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| Potential biomarker of acute haemorrhagic stroke identified |
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22 March 2006
Serum glial fibrillary acidic protein (GFAP) is a promising biomarker for the identification of intracerebral haemorrhage in patients with acute stroke, according to results of a pilot study published in the March issue of the Journal of Neurology, Neurosurgery and Psychiatry.
Investigators from Germany determined serum GFAP levels within 6 hours after the onset of stroke in 135 patients. Based on brain imaging, 42 had an intracerebral haemorrhage and 93 had an ischaemic stroke. According to Dr Christian Foerch and colleagues from the Johann Wolfgang Goethe University in Frankfurt, GFAP was detectable in the serum of 81% of intracerebral haemorrhage patients but in only 5% of ischaemic stroke patients. Median serum GFAP concentrations in the first 6 hours after symptom onset were significantly elevated in patients with an intracerebral haemorrhage compared with patients with an ischaemic stroke (11 ng/L vs. 0 ng/L).
The results indicate that GFAP is not detectable in the serum of the majority of ischaemic stroke patients within the first 6 hours after symptom onset. The finding fits in well with the previous studies reporting a delayed release of astroglial proteins (S100B and GFAP) into the serum in acute ischaemic stroke, reaching maximum concentrations between day 2 and day 4. Using a cut-off point of 2.9 ng/L, the specificity of GFAP for the identification of intracerebral haemorrhage was high (0.98), with only two false positives, the authors report, while sensitivity was 0.79, with nine false negatives in the intracerebral haemorrhage group.
"Biomarkers of stroke are an evolving field of clinical research," Dr Foerch and colleagues note. "A serum marker which can differentiate between haemorrhagic stroke and ischaemic stroke in the very early phase would help to optimise acute stroke management." GFAP may fit the bill, although further studies are needed to confirm the current results, they conclude.
Reference:
J Neurol Neurosurg Psychiatry 2006; 77 (2): 181-184.
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