International journal of stroke : official journal of the International Stroke Society · 2025
Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Guo Zhen-Ni, Qu Yang, Abuduxukuer Reziya, Jin Hang, Zhang Peng, Shen Zi-Duo, Zhang Han, Zheng Xiang-Yu, Zhang Yu, Chen Yu-Mei, Zheng Yang, Yuan Zhi-Mei, Yao Jing, Wang Ya-Li, Zhang Miao, Li Yang, Gu Yan-Qiu, Zhao Li-Li, Dong Chen-Peng, Jiang Yongfei, Pei Zhong-Rui, Song Wen-Tong, Shi Zhuang-Hong, Dong Yang, Qi Yingbin, Li Ying-Kui, Li Li, Sun Xin, Nguyen Thanh N, Li Chao, Yang Yi
Аннотация
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.
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.