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. 2024 Apr 5;28(1):109.
doi: 10.1186/s13054-024-04892-5.

GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma

Sabina Zylyftari  1 , Sebastian Luger  1   2 , Kristaps Blums  1 , Stephan Barthelmes  1 , Sebastian Humm  1 , Hannsjörg Baum  3 , Stephan Meckel  4 , Jörg Braun  5   6 , Gregor Lichy  5   6 , Andreas Heilgeist  5 , Love-Preet Kalra #  7   8 , Christian Foerch #  1   2
Affiliations

GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma

Sabina Zylyftari et al. Crit Care. .

Abstract

Background: Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospective study was to test whether prehospital GFAP measurements on a point-of-care device have the potential to rapidly differentiate intracranial hemorrhage from other causes of acute coma.

Methods: This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min) shortly after hospital admission.

Results: 143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613-10001] vs. 43 pg/mL [IQR 29-91.25], p < 0.001). When using an optimal cut-off value of 101 pg/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). In-hospital mortality risk was associated with prehospital GFAP values.

Conclusion: Increased GFAP plasma concentrations in patients with acute coma identify intracranial hemorrhage with high diagnostic accuracy. Prehospital GFAP measurements on a point-of-care platform allow rapid stratification according to the underlying cause of coma by rescue services. This could have major impact on triage and management of these critically ill patients.

Keywords: Biomarker; Coma; Diagnostics; GFAP; Glial fibrillary acidic protein.

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Conflict of interest statement

Prof. Foerch invented the following patent: Use of GFAP for identification of intracerebral hemorrhage (US20150247867). The other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
STARD flow diagram of the study
Fig. 2
Fig. 2
For the GFAP point-of-care measurements entirely performed in the prehospital phase (n = 5), a backpack was equipped. A Outer view of the PAX emergency backpack with the approximate dimensions 49 × 36 × 28 cm, weighing 8.0 kg. B Inside the backpack the i-STAT Alinity® device, a small portable centrifuge (visible) and a pipette with pipette consumables (not visible) are secured between foam
Fig. 3
Fig. 3
Box plots depicting the distribution of plasma GFAP values according to final diagnosis (i.e., cause of coma). A Y axis in metric scale. B Y axis in logarithmic scale for better visualization of the smaller GFAP values associated with diagnoses other than intracranial hemorrhage
Fig. 4
Fig. 4
Prehospital probability charts for acute coma patients. Bar charts showing the probability of an intracranial hemorrhage (A) and of a primary cerebral cause of coma (B) in correlation with GFAP plasma value ranges. In-hospital mortality rates correlated to GFAP plasma value ranges are visualized in graph C
See this image and copyright information in PMC

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