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.
| Original language | English |
|---|---|
| Pages (from-to) | 390-399 |
| Number of pages | 10 |
| Journal | International Journal of Stroke |
| Volume | 14 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Jun 1 2019 |
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ASJC Scopus subject areas
- Neurology
Cite this
Glial fibrillary acidic protein for the early diagnosis of intracerebral hemorrhage : Systematic review and meta-analysis of diagnostic test accuracy. / Perry, Luke A.; Lucarelli, Tom; Penny-Dimri, Jahan C.; McInnes, Matthew D.F.; Mondello, Stefania; Bustamante, Alejandro; Montaner, Joan; Foerch, Christian; Kwan, Patrick; Davis, Stephen; Yan, Bernard.
In: International Journal of Stroke, Vol. 14, No. 4, 01.06.2019, p. 390-399.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Glial fibrillary acidic protein for the early diagnosis of intracerebral hemorrhage
T2 - Systematic review and meta-analysis of diagnostic test accuracy
AU - Perry, Luke A.
AU - Lucarelli, Tom
AU - Penny-Dimri, Jahan C.
AU - McInnes, Matthew D.F.
AU - Mondello, Stefania
AU - Bustamante, Alejandro
AU - Montaner, Joan
AU - Foerch, Christian
AU - Kwan, Patrick
AU - Davis, Stephen
AU - Yan, Bernard
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85059636265&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059636265&partnerID=8YFLogxK
U2 - 10.1177/1747493018806167
DO - 10.1177/1747493018806167
M3 - Article
C2 - 30303809
AN - SCOPUS:85059636265
VL - 14
SP - 390
EP - 399
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
IS - 4
ER -