Association of Serum GFAP With Hematoma Expansion and Poor Outcome After Intracerebral Hemorrhage: The Factor VII for ICH Trial
Author Type(s)
Faculty
Document Type
Abstract
Publication Date
3-2021
Journal Title
Stroke
Department
Neurology
Abstract
Background: Biomarkers may help identify patients most likely to benefit from therapies. We tested whether serum glial fibrillary acidic protein (GFAP), a biomarker elevated early after intracerebral hemorrhage (ICH) in response to blood-brain barrier disruption, is associated with hematoma expansion (HE) and outcome after ICH and whether GFAP levels modify the effect of factor VII treatment.
Methods: We performed an exploratory analysis of the recombinant activated factor VII for acute ICH (FAST) trial. FAST collected serum GFAP levels were collected at admission within 4 hours of ICH onset prior to factor VII treatment. We used regression analyses to evaluate the associations between serum GFAP, HE (dichotomized as >e; 33% or > 6 mL increase in ICH volume from baseline to 24h and as the absolute volume of expansion), and 3-month poor outcome (modified Rankin Scale score 4-6). We tested for interaction between GFAP and factor VII treatment by adding product terms to multivariable regression models.
Results: Of 841 enrolled patients, we included 567 (67%) with available GFAP levels (mean age 64 [SD 13], female sex 203 [37%]). GFAP was associated with HE (adjusted odds ratio [OR] 1.54, 95% CI 1.10-2.17) and poor outcome (adjusted OR 1.86, 95% CI 1.18-3.09). Compared to patients in the lowest GFAP quartile, those in the highest quartile had 2 times the odds of HE (95% CI 1.08-3.89) and 2.7 times the odds of a poor outcome (95% CI 1.33-5.70). GFAP modified the association between factor VII treatment and HE volume (multivariable interaction p=0.04): treatment was not associated with reduced HE volume in the lowest GFAP quartile (β -0.44, 95% CI -3.54 to 2.67), but was associated with reduced HE volume in higher quartiles (β -3.82, 95% CI -7.58 to -0.06).
Conclusions: In the FAST trial population, early GFAP levels were associated with HE and poor functional outcome. Factor VII treatment was associated with a greater reduction in HE volume in patients with higher GFAP levels. Serum GFAP may be useful for risk-stratifying patients early after ICH onset.
Recommended Citation
Leasure, A. C., Vanent, K. N., Bevers, M. B., Kimberly, W. T., Mayer, S., Steiner, T., Matouk, C. C., Sansing, L. H., Falcone, G. J., & Sheth, K. N. (2021). Association of Serum GFAP With Hematoma Expansion and Poor Outcome After Intracerebral Hemorrhage: The Factor VII for ICH Trial. Stroke, 52 (Suppl. 1), AP410. https://doi.org/10.1161/str.52.suppl_1.P410
