Abstract TMP25: Potential of Rapid GFAP Levels in Acute Undifferentiated Stroke <24 Hours from Onset Using A Point-Of-Care Platform: An Exploratory Analysis of a Prospective Study
Bibliographic record
Abstract
Introduction: Glial fibrillary acidic protein (GFAP), highly brain-specific, is emerging as an attractive blood biomarker in acute stroke. GFAP can discriminate stroke type (ischemic stroke (IS), intracerebral hemorrhage (ICH), stroke mimics (SM) in the first hours after stroke onset. Rapid GFAP levels using novel point-of-care technology (results <15 minutes) may also offer insights in IS, particularly among those with unknown onset. In this study, we aim to evaluate the potential of rapid GFAP levels to distinguish among stroke types in acute undifferentiated stroke <24h from onset, as well as provide insights in IS of unknown onset. Methods: An exploratory analysis of an ongoing prospective study of patients with suspected undifferentiated stroke <24h from onset. Rapid plasma GFAP levels (pg/mL) are measured at hospital arrival using the i-STAT Alinity ® instrument and commercially-available cartridges. Study endpoints include quantitative GFAP levels according to final diagnosis (ICH, IS, SM), time from stroke onset/last seen well (<4.5h, 4.5-24h), and ASPECTS score (8-10 vs. <8). Results: Among the first 101 patients recruited (mean (±SD) 70.8±14.5 years, 48% female, median (IQR) NIHSS 9 (3-20), median ASPECTS (10 (8-10)), final diagnosis was IS (n=67 (33 LVO)), ICH (n=5), and SM (n=29). Median rapid GFAP levels were highest in ICH (3104 (2088-8622) pg/mL), and differed compared to IS (54 (30-100) pg/mL) and SM (29 (29-42) pg/mL), p<0.001. In IS, 58% patients presented <4.5h from onset, and 28% were wake-up strokes. Rapid GFAP levels were undetectable in 13/39 (33%) of IS <4.5h compared to 3/28 (11%) in IS >4.5h, p=0.03. Median GFAP levels was significantly higher in IS >4.5h (87 (42-134) pg/mL) compared to earlier presentations (44 (29-62) pg/mL, p=0.03). Lastly, median GFAP levels had fairly good discriminative ability to detect ASPECTS <8 (AUC 0.73 (95% CI: 0.55-0.91), p=0.003), with an optimal GFAP cutoff of 77 pg/mL (sensitivity 76.9%, specificity 76.9%). Conclusion: Rapid GFAP levels using novel point-of-care technology is feasible and show promise in acute stroke management. Beyond discrimination of stroke type, rapid GFAP levels appear to increase during the first 24 hours from IS onset and with extent of ischemic injury. These findings, although preliminary, suggest that rapid GFAP levels may inform treatment decisions in IS of unknown onset as well as optimize prehospital triage of acute undifferentiated stroke <24hours from onset.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".