Luke A Perry1, Tom Lucarelli2, Jahan C Penny-Dimri3, Matthew Df McInnes4,5, Stefania Mondello6,7, Alejandro Bustamante8,9, Joan Montaner8,9, Christian Foerch10, Patrick Kwan1, Stephen Davis1, Bernard Yan1. 1. 1 Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Australia. 2. 2 Department of Neuroscience, Eastern Health, Australia. 3. 3 Department of Surgery, Monash University, Australia. 4. 4 Department of Radiology, University of Ottawa, Canada. 5. 5 Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada. 6. 6 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy. 7. 7 "Oasi" Institute for Research on Mental Retardation and Brain Aging (I.R.C.C.S.), Troina (EN), Italy. 8. 8 Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain. 9. 9 Department of Neurology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Barcelona, Spain. 10. 10 Department of Neurology, Goethe University Frankfurt, Germany.
Abstract
BACKGROUND AND AIMS: Glial fibrillary acidic protein (GFAP) has shown promise in several studies for its ability to diagnose intracerebral hemorrhage (ICH). We evaluated the diagnostic accuracy of blood GFAP level to differentiate (ICH) from acute ischemic stroke (AIS) and stroke mimics, both overall, and in the first three hours after symptom onset. METHODS: We searched multiple databases, without language restriction, from inception until December 2017. Hierarchical summary receiver operating characteristic (HSROC) modeling was used to meta-analyze results. We conducted subgroup analyses restricted to blood samples collected within 0-60, 60-120, and 120-180 min time groups after symptom onset, to evaluate diagnostic accuracy in the early pre-hospital phase. Between and within study heterogeneity was explored using meta-regression. RESULTS: The search identified 199 potentially relevant citations from which 11 studies involving 1297 participants (350 ICH, 947 AIS, or mimic) were included. The pooled sensitivity, specificity, and area under the HSROC curve were 0.756 (95% CI 0.630-0.849), 0.945 (95% CI 0.858-0.980), and 0.904 (95% CI 0.878-0.931), respectively. Differences in assays used, but not the other covariates, partially explained between-study heterogeneity (p = 0.034). The summary estimates for the 0-60, 60-120, and 120-180 min subgroups were comparable to the primary analysis and there was no statistically significant difference in diagnostic accuracy between subgroups. CONCLUSIONS: GFAP is a promising diagnostic biomarker for ICH diagnosis in the early pre-hospital phase. Test accuracy is affected by assay subtype, but there are still unexplained sources of heterogeneity. High quality, international multi-center trials are warranted to develop and validate a point-of-care GFAP assay for the rapid triage and evaluation of acute stroke in the pre-hospital setting.
BACKGROUND AND AIMS: Glial fibrillary acidic protein (GFAP) has shown promise in several studies for its ability to diagnose intracerebral hemorrhage (ICH). We evaluated the diagnostic accuracy of blood GFAP level to differentiate (ICH) from acute ischemic stroke (AIS) and stroke mimics, both overall, and in the first three hours after symptom onset. METHODS: We searched multiple databases, without language restriction, from inception until December 2017. Hierarchical summary receiver operating characteristic (HSROC) modeling was used to meta-analyze results. We conducted subgroup analyses restricted to blood samples collected within 0-60, 60-120, and 120-180 min time groups after symptom onset, to evaluate diagnostic accuracy in the early pre-hospital phase. Between and within study heterogeneity was explored using meta-regression. RESULTS: The search identified 199 potentially relevant citations from which 11 studies involving 1297 participants (350 ICH, 947 AIS, or mimic) were included. The pooled sensitivity, specificity, and area under the HSROC curve were 0.756 (95% CI 0.630-0.849), 0.945 (95% CI 0.858-0.980), and 0.904 (95% CI 0.878-0.931), respectively. Differences in assays used, but not the other covariates, partially explained between-study heterogeneity (p = 0.034). The summary estimates for the 0-60, 60-120, and 120-180 min subgroups were comparable to the primary analysis and there was no statistically significant difference in diagnostic accuracy between subgroups. CONCLUSIONS:GFAP is a promising diagnostic biomarker for ICH diagnosis in the early pre-hospital phase. Test accuracy is affected by assay subtype, but there are still unexplained sources of heterogeneity. High quality, international multi-center trials are warranted to develop and validate a point-of-care GFAP assay for the rapid triage and evaluation of acute stroke in the pre-hospital setting.
Authors: Marie Dagonnier; Geoffrey A Donnan; Stephen M Davis; Helen M Dewey; David W Howells Journal: Front Neurol Date: 2021-02-05 Impact factor: 4.003
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