Abstract Body: Hemorrhagic strokes (HS) are increasingly significant causes of disability and mortality worldwide, making the use of blood biomarkers for their diagnosis and prognosis critical. Inflammatory markers in peripheral blood reflect the body's response to acute cerebrovascular incidents, and monitoring these during the acute phase of HS can provide valuable insights into disease progression and potential deterioration.
This prospective observational study, conducted without medical intervention, involved 130 patients with clinically and instrumentally verified hemorrhagic strokes in the acute phase, all with hypertension, and a control group of 30 individuals without stroke, average age 60 years. Upon admission, patients were assessed for consciousness and neurological status using the FOUR and NIHSS scales. Blood samples for Glial Fibrillary Acidic Protein (GFAP), a marker of astroglial damage, were collected within the first 24-30 hours after onset and analyzed using ELISA. All patients also underwent CT and MRI brain scans.
Statistical analysis was performed using multivariate linear regression and ROC analysis. The study found that GFAP levels were significantly higher in HS patients, particularly among those with fatal outcomes. Survivors had GFAP levels of 1.35 ng/mL, while deceased patients had levels of 1.94 ng/mL (p<0.05), suggesting the utility of GFAP in assessing HS severity and prognosis. GFAP levels were also significantly elevated in patients with an initial hematoma volume > 50 mL. These findings were used to develop multivariate binary logistic regression models for predicting HS outcomes during the acute phase.
The prognostic model, incorporating GFAP levels, FOUR and NIHSS scores, hematoma volume, perifocal edema, and midline structure shift, demonstrated a 95% sensitivity in determining fatal outcomes. GFAP, synthesized by astrocytes, plays a critical role in astrocyte differentiation, neuronal energy supply, blood-brain barrier formation, and reparative processes post-hemorrhage. Given its role as a marker of cellular damage and its regulatory function in brain repair, GFAP and other biomarkers should be employed to assess patient condition severity and guide the development of new therapeutic strategies for hemorrhagic strokes.