Abstract Number: Esoc2026a1219 Validation of a Point-of-Care Blood Biomarker Algorithm to Identify Intracerebral Hemorrhage in the Prehospital Setting: Ready to Treat Brain Bleedings at the Ambulance

Abstract Background and aims Intracerebral hemorrhage (ICH) requires urgent and specific management strategies, such as early blood pressure lowering, which differ from those for ischemic stroke (IS). Rapid prehospital differentiation of ICH from IS remains an unmet clinical need. A panel combining GFAP and NT-proBNP was previously identified in the BIOFAST study (NCT04612218) as a tool to detect ICH in the hyperacute phase. We now aimed to validate this panel using a rapid point-of-care test (POCT) integrated with clinical variables. Methods A prospective study was conducted within the Seville Stroke Network. Whole blood samples were obtained within 24 hours of symptom onset and analyzed using the Exdia TRF Plus Analyzer, a portable fluorescence-based POCT platform measuring GFAP and NT-proBNP. Stroke type (ICH or IS) was classified based on neuroimaging findings and clinical evaluation. A diagnostic algorithm was built using the combination of GFAP, the NT-proBNP/GFAP ratio, and NIHSS at admission. The decision tree was generated using WEKA software and validated by 10-fold cross-validation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results A total of 64 patients were included (45 IS, 19ICH). The algorithm showed a sensitivity of 84.20%, specificity of 93.30%, PPV of 84.20%, and NPV of 93.30% for differentiating ICH from IS. Conclusions A rapid POCT-based algorithm combining blood biomarkers and clinical data can accurately identify ICH in the early phase of stroke. This strategy may enable targeted prehospital interventions such as the INTERACT-3 bundle, bringing hemorrhagic stroke care directly to the ambulance. Conflict of interest de Jesus, Auzmendi and Sanchez are employed of ABCDx SL.