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
{"title":"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。","authors":"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","doi":"10.1177/17474930251366103","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Aim: </strong>This study investigates the association between serum GFAP and UCH-L1 levels with functional outcomes in patients receiving IVT.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Serum GFAP and UCH-L1 levels can be used to quantitatively evaluate brain tissue injury and predict the prognosis of patients with IVT.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251366103"},"PeriodicalIF":8.7000,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study.\",\"authors\":\"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\",\"doi\":\"10.1177/17474930251366103\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Aim: </strong>This study investigates the association between serum GFAP and UCH-L1 levels with functional outcomes in patients receiving IVT.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Serum GFAP and UCH-L1 levels can be used to quantitatively evaluate brain tissue injury and predict the prognosis of patients with IVT.</p>\",\"PeriodicalId\":14442,\"journal\":{\"name\":\"International Journal of Stroke\",\"volume\":\" \",\"pages\":\"17474930251366103\"},\"PeriodicalIF\":8.7000,\"publicationDate\":\"2025-08-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Stroke\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17474930251366103\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17474930251366103","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study.
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.
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.
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