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(Stroke. 2007;38:1489.)
© 2007 American Heart Association, Inc.

Original Contributions

Serum Glial Fibrillary Acidic Protein Is Related to Focal Brain Injury and Outcome After Aneurysmal Subarachnoid Hemorrhage

Karin Nylén, MD; Ludwig Z. Csajbok, MD; Martin Öst, MD; Anas Rashid, MD; Kaj Blennow, MD, PhD; Bengt Nellgård, MD, PhD Lars Rosengren, MD, PhD

From Department of Neurology (K.N., L.R.), Institute of Clinical Neuroscience, Department of Anaesthesia (L.Z.C., M.O., B.N.), Neurointensive Care Unit, Department of Neuroradiology (A.R.), Unit of Experimental Neuroscience (K.B.), Institute of Clinical Neuroscience, Sahlgrenska University Hospital, University of Göteborg, Sweden.

Correspondence to Karin Nylén, MD, Department of Neurology, Sahlgrenska University Hospital, University of Göteborg, 413 45 Göteborg, Sweden. E-mail karin.nylen{at}neuro.gu.se

Background and Purpose— Aneurysmal subarachnoid hemorrhage (aSAH) stands out from other subtypes of stroke because of the high early mortality and the risk of complications. Serum glial fibrillary acidic protein (s-GFAP) concentrations are increased after stroke. The aim of this study was to investigate whether s-GFAP could be used as a marker of brain damage and outcome after aSAH.

Methods— Serum samples were obtained on a regular basis from 116 adults during a 2-week period after aSAH and analyzed using an enzyme-linked immunosorbent assay. The World Federation of Neurological Surgeons scale was used for neurological evaluation. Outcome was assessed after 1 year and categorized according to the Extended Glasgow Outcome Scale.

Results— Increased s-GFAP levels were seen in 81 of the 116 patients. Maximum s-GFAP correlated with World Federation of Neurological Surgeons scale on arrival and on days 10 to 15 (r=0.37, P<0.001 and r=0.47, P<0.001, respectively). Furthermore, maximum s-GFAP levels were increased in the patient group with radiological signs of focal lesions acute or at 1 year, compared with the group without focal lesions (P<0.001 in both comparisons). Patients with secondary events (re-bleeding or ischemia) reached maximum levels later in the series and both maximum and final s-GFAP levels increased compared with the levels in patients without secondary events (P<0.001 in all 3 comparisons). Finally, maximum s-GFAP correlated with outcome (r=–0.48, P<0.001) and s-GFAP was an independent predictor of dichotomized outcome.

Conclusions— s-GFAP provides information about brain injury severity and outcome after aSAH, which can be useful as a complement to clinical data.

Key Words: outcome • s-GFAP • subarachnoid hemorrhage