Liu G, Geng J
Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China.
Hum Exp Toxicol. 2018 Oct;37(10):1048-1053. doi: 10.1177/0960327117751236. Epub 2018 Jan 8.
We investigated the association between serum levels of glial fibrillary acidic protein (GFAP) and stroke functional outcomes in a cohort of 286 patients with acute ischemic stroke (AIS).
We prospectively studied 286 patients with AIS who were admitted within 24 h after the onset of symptoms. Serum levels of GFAP and National Institutes of Health Stroke Scale (NIHSS) were measured at admission. The primary end point was stroke functional outcome among 1-year after stroke onset. We used logistic regression models to assess the relationship between GFAP levels and stroke outcomes.
The GFAP level was obtained with a median value of 0.18 (interquartile ranges (IQRs): 0.09-0.28) ng/ml. In multivariable models adjusted for age, gender, and other risk factors, GFAP levels were associated with an increased risk of a NIHSS>6 (odds ratio (OR) = 1.55; 95% confidence interval (CI): 1.16-1.89; p = 0.012). The poor outcome distribution across the GFAP quartiles ranged between 12.7% (first quartile) and 70.4% (fourth quartile). After adjusting for other established risk factors, in multivariate models comparing the Q3 and Q 4 quartiles against the Q1 of the GFAP, the levels of GFAP were associated with poor outcome, and the adjusted risk of poor outcome increased by 211% (3.11[1.80-5.05], p < 0.001) and 522% (6.22[2.98-11.83], p < 0.001), respectively. Interestingly, GFAP improved the ability of NIHSS score to diagnose poor outcomes (area under the curve [AUC] of the combined model 0.82; 95% CI: 0.77-0.88; p = 0.02).
GFAP levels are a novel and complementary biomarker to predict functional outcome 1 year after AIS.
我们在286例急性缺血性卒中（AIS）患者队列中研究了血清胶质纤维酸性蛋白（GFAP）水平与卒中功能结局之间的关联。
我们前瞻性地研究了286例症状发作后24小时内入院的AIS患者。入院时测量血清GFAP水平和美国国立卫生研究院卒中量表（NIHSS）。主要终点是卒中发作后1年内的卒中功能结局。我们使用逻辑回归模型评估GFAP水平与卒中结局之间的关系。
GFAP水平的中位数为0.18（四分位间距（IQR）：0.09 - 0.28）ng/ml。在根据年龄、性别和其他风险因素进行调整的多变量模型中，GFAP水平与NIHSS>6的风险增加相关（比值比（OR）= 1.55；95%置信区间（CI）：1.16 - 1.89；p = 0.012）。GFAP四分位数间不良结局分布在12.7%（第一四分位数）至70.4%（第四四分位数）之间。在调整其他既定风险因素后，在多变量模型中，将GFAP的Q3和Q4四分位数与Q1进行比较，GFAP水平与不良结局相关，调整后的不良结局风险分别增加211%（3.11[1.80 - 5.05]，p < 0.001）和522%（6.22[2.98 - 11.83]，p < 0.001）。有趣的是，GFAP提高了NIHSS评分诊断不良结局的能力（联合模型的曲线下面积[AUC]为0.82；95%CI：0.77 - 0.88；p = 0.02）。
GFAP水平是预测AIS后1年功能结局的一种新的补充生物标志物。
