Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study.

IF 8.7 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2025-08-02 DOI:10.1177/17474930251366103

Zhen-Ni Guo, Yang Qu, Reziya Abuduxukuer, Hang Jin, Peng Zhang, Zi-Duo Shen, Han Zhang, Xiang-Yu Zheng, Yu Zhang, Yu-Mei Chen, Yang Zheng, Zhi-Mei Yuan, Jing Yao, Ya-Li Wang, Miao Zhang, Yang Li, Yan-Qiu Gu, Li-Li Zhao, Chen-Peng Dong, Yongfei Jiang, Zhong-Rui Pei, Wen-Tong Song, Zhuang-Hong Shi, Yang Dong, Yingbin Qi, Ying-Kui Li, Li Li, Xin Sun, Thanh N Nguyen, Chao Li, Yi Yang

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引用次数: 0

Abstract

Background: It remains unclear whether the serum levels of the brain injury biomarkers (glial fibrillary acidic protein [GFAP] and ubiquitin C-terminal hydrolase-L1 [UCH-L1]) can be used to quantitatively evaluate brain tissue injury and predict prognosis in patients with intravenous thrombolysis (IVT).

Aim: This study investigates the association between serum GFAP and UCH-L1 levels with functional outcomes in patients receiving IVT.

Methods: Patients were prospectively enrolled from 16 hospitals. We measured serum GFAP and UCH-L1 levels 24 hours after IVT. Infarct volume, hemorrhagic transformation (HT), and short- and long-term prognostic indicators were evaluated. GFAP and UCH-L1 cutoff levels for predicting 3-month unfavorable outcomes were derived, and a biomarker-based model was established and subjected to internal and external validation.

Results: This study included 1028 patients. Higher GFAP and UCH-L1 levels were independently associated with larger infarct volume, HT, higher 24-hour and 7-day National Institutes of Health Stroke Scale scores, and 3-month modified Rankin Scale scores. The cutoff levels for GFAP and UCH-L1 (116 and 292 pg/mL, respectively) predicted patients with 3-month unfavorable outcomes with a specificity and positive predictive value (PPV) of 97.56% (95% confidence interval [CI], 94.51-99.00) and 88.68% (95% CI, 76.28-95.31), respectively, in the training cohort. In the testing and validation cohorts, specificity was 97.83% (95% CI, 91.62-99.62) and 96.90% (95% CI, 91.77-99.00), respectively, and PPV was 90.00% (95% CI, 66.87-98.25) and 75.00% (95% CI, 47.41-91.67), respectively. Furthermore, the biomarker-based nomogram model showed good predictability of 3-month prognosis in the different cohorts.

Conclusions: Serum GFAP and UCH-L1 levels can be used to quantitatively evaluate brain tissue injury and predict the prognosis of patients with IVT.

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使用血清GFAP和UCH-L1量化脑组织损伤和预测预后：一项多中心前瞻性队列研究。

背景：脑损伤生物标志物（胶质纤维酸性蛋白[GFAP]和泛素c端水解酶- l1 [UCH-L1]）的血清水平是否可用于定量评估静脉溶栓（IVT）患者脑组织损伤和预测预后尚不清楚。目的：本研究探讨血清GFAP和UCH-L1水平与IVT患者功能结局的关系。方法：前瞻性纳入来自16家医院的患者。IVT后24小时测定血清GFAP和UCH-L1水平。评估梗死面积、出血性转化（HT）和短期和长期预后指标。得出预测3个月不良结局的GFAP和UCH-L1截止水平，并建立了基于生物标志物的模型，并进行了内部和外部验证。结果：本研究纳入1028例患者。较高的GFAP和UCH-L1水平与较大的梗死体积、HT、较高的24小时和7天美国国立卫生研究院卒中量表评分以及3个月修正Rankin量表评分独立相关。GFAP和UCH-L1的截止水平（分别为116和292 pg/mL）预测患者3个月不良结局，特异性和阳性预测值（PPV）分别为97.56%（95%置信区间[CI]， 94.51-99.00）和88.68% （95% CI, 76.28-95.31）。在检测和验证队列中，特异性分别为97.83% （95% CI, 91.62-99.62）和96.90% (95% CI, 91.77-99.00)， PPV分别为90.00% （95% CI, 66.87-98.25）和75.00% （95% CI, 47.41-91.67）。此外，基于生物标志物的诺图模型在不同队列中显示出良好的3个月预后可预测性。结论：血清GFAP、UCH-L1水平可定量评价IVT患者脑组织损伤及预测预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.