Serum glial fibrillary acidic protein as a biomarker for differentiating intracerebral hemorrhage and ischemic stroke in patients with symptoms of acute stroke: a systematic review and meta-analysis

Serum glial fibrillary acidic protein (GFAP) has been reported to have high diagnosis accuracy for differentiating intracerebral hemorrhage (ICH) from ischemic stroke (IS) in patients within acute phase of stroke symptom onset. Our purpose was to perform a systematic review and diagnostic meta-analysis to evaluate the valuation of serum GFAP in the early identification of ICH and IS. We searched MEDLINE, EMBASE and other electronic databases for diagnostic accuracy studies that compared serum GFAP with standard clinical diagnosis of ICH and IS in patients with symptoms of acute stroke. All publication years were included through to April 2013. The sensitivity (SEN), specificity (SPE), and positive and negative likelihood ratios (PLR and NLR, respectively) of serum GFAP for differentiating ICH and IS were pooled using a bivariate meta-analysis. Summary receiver operating characteristic curves were used to summarize overall test performance. A total of five trials met our inclusion criteria. The summarized estimates of serum GFAP for the differentiation of ICH and IS within 24 h of symptom onset were as follows: SEN, 81.1 % (95 % CI, 72.6–87.5 %); SPE, 95.2 % (95 % CI 82.1–98.9 %); PLR, 16.945 (95 % CI 4.173–68.803); NLR, 0.198 (95 % CI 0.133–0.296), significant heterogeneity was present. The four summary estimates of serum GFAP for patients within 1–6 h of symptom onset were 81.1 % (95 % CI 72.5–88.0 %), 97.0 % (95 % CI 94.3–98.4 %), 26.786 (95 % CI 13.979–51.324), 0.191 (95 % CI 0.126–0.291), respectively, with no obvious heterogeneity. Serum GFAP is a sensitive and specific test for differentiating ICH and IS in patients within 1–6 h of acute stroke symptom onset.