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. 2016 Apr 14:6:24588.
doi: 10.1038/srep24588.

Assessment of Serum UCH-L1 and GFAP in Acute Stroke Patients

Changhong Ren  1   2   3 , Firas Kobeissy  4   5 , Ali Alawieh  6 , Na Li  1 , Ning Li  1 , Kazem Zibara  7   8 , Susie Zoltewicz  9 , Joy Guingab-Cagmat  9 , Stephen F Larner  9 , Yuchuan Ding  10 , Ronald L Hayes  9 , Xunming Ji  1   2   3 , Stefania Mondello  11
Affiliations

Assessment of Serum UCH-L1 and GFAP in Acute Stroke Patients

Changhong Ren et al. Sci Rep. .

Abstract

A rapid and reliable diagnostic test to distinguish ischemic from hemorrhagic stroke in patients presenting with stroke-like symptoms is essential to optimize management and triage for thrombolytic therapy. The present study measured serum concentrations of ubiquitin C-terminal hydrolase (UCH-L1) and glial fibrillary astrocytic protein (GFAP) in acute stroke patients and healthy controls and investigated their relation to stroke severity and patient characteristics. We also assessed the diagnostic performance of these markers for the differentiation of intracerebral hemorrhage (ICH) from ischemic stroke (IS). Both UCH-L1 and GFAP concentrations were significantly greater in ICH patients than in controls (p < 0.0001). However, exclusively GFAP differed in ICH compared with IS (p < 0.0001). GFAP yielded an AUC of 0.86 for differentiating between ICH and IS within 4.5hrs of symptom onset with a sensitivity of 61% and a specificity of 96% using a cut-off of 0.34ng/ml. Higher GFAP levels were associated with stroke severity and history of prior stroke. Our results demonstrate that blood UCH-L1 and GFAP are increased early after stroke and distinct biomarker-specific release profiles are associated with stroke characteristics and type. We also confirmed the potential of GFAP as a tool for early rule-in of ICH, while UCH-L1 was not clinically useful.

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Conflict of interest statement

Dr. Hayes owns stock, receives royalties and salaries from, and is officer of Banyan Biomarkers Inc. Drs. Kobeissy, Zoltewicz, Guingab-Cagmat, Larner and Mondello were employees and received salaries from Banyan Biomarkers, Inc. The other authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Box-and-whisker plots demonstrating UCH-L1 and GFAP concentrations within 24 hours of symptom onset.
Serum UCH-L1 (A) and GFAP concentrations (B) in patients with stroke or TIA and controls. The horizontal line in each box represents the median, with the boxes representing the interquartile range. Significant differences are indicated (Kruskal-Wallis test). The reference line (red line) represents the median of estimated normal values.
Figure 2
Figure 2. Correlations of logged serum GFAP and UCH-L1 concentrations in patients with IS and SAH (r = 0.36 and r = 1.00, respectively, test based on the Spearman’s rank correlation).
Figure 3
Figure 3. ROC curves for UCH-L1 (black line) and GFAP (red line) in serum for distinguishing patients with IS (A) and ICH (B) from controls, and for differentiating between patients with IS and patients with ICH at various time points (C) and within 4.5 hours of symptom onset (D).
The area under the curves is indicated.
See this image and copyright information in PMC

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