title: Assessment of Serum UCH-L1 and GFAP in Acute Stroke Patients.
abstract: A rapid and reliable diagnostic test to distinguish ischemic from hemorrhagic stroke in patients presenting with stroke-like symptoms is essential to optimize management and triage for thrombolytic therapy. The present study measured serum concentrations of ubiquitin C-terminal hydrolase (UCH-L1) and glial fibrillary astrocytic protein (GFAP) in acute stroke patients and healthy controls and investigated their relation to stroke severity and patient characteristics. We also assessed the diagnostic performance of these markers for the differentiation of intracerebral hemorrhage (ICH) from ischemic stroke (IS). Both UCH-L1 and GFAP concentrations were significantly greater in ICH patients than in controls (p < 0.0001). However, exclusively GFAP differed in ICH compared with IS (p < 0.0001). GFAP yielded an AUC of 0.86 for differentiating between ICH and IS within 4.5hrs of symptom onset with a sensitivity of 61% and a specificity of 96% using a cut-off of 0.34ng/ml. Higher GFAP levels were associated with stroke severity and history of prior stroke. Our results demonstrate that blood UCH-L1 and GFAP are increased early after stroke and distinct biomarker-specific release profiles are associated with stroke characteristics and type. We also confirmed the potential of GFAP as a tool for early rule-in of ICH, while UCH-L1 was not clinically useful.
authors.affiliation: Institute of Hypoxia Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.|Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, 100053, China.|Center of Stroke, Beijing Institute for Brain Disorder, Beijing 100069, China.
authors.forename: Changhong
authors.initials: C
authors.lastname: Ren
authors.affiliation: Department of Psychiatry, Center for Neuroproteomics and Biomarkers Research, University of Florida, Gainesville, Florida, USA.|Department of Biochemistry and MolecularGenetics, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Firas
authors.initials: F
authors.lastname: Kobeissy
authors.affiliation: Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Alawieh
authors.affiliation: Institute of Hypoxia Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
authors.forename: Na
authors.initials: N
authors.lastname: Li
authors.affiliation: Institute of Hypoxia Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.|Biology Department, Faculty of Sciences, Lebanese University, Beirut, Lebanon.
authors.forename: Kazem
authors.initials: K
authors.lastname: Zibara
authors.affiliation: Banyan Labs, Banyan Biomarkers Inc., Alachua, FL, USA.
authors.forename: Susie
authors.initials: S
authors.lastname: Zoltewicz
authors.affiliation: Banyan Labs, Banyan Biomarkers Inc., Alachua, FL, USA.
authors.forename: Joy
authors.initials: J
authors.lastname: Guingab-Cagmat
authors.affiliation: Banyan Labs, Banyan Biomarkers Inc., Alachua, FL, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Larner
authors.affiliation: Department of Neurosurgery, Wayne State University, School of Medicine, Detroit, 48201, MI, USA.
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Banyan Labs, Banyan Biomarkers Inc., Alachua, FL, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hayes
authors.affiliation: Institute of Hypoxia Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.|Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, 100053, China.|Center of Stroke, Beijing Institute for Brain Disorder, Beijing 100069, China.
authors.forename: Xunming
authors.initials: X
authors.lastname: Ji
authors.affiliation: Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Mondello
mesh_terms: D000328:Adult; D000368:Aged; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D044967:Serum / Q000737:chemistry*; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology*; D013997:Time Factors; D043222:Ubiquitin Thiolesterase / Q000097:blood*
chemical_list: D005904:Glial Fibrillary Acidic Protein; C507533:Ubiquitin carboxyl-Terminal Hydrolase L-1, human; D043222:Ubiquitin Thiolesterase