Hongyan Li, Xuegang Meng, Zhu Li, Lingling Wang, Chunli Zhang, Qing Li, Dilmurat Amit, Guoqing Bao, Mingyuan Wang, Fu Xu, Xiao Hu, Huan Lei, Wanting Lei, Yingzi Wang, Chuang Liu, Zimeng Li
The 24-hour GFAP change rate is a potential predictor for HT. Serial GFAP monitoring may provide preliminary evidence for early risk stratification of HT and functional outcomes in AIS patients.
BACKGROUND: Acute ischemic stroke (AIS) has high disability and mortality. Hemorrhagic transformation (HT) is a critical complication related to astrocyte damage, axonal injury and inflammation. GFAP, NfL and IL-6 are closely associated with HT, but 7-day continuous dynamic data are lacking.
OBJECTIVE: To investigate 7-day dynamic changes of serum GFAP, NfL, IL-6 and their predictive value for HT and 3-month functional outcomes in AIS patients.
METHODS: A prospective cohort study including 308 AIS patients. Serum biomarkers were measured daily for 7 days. Predictive performance was analyzed by Cox regression, ROC analysis, calibration, and decision curve analysis (DCA).
RESULTS: HT occurred in 13.6% (42/308) of patients. The 24-hour GFAP change rate independently predicted HT (HR = 1.041, 95% CI: 1.015-1.069, p = 0.002). The combined model had a bootstrap-corrected C-index of 0.877. Peak GFAP improved 3-month outcome prediction (AUC = 0.850, p = 0.048), outperforming NfL and IL-6.
CONCLUSION: The 24-hour GFAP change rate is a potential predictor for HT. Serial GFAP monitoring may provide preliminary evidence for early risk stratification of HT and functional outcomes in AIS patients.