Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Neurol Sci. 2022 Oct;43(10):6011-6019. doi: 10.1007/s10072-022-06274-7. Epub 2022 Jul 27.
Intracerebral and subarachnoid hemorrhage are critical conditions with a high mortality, and the outcome for the individual patient is notoriously difficult to predict. Biomarkers that reflect disease severity and predict outcome are therefore warranted.
Blood samples from 40 patients with intracerebral, 46 patients with subarachnoid hemorrhage, and 70 healthy individuals were collected. Levels of glial fibrillary acidic protein (GFAP) and neuroglobin were measured by ultra-sensitive single molecule array and enzyme-linked immunosorbent assay, respectively. Clinical information including mortality and functional outcome was recorded.
Blood levels of GFAP and neuroglobin in intracerebral and subarachnoid hemorrhage patients were significantly elevated when compared to healthy individuals (all p < 0.0001). GFAP levels were significantly higher in patients dying or with poor functional outcome than in healthy individuals (all p ≤ 0.01). GFAP levels separated survivors from non-survivors with an area under receiver operating characteristics (AUROC) = 0.78 (confidence interval (CI) 0.59-0.98) for intracerebral hemorrhage and 0.82 (CI 0.69-0.94) for subarachnoid hemorrhage patients. The Akaike and Bayesian information criteria (AIC/BIC) for mortality/poor outcome prediction improved when combining GFAP levels with hematoma volume (p = 0.04/p < 0.01), National Institutes of Health Stroke Scale (NIHSS) (p = 0.09/p < 0.01), Hunt-Hess (p < 0.05/p = 0.21), or Fischer score (p < 0.05/p = 0.02).
Elevated GFAP levels at admission to hospital predicted mortality and poor outcome in our cohort of intracerebral and subarachnoid hemorrhage patients. Neuroglobin levels did not provide additional information. Combining GFAP measurements with clinical disease severity scores increased outcome prediction precision. This may suggest that GFAP measurement could improve prognostication in patients with intracerebral or subarachnoid hemorrhage.
This sub-trial was not registered.
脑出血和蛛网膜下腔出血是两种死亡率极高的危急重症，个体患者的预后极难预测。因此，有必要寻找能够反映疾病严重程度并预测预后的生物标志物。
收集 40 例脑出血患者、46 例蛛网膜下腔出血患者和 70 例健康个体的血液样本。分别采用超敏单分子阵列和酶联免疫吸附试验测定胶质纤维酸性蛋白（GFAP）和神经球蛋白的水平。记录包括死亡率和功能结局在内的临床信息。
与健康个体相比，脑出血和蛛网膜下腔出血患者的血液 GFAP 和神经球蛋白水平均显著升高（均 p<0.0001）。死亡或功能结局不良的患者的 GFAP 水平明显高于健康个体（均 p≤0.01）。GFAP 水平可以将幸存者与非幸存者区分开来，ROC 曲线下面积（AUROC）分别为 0.78（0.59-0.98）的脑出血患者和 0.82（0.69-0.94）的蛛网膜下腔出血患者。当将 GFAP 水平与血肿量（p=0.04/p<0.01）、NIHSS 评分（p=0.09/p<0.01）、Hunt-Hess 分级（p<0.05/p=0.21）或 Fischer 评分（p<0.05/p=0.02）相结合时，对死亡率/不良结局的预测，AIC/BIC 均得到改善。
入院时 GFAP 水平升高可预测脑出血和蛛网膜下腔出血患者的死亡率和不良结局。神经球蛋白水平未提供额外信息。将 GFAP 测量值与临床疾病严重程度评分相结合可提高预后预测精度。这可能表明 GFAP 测量可改善脑出血或蛛网膜下腔出血患者的预后。
本亚试验未注册。
