title: Glial Fibrillary Acidic Protein Serum Levels Distinguish between Intracerebral Hemorrhage and Cerebral Ischemia in the Early Phase of Stroke.
abstract: BACKGROUND
  Recent studies have suggested that glial fibrillary acidic protein (GFAP) serum concentrations distinguish between intracerebral hemorrhage (ICH) and ischemic stroke (IS) shortly after symptom onset. In this prospective multicenter trial we validated GFAP in an independent patient cohort and assessed the quantitative relationship between GFAP release, bleeding size, and localization.
  
  
  METHODS
  We included patients with a persistent neurological deficit (NIH Stroke Scale ≥4) suggestive of stroke within 6 h of symptom onset. Blood samples were drawn at hospital admission. GFAP serum concentrations were measured using an electrochemiluminometric immunoassay. Primary endpoint was the final diagnosis established at hospital discharge (ICH, IS, or stroke mimic).
  
  
  RESULTS
  202 patients were included (45 with ICH, 146 with IS, 11 stroke mimics). GFAP concentrations were significantly higher in ICH than in IS patients [median (interquartile range) 0.16 μg/L (0.04-3.27) vs 0.01 μg/L (0.01-0.01), P <0.001]. A GFAP cutoff of 0.03 μg/L provided a sensitivity of 77.8% and a specificity of 94.2% in distinguishing ICH from IS and stroke mimics [ROC analysis area under the curve 0.872 (95% CI, 0.802-0.942), P <0.001]. GFAP serum concentrations were positively correlated with ICH volume. Lobar ICH volumes were larger and thus associated with higher GFAP concentrations as compared to deep ICH.
  
  
  CONCLUSIONS
  Serum GFAP was confirmed to be a biomarker indicating ICH in patients presenting with acute stroke symptoms. Very small ICH may be missed owing to less tissue destruction.
authors.affiliation: Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Luger
authors.affiliation: Charité Center for Stroke Research Berlin (CSB), Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Witsch
authors.affiliation: Department of Neurology, Hochtaunus-Kliniken, Bad Homburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Dietz
authors.affiliation: Department of Neurology, Horst Schmidt Klinikum, Wiesbaden, Germany & Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Germany.
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Hamann
authors.affiliation: Department of Neurology, Universitätsklinikum Münster, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
authors.affiliation: Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Schneider
authors.affiliation: Department of Neurology, Klinikum Herford, Herford, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Sitzer
authors.affiliation: Department of Neurology, Universitätsklinikum Halle/Saale, Germany.
authors.forename: Katja E
authors.initials: KE
authors.lastname: Wartenberg
authors.affiliation: Roche Diagnostics GmbH, Penzberg, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Niessner
authors.affiliation: Department of Neurology, Goethe-University, Frankfurt am Main, Germany; foerch@em.uni-frankfurt.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Foerch
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000175:diagnosis; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D008297:Male; D020521:Stroke / Q000097:blood* / Q000175:diagnosis
chemical_list: D005904:Glial Fibrillary Acidic Protein