Details

Autor(en) / Beteiligte

• Luger, Sebastian
• Jæger, Henriette S.
• Dixon, Joanna
• Bohmann, Ferdinand O.
• Schaefer, JanHendrik
• Richieri, Steven P.
• Larsen, Karianne
• Hov, Maren R.
• Bache, Kristi G.
• Foerch, Christian

Titel

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

Ist Teil von

• Neurocritical care, 2020-08, Vol.33 (1), p.39-48

Ort / Verlag

New York: Springer US

Erscheinungsjahr

2020

Quelle

SpringerLink

Beschreibungen/Notizen

• Background Biomarkers indicative of intracerebral hemorrhage (ICH) may help triage acute stroke patients in the pre-hospital phase. We hypothesized that serum concentration of glial fibrillary acidic protein (GFAP) in combination with ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), measured by a rapid bio-assay, could be used to distinguish ICH from ischemic stroke. Methods This prospective two-center study recruited patients with a clinical diagnosis of acute stroke both in the pre-hospital phase and at hospital admission (within 4 and 6 h after symptom onset, respectively). Blood samples were analyzed for concentrations of GFAP and UCH-L1 using ELISA techniques. The reference standard was the diagnosis of ICH, ischemic stroke, or stroke mimicking condition achieved after clinical workup including brain imaging. Results A total of 251 patients were included (mean age [± SD] 72 ± 15 years; 5 ICH, 23 ischemic strokes and 14 stroke mimics in the pre-hospital part; and 59 ICH, 148 ischemic strokes and 2 stroke mimics in the in-hospital part). Mean delay (± SD) from symptom onset to blood withdrawal was 130 ± 79 min for the pre-hospital patients and 136 ± 86 min for the in-hospital patients. Both GFAP and UCH-L1 serum concentrations were higher in patients having ICH as compared to other diagnoses (GFAP: median 330 ng/L [interquartile range 64–7060, range 8–56,100] vs. 27.5 ng/L [14–57.25, 0–781], p  < 0.001; UCH-L1: 401 ng/L [265–764, 133–1812] vs. 338 ng/L [213–549.5, 0–2950], p  = 0.025). Area-under-the-curve values were 0.866 (95% CI 0.809–0.924, p  < 0.001) for GFAP, and 0.590 (0.511–0.670, p  = 0.033) for UCH-L1. Regarding overall diagnostic accuracy, UCH-L1 did not add significantly to the performance of GFAP. Conclusions GFAP may differentiate ICH from ischemic stroke and stroke mimics. A point-of-care test to distinguish between ischemic and hemorrhagic strokes might facilitate triage to different treatment pathways or locations, or be used to select patients for trials of ultra-early interventions.