Multicenter Study

. 2025 Jan;56(1):22-29.

doi: 10.1161/STROKEAHA.124.047887. Epub 2024 Dec 9.

Serum GFAP and UCH-L1 Levels for the Assessment of the Absence of Hemorrhagic Transformation: A Multicenter Prospective Cohort Study

Zhen-Ni Guo^{1

2}, Yang Qu¹, Reziya Abuduxukuer¹, Hang Jin¹, Peng Zhang¹, Jing Wang¹, Ke-Jia Zhang¹, Shuang Qi¹, Xiang-Yu Zheng², Yu Zhang³, Jian-Hua Gao⁴, De-Wang Pan⁵, Xiao-Dong Liu⁶, Chun-Ying Li⁷, Li-Ping Chen⁸, Jin-Hua Chen⁹, Ji-Liang Gu¹⁰, An-Ying Wang¹¹, Ligang Jiang⁹, Liang Liu¹², Yongfei Jiang^{13

14}, Chun-Fei Wang¹⁵, Yan Jia¹⁶, Hong Xin¹², Chun-Li Jiang¹², Ying-Bin Qi¹⁷, Xue-Feng Hu¹⁸, Song Li¹⁷, Xin Sun¹, Thanh N Nguyen¹⁹, Yi Yang¹; Biomarkers of Brain Injury Investigator Study Group

Collaborators, Affiliations

Collaborators

Biomarkers of Brain Injury Investigator Study Group:
Lijuan Wang, Yu-Mei Chen, Xian-Kun Zhang, Zhi-Mei Yuan, Dong-Sheng Ju, Xiao-Ying Cheng, Junmin Wang, Yang Li, Yan-Qiu Gu, Li-Li Zhao, Chen-Peng Dong, Li Liu, Rui-Hong Teng, Cui Wang, Xue Liu, Yang Dong, Ling He, Meng Pang

Affiliations

¹ Stroke Center, Department of Neurology (Z.-N.G., Y.Q., R.A., H.J., P.Z., J.W., K.-J.Z., S.Q., X.S., Y.Y.), The First Hospital of Jilin University, Changchun, China.
² Neuroscience Research Center, Department of Neurology (Z.-N.G.), The First Hospital of Jilin University, Changchun, China.
³ Department of Neurology, Songyuan Central Hospital, China (Y.Z.).
⁴ Department of Neurology, Jilin Neuropsychiatric Hospital, Siping, China (J.-H.G.).
⁵ Stroke Center, Department of Neurology, Siping Central People's Hospital, China (D.-W.P.).
⁶ Department of Neurosurgery, Tonghua City Vascular Disease Hospital and Dongchang District People's Hospital, China (X.-D.L.).
⁷ Department of Neurology, Songyuan Jilin Oilfield Hospital, China (C.-Y.L.).
⁸ Stroke Center, Department of Neurology, Dehuishi People's Hospital, Changchun, China (L.-P.C.).
⁹ Department of Neurology, Affiliated Hospital of Jilin Medical College, China (J.-H.C., L.J.).
¹⁰ Department of Neurology, Songyuan Hospital of Integrated Traditional Chinese and Western Medicine, China (J.-L.G.).
¹¹ Stroke Center, Department of Neurology, Qianguoerros Mongolian Autonomous County Hospital, Songyuan, China (A.-Y.W.).
¹² Department of Neurology, Jilin City Hospital of Chemical Industry, China (L.L., H.X., C.-L.J.).
¹³ Department of Neurology, Changchun People's Hospital, China (Y.J.).
¹⁴ Department of Neurology, Changchun Second Hospital, China (Y.J.).
¹⁵ Department of Neurology, Dongliao First People's Hospital, Liaoyuan, China (C.-F.W.).
¹⁶ Department of Neurology, Jilin People's Hospital, China (Y.J.).
¹⁷ Department of Neurology, Jilin Province People's Hospital, Changchun, China (Y.-B.Q., S.L.).
¹⁸ Stroke Center, Department of Neurology, Jilin Central General Hospital, China (X.-F.H.).
¹⁹ Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.).

PMID: 39648906
DOI: 10.1161/STROKEAHA.124.047887

Multicenter Study

Serum GFAP and UCH-L1 Levels for the Assessment of the Absence of Hemorrhagic Transformation: A Multicenter Prospective Cohort Study

Zhen-Ni Guo et al. Stroke. 2025 Jan.

. 2025 Jan;56(1):22-29.

doi: 10.1161/STROKEAHA.124.047887. Epub 2024 Dec 9.

Authors

Collaborators

Biomarkers of Brain Injury Investigator Study Group:
Lijuan Wang, Yu-Mei Chen, Xian-Kun Zhang, Zhi-Mei Yuan, Dong-Sheng Ju, Xiao-Ying Cheng, Junmin Wang, Yang Li, Yan-Qiu Gu, Li-Li Zhao, Chen-Peng Dong, Li Liu, Rui-Hong Teng, Cui Wang, Xue Liu, Yang Dong, Ling He, Meng Pang

Affiliations

¹ Stroke Center, Department of Neurology (Z.-N.G., Y.Q., R.A., H.J., P.Z., J.W., K.-J.Z., S.Q., X.S., Y.Y.), The First Hospital of Jilin University, Changchun, China.
² Neuroscience Research Center, Department of Neurology (Z.-N.G.), The First Hospital of Jilin University, Changchun, China.
³ Department of Neurology, Songyuan Central Hospital, China (Y.Z.).
⁴ Department of Neurology, Jilin Neuropsychiatric Hospital, Siping, China (J.-H.G.).
⁵ Stroke Center, Department of Neurology, Siping Central People's Hospital, China (D.-W.P.).
⁶ Department of Neurosurgery, Tonghua City Vascular Disease Hospital and Dongchang District People's Hospital, China (X.-D.L.).
⁷ Department of Neurology, Songyuan Jilin Oilfield Hospital, China (C.-Y.L.).
⁸ Stroke Center, Department of Neurology, Dehuishi People's Hospital, Changchun, China (L.-P.C.).
⁹ Department of Neurology, Affiliated Hospital of Jilin Medical College, China (J.-H.C., L.J.).
¹⁰ Department of Neurology, Songyuan Hospital of Integrated Traditional Chinese and Western Medicine, China (J.-L.G.).
¹¹ Stroke Center, Department of Neurology, Qianguoerros Mongolian Autonomous County Hospital, Songyuan, China (A.-Y.W.).
¹² Department of Neurology, Jilin City Hospital of Chemical Industry, China (L.L., H.X., C.-L.J.).
¹³ Department of Neurology, Changchun People's Hospital, China (Y.J.).
¹⁴ Department of Neurology, Changchun Second Hospital, China (Y.J.).
¹⁵ Department of Neurology, Dongliao First People's Hospital, Liaoyuan, China (C.-F.W.).
¹⁶ Department of Neurology, Jilin People's Hospital, China (Y.J.).
¹⁷ Department of Neurology, Jilin Province People's Hospital, Changchun, China (Y.-B.Q., S.L.).
¹⁸ Stroke Center, Department of Neurology, Jilin Central General Hospital, China (X.-F.H.).
¹⁹ Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.).

PMID: 39648906
DOI: 10.1161/STROKEAHA.124.047887

Abstract

Background: Currently, validated biomarkers for assessing hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) are lacking. We aimed to validate a test combining GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin C-terminal hydrolase-L1) to indicate the absence of HT after IVT.

Methods: We prospectively enrolled consecutive patients with stroke treated with IVT from 16 hospitals. Serum GFAP and UCH-L1 levels were measured 24 hours after IVT. Cases from 1 hospital were randomly assigned to the training (70%) and testing (30%) cohorts for internal validation. The external validation cohort included patients from the other 15 hospitals. Cutoff levels of GFAP and UCH-L1 for assessing the absence of HT were established in the training cohort and subjected to internal and external verification.

Results: A total of 1063 patients were included. Both GFAP and UCH-L1 levels were independently associated with HT, infarct volume, and 3-month outcome; levels lower than cutoff (12.6 and 63.1 pg/mL, respectively) excluded patients with HT with a negative predictive value of 98.31% (95% CI, 89.70%-99.91%) and detection sensitivity of 98.08% (95% CI, 88.42%-99.90%) in the training cohort. In the testing and validation cohorts, negative predictive value was 100% (95% CI, 75.93%-100%) and 100% (95% CI, 82.19%-100%), respectively, and the sensitivity was 100% (95% CI, 80.76%-100%) and 100% (95% CI, 77.08%-100%), respectively.

Conclusions: Serum GFAP and UCH-L1 levels exhibit high sensitivity and negative predictive value for indicating the absence of HT 24 hours after IVT, which supports their potential role in assessing patients' condition after IVT.

Keywords: glial fibrillary acidic protein; hemorrhage; infarction; stroke; thrombolytic therapy.

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Conflict of interest statement

Dr Nguyen received consultant fees from Aruna and Brainomix and other fees from the American Stroke Association. The other authors report no conflicts.

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Serum GFAP and UCH-L1 Levels for the Assessment of the Absence of Hemorrhagic Transformation: A Multicenter Prospective Cohort Study

Collaborators

Affiliations

Serum GFAP and UCH-L1 Levels for the Assessment of the Absence of Hemorrhagic Transformation: A Multicenter Prospective Cohort Study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Miscellaneous