Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 2:17474930251366103.
doi: 10.1177/17474930251366103. Online ahead of print.

Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study

Zhen-Ni Guo  1   2 , Yang Qu  1 , Reziya Abuduxukuer  1 , Hang Jin  1 , Peng Zhang  1 , Zi-Duo Shen  1 , Han Zhang  1 , Xiang-Yu Zheng  3 , Yu Zhang  4 , Yu-Mei Chen  5 , Yang Zheng  6 , Zhi-Mei Yuan  7 , Jing Yao  8 , Ya-Li Wang  9 , Miao Zhang  10 , Yang Li  11 , Yan-Qiu Gu  12 , Li-Li Zhao  10 , Chen-Peng Dong  13 , Yongfei Jiang  14   15 , Zhong-Rui Pei  16 , Wen-Tong Song  17 , Zhuang-Hong Shi  13 , Yang Dong  13 , Yingbin Qi  18 , Ying-Kui Li  19 , Li Li  18 , Xin Sun  1 , Thanh N Nguyen  20 , Chao Li  1 , Yi Yang  1
Affiliations

Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study

Zhen-Ni Guo et al. Int J Stroke. .

Abstract

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.

Keywords: Glial fibrillary acidic protein; intravenous thrombolysis; prognosis; ubiquitin C-terminal hydrolase-L1.

PubMed Disclaimer

LinkOut - more resources