ArticleNeurocritical care2020
Diagnostic Accuracy of Glial Fibrillary Acidic Protein and Ubiquitin Carboxy-Terminal Hydrolase-L1 Serum Concentrations for Differentiating Acute Intracerebral Hemorrhage from Ischemic Stroke.
Article in Neurocritical care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Blood-based protein biomarkers during the acute ischemic stroke treatment window: a systematic review.Frontiers in neurology · 2024Pooled it
- Trial
- Research Progress of Blood-Based Biomarkers for the Diagnosis and Prognostic Evaluation of Acute Ischemic Stroke.Biomolecules · 2026Review
- Prehospital intensive blood pressure management in intracerebral hemorrhage: current evidence, controversies, and future directions.Frontiers in medicine · 2026Review
- The use of brain-specific biomarkers in urine for prediction of neurological outcome and extent of tissue damage following stroke.Scientific reports · 2025Article
- Serum Biomarkers in Acute Ischemic Stroke: Clinical Applications and Emerging Insights.Journal of clinical medicine · 2025Review
- Performance of GFAP and UCH-L1 for Early Acute Stroke Diagnosis in the Emergency Department.Journal of clinical medicine · 2025Article
- Prediction of outcomes following intravenous thrombolysis in patients with acute ischemic stroke using serum UCH-L1, S100β, and NSE: a multicenter prospective cohort study employing machine learning methods.Therapeutic advances in neurological disorders · 2025Article
- Advances in the detection of biomarkers for ischemic stroke.Frontiers in neurology · 2025Review
- Perspective: Use of protein S100B as a quality assurance marker for endovascular therapy in acute ischemic stroke.Frontiers in neurology · 2025Article
- Article
- Intracerebral haemorrhage - mechanisms, diagnosis and prospects for treatment and prevention.Nature reviews. Neurology · 2024Review
- Circulating Blood-Brain Barrier Proteins for Differentiating Ischaemic Stroke Patients from Stroke Mimics.Biomolecules · 2024Article
- Review
- GFAP as Astrocyte-Derived Extracellular Vesicle Cargo in Acute Ischemic Stroke Patients-A Pilot Study.International journal of molecular sciences · 2024Article
- Comparison of GFAP and UCH-L1 Measurements Using Two Automated Immunoassays (i-STATInternational journal of molecular sciences · 2024Article
- GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma.Critical care (London, England) · 2024Article
- Expression of Acidic Fibrillar Protein and Neuroglobin in Thrombolytic Patients in Ischemic Stroke.Clinical interventions in aging · 2024Article
- Blood-Based Biomarkers for Neuroprognostication in Acute Brain Injury.Seminars in neurology · 2023Review
- Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital.BMC neurology · 2023Observational
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Authors and funding
11 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBiomarkers indicative of intracerebral hemorrhage (ICH) may help triage acute stroke patients in the pre-hospital phase. We hypothesized that serum concentration of glial fibrillary acidic protein (GFAP) in combination with ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), measured by a rapid bio-assay, could be used to distinguish ICH from ischemic stroke.
methodsThis prospective two-center study recruited patients with a clinical diagnosis of acute stroke both in the pre-hospital phase and at hospital admission (within 4 and 6 h after symptom onset, respectively). Blood samples were analyzed for concentrations of GFAP and UCH-L1 using ELISA techniques. The reference standard was the diagnosis of ICH, ischemic stroke, or stroke mimicking condition achieved after clinical workup including brain imaging.
resultsA total of 251 patients were included (mean age [± SD] 72 ± 15 years; 5 ICH, 23 ischemic strokes and 14 stroke mimics in the pre-hospital part; and 59 ICH, 148 ischemic strokes and 2 stroke mimics in the in-hospital part). Mean delay (± SD) from symptom onset to blood withdrawal was 130 ± 79 min for the pre-hospital patients and 136 ± 86 min for the in-hospital patients. Both GFAP and UCH-L1 serum concentrations were higher in patients having ICH as compared to other diagnoses (GFAP: median 330 ng/L [interquartile range 64-7060, range 8-56,100] vs. 27.5 ng/L [14-57.25, 0-781], p < 0.001; UCH-L1: 401 ng/L [265-764, 133-1812] vs. 338 ng/L [213-549.5, 0-2950], p = 0.025). Area-under-the-curve values were 0.866 (95% CI 0.809-0.924, p < 0.001) for GFAP, and 0.590 (0.511-0.670, p = 0.033) for UCH-L1. Regarding overall diagnostic accuracy, UCH-L1 did not add significantly to the performance of GFAP.
conclusionsGFAP may differentiate ICH from ischemic stroke and stroke mimics. A point-of-care test to distinguish between ischemic and hemorrhagic strokes might facilitate triage to different treatment pathways or locations, or be used to select patients for trials of ultra-early interventions.
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