Clinical Usefulness of Serum Glial Fibrillary Acidic Protein in Patients with Acute Ischemic Stroke
Mi-Hwa Kim, MD1, Seung-Hun Oh, MD1, Young-Do Kwon, PhD2, Min-Jung Baek2, You-Kyung Kim2, Hyun Sook Kim, MD1, Won-Chan Kim, MD1 and Ok Joon Kim, MD, PhD1
Departments of Neurology, 2Institute for Clinical Research, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
ABSTRACT
Background: Glial fibrillary acidic protein (GFAP) is known to be leaked into the peripheral blood through disrupted blood-brain barrier in brain injury. We investigate the usefulness of measurement of serum GFAP as a biomarker for prediction of diagnosis and prognosis in acute ischemic stroke. Methods: Serum GFAP levels were measured in 63 patients with acute ischemic stroke within 24 hours of onset (44 territorial and 19 lacunar infarctions) and 68 healthy controls. The patient’s clinical status and functional outcome were evaluated by the National Institute of Health Stroke Scale (NIHSS) on admission and 7th day of onset, and modified Rankin Scale (mRS) at 3 months of onset. The serum GFAP levels were compared according to the extent of infarct. Results: In stroke group, serum GFAP levels were highly elevated than control group (P=0.003). Serum GFAP test exhibited high specificity but low sensitivity (area under curve=0.637, P=0.007) for diagnosis of ischemic stroke. This low diagnostic sensitivity was attributed to low detection rate of lacunar infarction. The serum GFAP levels were correlated with the extent of infarct size (P<0.001). The serum GFAP levels were highly correlated with the short-term clinical severity in the acute phase (initial NIHSS: r=0.530, P<0.001, 7-day NIHSS: r=0.568, P<0.001) and long-term functional outcome (3 month mRS: r=0.580, P<0.001). Conclusions: Measurement of serum GFAP level as a diagnostic biomarker for acute ischemic stroke is limited. However, serum GFAP measurement had predictive values of severities of neuronal damage and clinical outcome in patients with acute ischemic stroke.
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