TY  - JOUR
A1  - Kalra, Love-Preet
A1  - Khatter, Himani
A1  - Ramanathan, Sarvotham
A1  - Sapehia, Sameer
A1  - Devi, Kavita
A1  - Kaliyaperumal, Abirami
A1  - Bal, Deepti
A1  - Sebastian, Ivy
A1  - Kakarla, Raviteja
A1  - Singhania, Anusha
A1  - Rathore, Shubhra
A1  - Klinsing, Svenja
A1  - Pandian, Jeyaraj Durai
A1  - Förch, Christian
T1  - Serum GFAP for stroke diagnosis in regions with limited access to brain imaging (BE FAST India)
T2  - European stroke journal
N2  - Introduction: Despite a high burden of stroke, access to rapid brain imaging is limited in many middle- and low-income countries. Previous studies have described the astroglial protein GFAP (glial fibrillary acidic protein) as a biomarker of intracerebral hemorrhage. The aim of this study was to test the diagnostic accuracy of GFAP for ruling out intracranial hemorrhage in a prospective cohort of Indian stroke patients. Patients and methods: This study was conducted in an Indian tertiary hospital (Christian Medical College, Ludhiana). Patients with symptoms suggestive of acute stroke admitted within 12 h of symptom onset were enrolled. Blood samples were collected at hospital admission. Single Molecule Array technology was used for determining serum GFAP concentrations. Results: A total number of 155 patients were included (70 intracranial hemorrhage, 75 ischemic stroke, 10 stroke mimics). GFAP serum concentrations were elevated in intracranial hemorrhage patients compared to ischemic stroke patients [median (interquartile range) 2.36 µg/L (0.61–7.16) vs. 0.18 µg/L (0.11–0.38), p < 0.001]. Stroke mimics patients had a median GFAP serum level of 0.14 µg/L (0.09–0.26). GFAP values below the cut-off of 0.33 µg/L (area under the curve 0.871) ruled out intracranial hemorrhage with a negative predictive value of 89.7%, (at a sensitivity for detecting intracranial hemorrhage of 90.0%). Discussion: The high negative predictive value of a GFAP test system allows ruling out patients with intracranial hemorrhage. Conclusion: In settings where immediate brain imaging is not available, this would enable to implement secondary prevention (e.g., aspirin) in suspected ischemic stroke patients as soon as possible.
KW  - GFAP
KW  - glial fibrillary acidic protein
KW  - biomarker
KW  - diagnostic method
KW  - ischemic stroke
KW  - intracranial hemorrhage
KW  - intracerebral hemorrhage
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62498
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-624983
SN  - 2396-9881
N1  - The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Department of Neurology, Goethe University, Frankfurt am Main, Germany.
VL  - 6
IS  - 2
SP  - 176
EP  - 184
PB  - Sage Publishing
CY  - London
ER  -