Serum GFAP for stroke diagnosis in regions with limited access to brain imaging (BE FAST India)

Abstract

Introduction Despite a high burden of stroke, access to rapid brain imaging is limited in many middle- and low-income countries. Previous studies have described the astroglial protein GFAP (glial fibrillary acidic protein) as a biomarker of intracerebral hemorrhage. The aim of this study was to test the diagnostic accuracy of GFAP for ruling out intracranial hemorrhage in a prospective cohort of Indian stroke patients. Patients and methods This study was conducted in an Indian tertiary hospital (Christian Medical College, Ludhiana). Patients with symptoms suggestive of acute stroke admitted within 12 h of symptom onset were enrolled. Blood samples were collected at hospital admission. Single Molecule Array technology was used for determining serum GFAP concentrations. Results A total number of 155 patients were included (70 intracranial hemorrhage, 75 ischemic stroke, 10 stroke mimics). GFAP serum concentrations were elevated in intracranial hemorrhage patients compared to ischemic stroke patients [median (interquartile range) 2.36 µg/L (0.61–7.16) vs. 0.18 µg/L (0.11–0.38), p < 0.001]. Stroke mimics patients had a median GFAP serum level of 0.14 µg/L (0.09–0.26). GFAP values below the cut-off of 0.33 µg/L (area under the curve 0.871) ruled out intracranial hemorrhage with a negative predictive value of 89.7%, (at a sensitivity for detecting intracranial hemorrhage of 90.0%). Discussion The high negative predictive value of a GFAP test system allows ruling out patients with intracranial hemorrhage. Conclusion In settings where immediate brain imaging is not available, this would enable to implement secondary prevention (e.g., aspirin) in suspected ischemic stroke patients as soon as possible.

Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

“…Recent studies have highlighted the potential of blood-derived parameters as biomarkers for timely patient triage, therapeutics, and stroke mechanisms [ 30 , 31 , 32 ]. Easily accessible fluid biomarkers can provide an objective evaluation of the real-time panorama, supporting stroke diagnosis or predicting the patients’ outcome and ultimately guiding clinical decisions [ 20 , 32 , 33 , 34 , 35 ].…”

Serum glial fibrillary acidic protein is sensitive to acute but not chronic tissue damage in cerebral small vessel disease

“…Prior studies have also analyzed serum GFAP (sGFAP) in patients with acute stroke and consistently indicated that sGFAP, measured in the hyperacute phase, is substantially higher in intracerebral hemorrhage compared to ischemic stroke [ 3 – 5 ]. In addition, higher sGFAP levels on day one after the onset of ischemic stroke have been associated with worse functional neurological outcome at one year even after adjusting for age, initial clinical stroke severity and infarct size [ 6 ].…”

Glial Fibrillary Acidic Protein in Blood as a Disease Biomarker of Neuromyelitis Optica Spectrum Disorders

“…Blood GFAP levels increase not only in NMOSD but in various neurological diseases ( 109 ), thus the specificity of GFAP as an NMOSD biomarker should be discussed. Blood GFAP levels in patients with NMOSD, which often increase more than 1,000 pg/mL during relapses, tend to be higher than in patients with other diseases such as relapsing remitting MS ( 59 , 60 , 77 ), progressive MS ( 59 – 61 ), and even ischemic stroke ( 62 ). This is because patients with NMOSD are accompanied by direct damage of astrocytes.…”