Diagnostic Accuracy of Plasma Glial Fibrillary Acidic Protein for Differentiating Intracerebral Hemorrhage and Cerebral Ischemia in Patients with Symptoms of Acute Stroke

被引:143
作者
Foerch, Christian [1 ]
Niessner, Marion [2 ]
Back, Tobias [3 ]
Bauerle, Michael [4 ]
De Marchis, Gian Marco [5 ]
Ferbert, Andreas [6 ]
Grehl, Holger [7 ]
Hamann, Gerhard F. [8 ]
Jacobs, Andreas [9 ]
Kastrup, Andreas [10 ]
Klimpe, Sven [11 ]
Palm, Frederick [12 ]
Thomalla, Goetz [13 ]
Worthmann, Hans [14 ]
Sitzer, Matthias [1 ,15 ]
机构
[1] Goethe Univ Frankfurt, Dept Neurol, D-60528 Frankfurt, Germany
[2] Roche Diagnost, Penzberg, Germany
[3] Sachs Krankenhaus Arnsdorf, Dept Neurol, Arnsdorf, Germany
[4] Klinikum Emden, Dept Neurol, Emden, Germany
[5] Univ Bern, Inselspital, Dept Neurol, CH-3010 Bern, Switzerland
[6] Klinikum Kassel, Dept Neurol, Kassel, Germany
[7] Evangel & Johanniter Klinikum, Dept Neurol, Duisburg, Germany
[8] Horst Schmidt Kliniken, Dept Neurol, Wiesbaden, Germany
[9] Klinikum Fulda, Dept Neurol, Fulda, Germany
[10] Klinikum Bremen Mitte, Dept Neurol, Bremen, Germany
[11] Johannes Gutenberg Univ Mainz, Dept Neurol, Mainz, Germany
[12] Klinikum Stadt Ludwigshafen, Dept Neurol, D-6700 Ludwigshafen, Germany
[13] Univ Klinikum Hamburg Eppendorf, Dept Neurol, Hamburg, Germany
[14] Hannover Med Sch, Dept Neurol, D-30623 Hannover, Germany
[15] Klinikum Herford, Dept Neurol, Herford, Germany
关键词
QUALITY-OF-CARE; BLOOD-PRESSURE; SURROGATE MARKER; ARTERY OCCLUSION; S100B LEVEL; SERUM; INFARCTION; THROMBOLYSIS; BIOMARKERS; GUIDELINES;
D O I
10.1373/clinchem.2011.172676
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
BACKGROUND: Glial fibrillary acidic protein (GFAP) is a biomarker candidate indicative of intracerebral hemorrhage (ICH) in patients with symptoms of acute stroke. GFAP is released rapidly in the presence of expanding intracerebral bleeding, whereas a more gradual release occurs in ischemic stroke. In this study the diagnostic accuracy of plasma GFAP was determined in a prospective multicenter approach. METHODS: Within a 1-year recruitment period, patients suspected of having acute (symptom onset < 4.5 h before admission) hemispheric stroke were prospectively included into the study in 14 stroke centers in Germany and Switzerland. A blood sample was collected at admission, and plasma GFAP was measured by use of an electrochemiluminometric immunoassay. The final diagnosis, established at hospital discharge, was classified as ICH, ischemic stroke, or stroke mimic. RESULTS: The study included 205 patients (39 ICH, 163 ischemic stroke, 3 stroke mimic). GFAP concentrations were increased in patients with ICH compared with patients with ischemic stroke [median (interquartile range) 1.91 mu g/L (0.41-17.66) vs 0.08 mu g/L (0.02-0.14), P < 0.001]. Diagnostic accuracy of GFAP for differentiating ICH from ischemic stroke and stroke mimic was high [area under the curve 0.915 (95% CI 0.847-0.982), P < 0.001]. A GFAP cutoff of 0.29 mu g/L provided diagnostic sensitivity of 84.2% and diagnostic specificity of 96.3% for differentiating ICH from ischemic stroke and stroke mimic. CONCLUSIONS: Plasma GFAP analysis performed within 4.5 h of symptom onset can differentiate ICH and ischemic stroke. Studies are needed to evaluate a GFAP point-of-care system that may help optimize the prehospital triage and management of patients with symptoms of acute stroke. (C) 2011 American Association for Clinical Chemistry
引用
收藏
页码:237 / 245
页数:9
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