were assessed on admission (Day 1 postpoisoning) and on Days 3 and 7 postpoisoning. The associations between serum UCH‐L1 levels, other clinical predictors, and cognitive function evaluated on Day 30 postpoisoning were investigated.ResultsOn multivariate analysis, serum UCH‐L1 levels on admission (odds ratio [OR] 1.889, 95% confidence interval [CI] 1.609‐3.082, P = 0.002) and 24‐hour APACHE II score (OR 1.736, 95% CI 1.264‐3.272, P = 0.012) were independent predictors of cognitive impairment on Day 30 postpoisoning. Based on the receiver operating characteristic curve, serum UCH‐L1 levels >5.9 ng/mL on admission predicted cognitive impairment on Day 30 postpoisoning with 86.1% sensitivity and 72.5% specificity (area under the curve, 0.869; 95% CI 0.815‐0.923). On admission [8.51 (6.53‐10.22) ng/mL vs 4.25 (2.57‐6.31) ng/mL, P < 0.001] and Day 3 [9.31 (7.92‐10.98) ng/mL vs 3.32 (2.25‐5.13) ng/mL, P < 0.001] and Day 7 [4.96 (3.28‐7.26) ng/mL vs 2.27 (1.55‐3.24) ng/mL, P < 0.001] postpoisoning, serum UCH‐L1 concentration was significantly higher in patients that developed cognitive impairment compared to those that did not.ConclusionThis study demonstrates that serum UCH‐L1 level has potential as a novel biomarker for predicting cognitive impairment 30 days after AOPP.

show abstract

“…Out of these markers, glial fibrillary acidic protein (GFAP) is so far the most promising for translation into prehospital use. In several hospital cohorts in which samples were collected upon hospital arrival, GFAP has systematically demonstrated high sensitivity and specificity for diagnosing acute ICH [9][10][11]. For example, Foerch et al found sensitivity and specificity values of 84.2 and 96.3% respectively.…”

Section: Past Researchmentioning

confidence: 99%

How Development of Blood Biomarkers Could Benefit Prehospital Management of Acute Stroke

2017

View full text Add to dashboard Cite

Stroke is one of the leading causes of death worldwide and leaves most survivors with permanent disability [1,2]. Unfortunately, treatment options of acute stroke are still limited. In developed urban hospitals roughly a third of all ischemic stroke patients receive urgent recanalization therapy, in other words thrombolysis with recombinant tissue plasminogen activator (rtPA) and/or endovascular mechanical thrombectomy for large vessel occlusion (LVO). These treatments are highly efficacious and cost effective, but remain markedly underused [3]. Furthermore, their efficacy is time dependent, with strict therapeutic windows. To enhance the stroke chain of survival, current guidelines recommend a tiered system with acute stroke ready hospitals, primary stroke centers and comprehensive stroke centers to ensure timely initiation of intravenous rtPA with the least possible delay after symptom onset and rapid triage of large vessel occlusions eligible for thrombectomy in a comprehensive stroke center [3].The challenge of stroke diagnostics Time delay in the prehospital phase is the most important reason for missing recanalization therapy. Even for patients meeting the appropriate time window, the median prehospital delay is commonly around 2 h [4]. Emergency medical services (EMS) are challenged with the difficult task of identifying likely acute stroke from the wide range of acutely ill patients and ensuring rapid transport to the appropriate emergency department for immediate neurological examination and diagnostic brain imaging. For now, the main diagnostic groups causing acute strokelike symptoms, namely ischemic stroke, transient ischemic attack, hemorrhagic stroke and conditions mimicking stroke, can only be differentiated with hospital-based tests. EMS are therefore restricted to using simple, nonspecific clinical scales for stroke recognition, preventing them from initiating specific treatments.Mobile CT-equipped ambulances, directed by an onboard stroke neurologist or telemedicine consultation, are one active approach to front load diagnostic and therapeutic procedures and reduce treatment delays [5,6], but require significant resources and are only applicable in urban settings, missing rural areas with longer transportation distances. What is clearly missing is an easier surrogate marker for recognizing the condition of brain tissue (either biochemical or functional) while the described, tiered prehospital stroke management is being advanced. Such markers, including blood troponin measurement and ECG recording, are widely used in the prehospital management of acute myocardial infarction, but are still unavailable for stroke. Useful point-of-care (POC) blood tests would have the significant benefit of being relatively inexpensive and more easily applicable around the world.

show abstract

Assessment of Serum UCH-L1 and GFAP in Acute Stroke Patients

Cited by 90 publications

References 47 publications

Glial Fibrillary Acidic Protein for Prehospital Diagnosis of Intracerebral Hemorrhage

Glial Fibrillary Acidic Protein for Prehospital Diagnosis of Intracerebral Hemorrhage

Serum ubiquitin C‐terminal hydrolase L1 predicts cognitive impairment in patients with acute organophosphorus pesticide poisoning

How Development of Blood Biomarkers Could Benefit Prehospital Management of Acute Stroke

Contact Info

Product

Resources

About