Kalra Love-Preet, Khatter Himani, Ramanathan Sarvotham, Sapehia Sameer, Devi Kavita, Kaliyaperumal Abirami, Bal Deepti, Sebastian Ivy, Kakarla Raviteja, Singhania Anusha, Rathore Shubhra, Klinsing Svenja, Pandian Jeyaraj Durai, Foerch Christian
Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
Department of Neurology, Christian Medical College, Ludhiana, Punjab, India.
Eur Stroke J. 2021 Jun;6(2):176-184. doi: 10.1177/23969873211010069. Epub 2021 May 11.
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.
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.
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%).
The high negative predictive value of a GFAP test system allows ruling out patients with intracranial hemorrhage.
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.
尽管中风负担沉重，但在许多中低收入国家，快速脑部成像的可及性有限。先前的研究已将星形胶质细胞蛋白GFAP（胶质纤维酸性蛋白）描述为脑出血的生物标志物。本研究的目的是在前瞻性队列的印度中风患者中测试GFAP排除颅内出血的诊断准确性。
本研究在印度一家三级医院（卢迪亚纳基督教医学院）进行。纳入症状发作后12小时内入院、有急性中风症状的患者。入院时采集血样。采用单分子阵列技术测定血清GFAP浓度。
共纳入155例患者（70例颅内出血、75例缺血性中风、10例类中风）。与缺血性中风患者相比，颅内出血患者的GFAP血清浓度升高[中位数（四分位间距）2.36µg/L（0.61 - 7.16） vs. 0.18µg/L（0.11 - 0.38），p < 0.001]。类中风患者的GFAP血清中位水平为0.14µg/L（0.09 - 0.26）。GFAP值低于0.33µg/L的临界值（曲线下面积0.871）排除颅内出血的阴性预测值为89.7%，（检测颅内出血的敏感性为90.0%）。
GFAP检测系统的高阴性预测值可排除颅内出血患者。
在无法立即进行脑部成像的情况下，这将有助于尽快对疑似缺血性中风患者实施二级预防（如阿司匹林）。
