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Serum biomarker dynamics for predicting clinical outcomes and hemorrhagic transformation in acute ischemic stroke:A
Hongyan Li1, Xuegang Meng1, Zhu Li1
1Xinjiang Clinical Research Center for Stroke and Neurological Rare Disease, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
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.
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