High serum glial fibrillary acidic protein levels are associated with increased risk of post-stroke cognitive impairment

Background and purpose: The correlation between glial fibrillary acidic protein (GFAP) and cognitive impairment in acute ischemic stroke patients remains uncertain. We aimed to evaluate GFAP in serum as predictor of post-stroke cognitive impairment (PSCI) at 90 days. Methods: From March 2022 to February 2023, patients with first-ever ischemic stroke were prospectively enrolled. Serum GFAP concentrations were measured within 24 h after admission using an enzyme-linked immunosorbent assay. Cognitive function measurement was performed at the 90 days follow-up using the Mini-mental state examination (MMSE). A MMSE score <27 was defined as PSCI. Multiple logistic regression and restricted cubic spline were performed to examine the association between GFAP and cognitive impairment. Results: A total of 336 patients (mean age: 66.3 +/- 9.0 years; 58.3% male) with acute ischemic stroke were included. The median GFAP levels were 0.73 ng/mL (interquartile range, 0.38-1.09 ng/mL). During the 3-month follow-up, 164 participants (48.8%) experienced PSCI. Higher GFAP levels were independently associated with PSCI after adjusting for potential confounders (per 1-unit increase, odds ratio: 3.91; 95% confidence interval: 2.24-6.82; p = 0.001). Additionally, restricted cubic spline confirmed a linear relationship between serum GFAP concentrations and PSCI risk (P for linearity = 0.001). Conclusion: This study demonstrated that higher levels of GFAP were associated with PSCI, suggesting that GFAP could be a promising and straightforward screening indicator of cognitive impairment after stroke.