TY - JOUR
TI - Discriminative value of glial fibrillar acidic protein (GFAP) as a diagnostic tool in acute stroke. Individual patient data meta-Analysis
AU - Cabezas, J.A.
AU - Bustamante, A.
AU - Giannini, N.
AU - Pecharroman, E.
AU - Katsanos, A.H.
AU - Tsivgoulis, G.
AU - Rozanski, M.
AU - Audebert, H.
AU - Mondello, S.
AU - Llombart, V.
AU - Montaner, J.
JO - Journal of Investigative Medicine
PY - 2020
VL - 68
TODO - 8
SP - 1379-1385
PB - BMJ Publishing Group
SN - 1081-5589, 1708-8267
TODO - 10.1136/jim-2020-001432
TODO - glial fibrillary acidic protein;  glial fibrillary acidic protein, adult;  aged;  Article;  brain hemorrhage;  brain ischemia;  diagnostic value;  differential diagnosis;  female;  human;  major clinical study;  male;  predictive value;  prognosis;  systematic review;  blood;  brain hemorrhage;  cerebrovascular accident;  cohort analysis;  meta analysis;  middle aged;  publishing;  treatment outcome;  very elderly, Aged;  Aged, 80 and over;  Cerebral Hemorrhage;  Cohort Studies;  Diagnosis, Differential;  Female;  Glial Fibrillary Acidic Protein;  Humans;  Male;  Middle Aged;  Publication Bias;  Stroke;  Treatment Outcome
TODO - Glial fibrillar acidic protein (GFAP) in serum has been evaluated as a promising biomarker to differentiate between intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS). We assessed its value as diagnostic and prognostic tool for ICH through a literature systematic review and individual patient data (IPD) meta-Analysis. We performed a systematic search in PubMed database until November 2018 for publications that evaluated GFAP to differentiate AIS and ICH within 4.5 hours after symptoms onset. Thereafter, we invited authors of selected studies to participate in this work by providing IPD from their cohorts. We used standardized individual subject's data to evaluate the association of GFAP concentrations with stroke subtype, demographics, stroke characteristics and factors related with GFAP measurement. From 4 selected studies, we collected data of 340 patients (236 AIS and 104 ICH). Standardized GFAP blood levels were significantly elevated in ICH compared with those with AIS (median and IQR: 0.84 (0.781-1.24), 0.79 (0.74-0.81); p<0.0001). In both stroke types, GFAP concentrations correlated with baseline stroke severity (r=0.27, p<0.0001; r=0.36, p<0.001; for AIS and ICH, respectively) but no correlation was found regarding time to sampling. Limited data precluded the evaluation of GFAP levels and functional outcome. These findings demonstrate substantially different levels of GFAP in the blood of patients with ICH compared with patients with AIS soon after the event, while no association was found with outcome. In summary, GFAP could be a valuable diagnostic tool to assist in medical decision-making and to optimize management of stroke in the acute setting. © 2020 Journal of Investigative Medicine. All rights reserved.
ER -