Glial Fibrillary Acidic Protein as a Potential Indicator for Symptomatic Intracranial Hemorrhage in Acute Ischemic Patients Undergoing Endovascular Thrombectomy

Abstract

Background

The correlation between glial fibrillary acidic protein (GFAP) and symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) treatment remains uncertain. We aimed to assess the association between levels of GFAP in the bloodstream and the occurrence of sICH.

Methods

Between June 2019 and May 2023, 142 consecutive AIS patients undergoing EVT at Stroke Center and 35 controls from the Physical Examination Center were retrospectively included. The levels of GFAP in the bloodstream were quantified using enzyme-linked immunosorbent assay prior to endovascular treatment (T1) and 24 h after the procedure (T2). The identification of sICH was based on the Heidelberg Bleeding Classification.

Results

Serum GFAP levels at T1 in AIS patients were significantly higher than those in the controls (0.249 [0.150–0.576] versus 0.065 [0.041–0.110] ng/mL, p = 0.001), and there was a notably elevation in GFAP levels at T2 compared to T1 (3.813 [1.474, 5.876] versus 0.249 [0.150–0.576] ng/mL, p = 0.001). Of the 142 AIS patients, 18 (14.5%) had sICH after EVT. Serum GFAP levels at T2 showed significant associations with sICH in both the unadjusted model (OR 1.513, 95% CI 1.269–1.805, p = 0.001) and multivariable adjusted model (OR 1.518, 95% CI 1.153–2.000, p = 0.003). Furthermore, the addition of GFAP at T2 to conventional model resulted in a significant enhancement of risk reclassification for sICH (integrated discrimination improvement [IDI] 0.183, 95% CI 0.070–0.295, p = 0.001).

Conclusion

Serum GFAP levels were notably increased in AIS patients 24 h after EVT. Elevated GFAP levels were correlated to an elevated risk of sICH. GFAP could potentially serve as a dependable indicator for sICH in AIS individuals who treated with EVT.

Keywords:

• glial fibrillary acidic protein
• stroke
• symptomatic intracranial hemorrhage
• indicator
• endovascular thrombectomy

Data Sharing Statement

The data that support the findings of this study are available from Guomei Shi upon reasonable request.

Ethics Approval

The study was approved by the Ethics Committee of Taixing People’s Hospital (No. LS2021017) and conducted according to the Declaration of Helsinki. The fully de- identified data on the participants enrolled in the study and its virtue of retrospective study design enables this study conducted under a waiver of informed consent by the Ethics Committee of Taixing People’s Hospital.

Consent for Publication

No information or images that could lead to identification of a study participant were mentioned in our study.

Author Contributions

All authors made significant contributions to conception, study design, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflict of interest.

Additional information

Funding

This study was supported by grants from Jiangsu Association for Science and Technology (TJ2021019), Science Foundation of Kangda College of Nanjing Medical University (KD2020KYJJZD021), Doctoral Science Foundation of Taixing People’s Hospital Foundation Project (TRYBS2022001) and Instructive Project of Jiangsu Provincial Health Commission (Z2023052).