检测院前GFAP水平对急性脑卒中患者脑出血的快速诊断

IF 7.7 1区 医学 Q1 CLINICAL NEUROLOGY
Neurology Pub Date : 2025-07-22 Epub Date: 2025-06-26 DOI:10.1212/WNL.0000000000213823
Love-Preet Kalra, Sabina Zylyftari, Kristaps Blums, Stephan Barthelmes, Hannsjoerg Baum, Stephan Meckel, Andreas Heilgeist, Sebastian Luger, Christian Foerch
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引用次数: 0

摘要

背景和目的:快速识别急性脑卒中患者脑出血(ICH)是院前分诊和启动靶向治疗的决定性因素。胶质原纤维酸性蛋白(GFAP)是一种非常有前途的血液生物标志物。在这项研究中,我们研究了在护理点平台上运行的新的GFAP测试在院前阶段区分脑出血与缺血性卒中(IS)和卒中模拟(SM)的潜力。方法:这项前瞻性诊断准确性研究是在德国巴登-符腾堡州三级保健医院路德维希堡RKH Klinikum医院进行的。在症状出现6小时内入院的急性脑卒中患者被纳入研究。在院前阶段采集血样。血浆GFAP测量在i-STAT-Alinity设备上进行(持续时间:15分钟)。金标准是最终诊断为ICH、IS或SM。结果:共纳入353例患者(平均年龄74.6±13.4岁;46.7%的女性)。脑出血患者GFAP浓度升高(n = 76;中位数208 pg/mL[四分位数范围60- 5907]),与IS相比(n = 258;30 pg/mL[29-51])和SM (n = 19;48 pg/mL [29-97];P < 0.001)。鉴别ICH与IS、SM的最佳GFAP截断点为55 pg/mL(曲线下面积0.880,95% CI 0.834 ~ 0.925, p < 0.001)。IS和SM GFAP水平随年龄的增加而略有增加。因此,确定了不同的GFAP截止点,以识别ICH在3个年龄组中具有中高阳性预测值(ppv) (90.0%-95.5%;最小下CI 55.0%,最大上CI 99.3%)(敏感性56.3% ~ 72.4%,特异性98.9% ~ 99.0%,阴性预测值[npv] 87.5% ~ 92.7%)。反之亦然,在中度至重度神经功能障碍患者(NIH卒中量表>.6)中,GFAP值讨论:在院前阶段急性卒中症状患者采集的血液样本中,在护理点平台上的实验室GFAP测量可以帮助识别中度至高PPV的ICH。在使用优化的资格标准和验证的年龄特异性截止值的更大的独立队列中确认,GFAP检测可以促进优化的分诊,并在更早的时间框架内开始降压治疗和抗凝逆转。证据分类:本研究提供II类证据,表明症状出现6小时内血浆GFAP水平升高可准确区分ICH与IS和SM患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rapid Diagnosis of Intracerebral Hemorrhage in Patients With Acute Stroke by Measuring Prehospital GFAP Levels on a Point-of-Care Device (DETECT).

Background and objectives: The rapid identification of intracerebral hemorrhage (ICH) in patients with symptoms of acute stroke is decisive for prehospital triage and initiation of targeted therapies. Glial fibrillary acidic protein (GFAP) is a highly promising blood-biomarker indicating ICH. In this study, we investigated the potential of a new GFAP test run on a point-of-care platform for distinguishing ICH from ischemic stroke (IS) and stroke mimics (SM) in the prehospital phase.

Methods: This prospective diagnostic accuracy study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in Baden-Württemberg, Germany. Patients with symptoms of acute stroke admitted within 6 hours of symptom onset were enrolled. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT-Alinity device (duration: 15 minutes) in-hospital. The gold standard was the final diagnosis categorized ICH, IS, or SM.

Results: A total of 353 patients were enrolled (mean age 74.6 ± 13.4 years; 46.7% female). GFAP concentrations were elevated in patients with ICH (n = 76; median 208 pg/mL [interquartile range 60-5,907]) compared with IS (n = 258; 30 pg/mL [29-51]) and SM (n = 19; 48 pg/mL [29-97]; p < 0.001). The optimal GFAP cutoff point to differentiate ICH from IS and SM was 55 pg/mL (area under the curve of 0.880, 95% CI 0.834-0.925, p < 0.001). IS and SM GFAP levels slightly increased in parallel with increasing age. Hence, different GFAP cutoff points were determined to identify ICH across 3 age groups with moderate to high positive predictive values (PPVs) (90.0%-95.5%; minimum lower CI 55.0%, maximum upper CI 99.3%) (sensitivity values 56.3%-72.4%, specificity values 98.9%-99.0% and negative predictive values [NPVs] 87.5%-92.7%). Vice versa, in patients with a moderate to severe neurologic deficit (NIH Stroke Scale >6), GFAP values <30 pg/mL ruled out ICH with a NPV of 100.0%.

Discussion: Laboratory GFAP measurements on a point-of-care platform in blood samples collected from patients with symptoms of acute stroke in the prehospital phase can help to identify ICH with moderate to high PPV. Following confirmation in larger independent cohorts using optimized eligibility criteria and validated age-specific cutoff values, GFAP testing could facilitate optimized triage and the initiation of blood pressure-lowering therapy and anticoagulation reversal in earlier time frames.

Classification of evidence: This study provides Class II evidence that elevated plasma GFAP levels within 6 hours of symptom onset accurately distinguish patients with ICH from IS and SM.

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来源期刊
Neurology
Neurology 医学-临床神经学
CiteScore
12.20
自引率
4.00%
发文量
1973
审稿时长
2-3 weeks
期刊介绍: Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
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