Dynamic Changes in Serum Glial Fibrillary Acidic Protein Levels Predicts Early Neurological Deterioration After Intravenous Thrombolysis in Minor Stroke

Q: What are the key findings of this study?

An elevated dynamic change in serum GFAP (∆GFAP) after intravenous thrombolysis independently predicted early neurological deterioration in patients with minor strokes (adjusted OR 4.64, p < 0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Minor stroke (n=272). Intervention: Elevated dynamic change in serum GFAP (∆GFAP) vs. Lower ∆GFAP. Primary outcome: Early neurological deterioration (END), defined as an increase in the NIHSS score ≥ 4 at 24 h after IVT (adjusted OR 4.64, 95% CI 1.86 to 11.54, p=< 0.001).

Q: What does this research mean for the field?

An elevated dynamic change in serum glial fibrillary acidic protein (∆GFAP) after intravenous thrombolysis independently predicts early neurological deterioration in patients with minor ischemic stroke. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the role of dynamic changes in serum glial fibrillary acidic protein (GFAP) levels in predicting early neurological deterioration following intravenous thrombolysis in patients with minor stroke.

Jie Zhou; Yang Qu; Reziya Abuduxukuer; Peng Zhang; Ting Wang; Jian‐Hua Gao; De-Wang Pan; Zhi‐Mei Yuan; Chun‐Ying Li; Liping Chen; Jin‐Hua Chen; Ji‐Liang Gu; An‐Ying Wang; Li‐Gang Jiang; Liang Liu; Yong‐Fei Jiang; Chun‐Fei Wang; Yan Jia; Hong Xin; Chun‐Li Jiang; Ying‐Bin Qi; Xue‐Feng Hu; Song Li; Hang Jin; Zhen‐Ni Guo; Yi Yang; the Biomarkers of Brain Injury Investigator Study Group

doi:10.1002/acn3.70552

Key result

Elevated post-thrombolysis serum ∆GFAP linked to ~4.6-fold higher odds of early neurological deterioration in minor stroke.

adjusted OR 4.64
95% CI 1.86 to 11.54
P<0.001
n=272

Figures

Why the study?

Minor strokes may be associated with early neurological deterioration and disabilities, but the role of serum GFAP levels in predicting END is unclear.

Does the dynamic change in serum GFAP levels (∆GFAP) predict early neurological deterioration in patients with minor strokes receiving intravenous thrombolysis?

Key Points

To evaluate the role of dynamic changes in serum glial fibrillary acidic protein (GFAP) levels in predicting early neurological deterioration following intravenous thrombolysis in patients with minor stroke.
Prospective multicenter cohort study analyzing 272 patients with minor ischemic stroke who underwent intravenous thrombolysis.
Calculated ΔGFAP as the ratio of serum GFAP at 24 hours post-thrombolysis to baseline pre-thrombolysis GFAP.
Assessed independent associations with early neurological deterioration using univariable and multivariable logistic regression and developed a predictive nomogram model.
Early neurological deterioration occurred in 20 (7.35%) of the 272 patients, and favorable 90-day outcomes occurred in 25.0% of deteriorated patients versus 67.1% of non-deteriorated patients (p < 0.001).
Elevated ΔGFAP was independently associated with early neurological deterioration in univariable analysis (OR, 3.50; 95% CI, 1.67 to 7.31; p < 0.001) and remained significant after multivariable adjustment (adjusted OR, 4.64; 95% CI, 1.86 to 11.54; p < 0.001).
A prognostic nomogram combining ΔGFAP, age, and admission NIHSS score demonstrated good discriminative ability for predicting early neurological deterioration (AUC = 0.77; 95% CI, 0.67 to 0.89).

Study Design

Type

Cohort (n=272)

Blinding

Assessor-blinded

Multicenter

Yes

Structured PICO

Does the dynamic change in serum GFAP levels (∆GFAP) predict early neurological deterioration in patients with minor strokes receiving intravenous thrombolysis?

P

Population

272 adult patients with minor ischemic stroke (NIHSS ≤ 5) receiving intravenous thrombolysis within 4.5 hours of symptom onset, followed for 90 days.

E

Exposure

Measurement of dynamic changes in serum glial fibrillary acidic protein (∆GFAP), calculated as the ratio of post-thrombolysis GFAP at 24 hours to baseline GFAP.

O

Outcome

Early neurological deterioration (END), defined as an increase in the NIHSS score ≥4 at 24 hours after intravenous thrombolysis.hard clinical

Main Result

Odds Ratio: 4.64 (95% CI 1.86–11.54)

p-value: p=< 0.001

An elevated ratio of 24-hour to baseline serum GFAP is a strong, independent predictor of early neurological deterioration in patients with minor stroke treated with intravenous thrombolysis, which may facilitate early identification of high-risk patients.

Limitations

Did not differentiate between disabling and non‐disabling minor strokes
Lacked a control group of patients receiving standard medical care without IVT
Insufficient sample size to make more precise predictions for hemorrhagic and ischemic conditions
Did not differentiate between disabling and non-disabling minor strokes
Lacked a control group of patients receiving standard medical care without intravenous thrombolysis
Insufficient sample size to make more precise predictions for hemorrhagic and ischemic early neurological deterioration conditions

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Implication

May aid early risk stratification post-thrombolysis in minor stroke; extends GFAP biomarker data but remains hypothesis-generating.

Abstract

Objective Minor strokes may be associated with early neurological deterioration (END) and disabilities. The objective was to investigate the role of serum glial fibrillary acidic protein (GFAP) levels in predicting END. Methods Data originated from a multicenter cohort study conducted prospectively. ΔGFAP was calculated as the ratio of post‐thrombolysis GFAP at 24 h to baseline GFAP. Univariable and multivariable binary logistic regression analyses were performed to assess the association between ∆GFAP and END, and a nomogram was established to illustrate its predictive value. Results END occurred in 20 (7.35%) of the 272 patients with minor stroke who underwent intravenous thrombolysis (IVT). Elevated ∆GFAP was independently associated with END (OR, 3.50; 95% CI, 1.67 to 7.31; p < 0.001), even after adjusting for confounders (adjusted OR, 4.64; 95% CI, 1.86 to 11.54; p < 0.001). Furthermore, a model combining ∆GFAP, age, and National Institutes of Health Stroke Scale (NIHSS) score at admission demonstrated a good predictive value for END (AUC = 0.77; 95% CI, 0.67 to 0.89). Interpretation ∆GFAP is a strong, independent predictor of END in patients with minor strokes. Integrating ∆GFAP, age, and NIHSS score into a prognostic model results in a good discriminative ability for predicting END.

Discussion

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Cite This Study

Zhou et al. (2026) conducted a cohort in Minor stroke (n=272). Elevated dynamic change in serum GFAP (∆GFAP) vs. Lower ∆GFAP was evaluated on Early neurological deterioration (END), defined as an increase in the NIHSS score ≥ 4 at 24 h after IVT (adjusted OR 4.64, 95% CI 1.86 to 11.54, p=< 0.001). An elevated dynamic change in serum GFAP (∆GFAP) after intravenous thrombolysis independently predicted early neurological deterioration in patients with minor strokes (adjusted OR 4.64, p < 0.001).

synapsesocial.com/papers/6ad8a1e74fe90d57c13299c5 https://doi.org/10.1002/acn3.70552

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Dynamic Changes in Serum Glial Fibrillary Acidic Protein Levels Predicts Early Neurological Deterioration After Intravenous Thrombolysis in Minor Stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Dynamic Changes in Serum Glial Fibrillary Acidic Protein Levels Predicts Early Neurological Deterioration After Intravenous Thrombolysis in Minor Stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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