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  • 1
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    Abstract 57: Rapid Prehospital Diagnosis of Intracerebral Hemorrhage by Measuring GFAP on a Point-of-Care Platform
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Kurzfassung: Background: The rapid differentiation between intracerebral hemorrhage (ICH) and ischemic stroke (IS) in patients with symptoms of acute stroke is decisive for triage and initiation of targeted therapies. Glial fibrillary acidic protein (GFAP) is a highly promising blood biomarker indicating acute ICH. In this study we investigated the potential of a new GFAP plasma test on a point-of-care (POC) platform for rapidly distinguishing ICH from IS in the prehospital phase. Methods: Patients with symptoms of acute stroke admitted within 6 hours of symptom onset were enrolled. Blood samples were collected already in the prehospital phase in most patients. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min). The primary endpoint was the final diagnosis at hospital discharge categorized as ICH, IS or stroke mimics. Results: 155 patients were enrolled (mean age 75±13, 49% females; final diagnosis 33 ICH, 115 IS, 7 stroke mimics). Prehospital GFAP serum concentrations were strongly elevated in ICH patients compared to IS patients (mean 2283±3821 pg/mL, median 144 [IQR 52.5-2562] vs. mean 45±25 pg/mL, median 29 [IQR 29-53] ; p 〈 0.001). In patients with a moderate to severe neurological deficit (NIHSS 〉 7), GFAP values below 30 pg/mL were associated with a negative predictive value of 100% (i.e. ruling out ICH). The probability of ICH increased in parallel with higher GFAP levels. GFAP concentrations above 120 pg/mL indicated ICH with a positive predictive value of 94%. Conclusion: Rapid prehospital GFAP measurements on a point-of-care platform allow a reliable differentiation between patients with IS and ICH. This opens the potential for optimized triage and for the administration of antidots in severely affected patients with suspected anticoagulation-associated ICH.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.57
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2024
    ZDB Id: 1467823-8
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  • 2
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    Abstract 151: GFAP Measurements for Rapid Prehospital Identification of Intracranial Hemorrhage in Patients With Acute Coma
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Kurzfassung: Background: Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathogenetic conditions are highly heterogenous and difficult to assess. Glial fibrillary acidic protein (GFAP) has been recently identified as a biomarker of intracerebral hemorrhage. The aim of this study was to test the diagnostic value of a GFAP point-of-care(poc) device to rapidly differentiate intracranial hemorrhage from other causes of acute coma (including seizures, metabolic disorders, cardiovascular disorders, and intoxication) in the prehospital phase. Methods: Patients who were admitted to the emergency department due to acute coma (Glasgow Coma Scale scores between 3-8) were enrolled prospectively. Blood samples were collected already in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min). The primary endpoint was the final diagnosis at hospital discharge. Results: 95 patients were enrolled (mean age 64±20 years, 43% female). GFAP concentrations were strongly elevated in patients with a primary cerebral cause of coma compared to primary non-cerebral causes (p 〈 0.001). The GFAP concentrations (mean±SD in pg/mL) according to final diagnosis were as follows: intracerebral hemorrhage 4840±4500 (n=15), subarachnoid hemorrhage 4858±4662 (n=11), subdural or epidural hematoma 3462±4005 (n=4), ischemic stroke 992±2857 (n=12), seizure 45±21 (n=11), cardiovascular or metabolic disorder 258±888 (n=29), intoxication 30±2 (n=6), psychogenic stupor 29±0 (n=2); n=5 patients had missing diagnoses. GFAP values over 1000 pg/ml indicated a primary cerebral cause of coma with 100% certainty (hereof, 86% had intracranial hemorrhage). Conclusion: Increased GFAP plasma values in patients with acute coma identify a primary cerebral cause of coma (mostly intracranial hemorrhage) with very high diagnostic accuracy. Patients with primary non-cerebral causes of coma showed overall low GFAP concentrations. Prehospital GFAP measurements on a poc platform may allow rapid stratification according to the underlying cause of coma by rescue services. This could have major impact on triage and management of these critically ill patients.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.151
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2024
    ZDB Id: 1467823-8
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  • 3
    Online-Ressource
    Online-Ressource
    Glial Fibrillary Acidic Protein Serum Levels Distinguish between Intracerebral Hemorrhage and Cerebral Ischemia in the Early Phase of Stroke
    Oxford University Press (OUP) ; 2017
    In:  Clinical Chemistry Vol. 63, No. 1 ( 2017-01-01), p. 377-385
    Details
    In: Clinical Chemistry, Oxford University Press (OUP), Vol. 63, No. 1 ( 2017-01-01), p. 377-385
    Kurzfassung: Recent studies have suggested that glial fibrillary acidic protein (GFAP) serum concentrations distinguish between intracerebral hemorrhage (ICH) and ischemic stroke (IS) shortly after symptom onset. In this prospective multicenter trial we validated GFAP in an independent patient cohort and assessed the quantitative relationship between GFAP release, bleeding size, and localization. METHODS We included patients with a persistent neurological deficit (NIH Stroke Scale ≥4) suggestive of stroke within 6 h of symptom onset. Blood samples were drawn at hospital admission. GFAP serum concentrations were measured using an electrochemiluminometric immunoassay. Primary endpoint was the final diagnosis established at hospital discharge (ICH, IS, or stroke mimic). RESULTS 202 patients were included (45 with ICH, 146 with IS, 11 stroke mimics). GFAP concentrations were significantly higher in ICH than in IS patients [median (interquartile range) 0.16 μg/L (0.04–3.27) vs 0.01 μg/L (0.01–0.01), P & lt;0.001]. A GFAP cutoff of 0.03 μg/L provided a sensitivity of 77.8% and a specificity of 94.2% in distinguishing ICH from IS and stroke mimics [ROC analysis area under the curve 0.872 (95% CI, 0.802–0.942), P & lt;0.001]. GFAP serum concentrations were positively correlated with ICH volume. Lobar ICH volumes were larger and thus associated with higher GFAP concentrations as compared to deep ICH. CONCLUSIONS Serum GFAP was confirmed to be a biomarker indicating ICH in patients presenting with acute stroke symptoms. Very small ICH may be missed owing to less tissue destruction.
    Materialart: Online-Ressource
    ISSN: 0009-9147 , 1530-8561
    URL: Article
    DOI: 10.1373/clinchem.2016.263335
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2017
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  • 4
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    Online-Ressource
    Predictors of Dysphagia in Acute Pontine Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 5 ( 2017-05), p. 1397-1399
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 5 ( 2017-05), p. 1397-1399
    Kurzfassung: Little is known about the frequency and the clinical characteristics of neurogenic dysphagia in pontine strokes. In this study, we sought to identify predictors for dysphagia in a cohort of patients with isolated pontine infarctions. Methods— We included all patients admitted to our department between 2008 and 2014 having an acute ( 〈 48 hours after symptom onset) ischemic stroke in the pons, as documented by means of diffusion-weighted magnetic resonance imaging. Precise infarct localization was stratified according to established vascular territories. The presence of dysphagia was the primary end point of the study and was assessed by a Speech-Language Pathologist according to defined criteria. Results— The study recruited 59 patients, 14 with and 45 without dysphagia. Median (interquartile range) stroke severity (in terms of National Institutes of Health Stroke Scale values) was higher in the dysphagic group as compared with patients without dysphagia (8.5 [6–12] versus 2 [1–5] ; P 〈 0.001). Infarct localization in the upper part of the pons (78.6% versus 33.3%; P =0.004) and in the anterolateral vascular territory (78.6% versus 31.1%; P =0.002) occurred more often in the dysphagic group. In a multivariate model, age, infarct volume, and National Institutes of Health Stroke Scale value were independent predictors of dysphagia. Conclusions— Dysphagia occurs frequently in patients with isolated pontine infarctions. Clinical and imaging predictors of dysphagia may help to provide optimal screening, to prevent complications and to improve long-term prognosis.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.015045
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2017
    ZDB Id: 1467823-8
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  • 5
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    Differential expression of CD8 defines phenotypically distinct cytotoxic T cells in cancer and multiple sclerosis
    Wiley ; 2022
    In:  Clinical and Translational Medicine Vol. 12, No. 12 ( 2022-12)
    Details
    In: Clinical and Translational Medicine, Wiley, Vol. 12, No. 12 ( 2022-12)
    Kurzfassung: Cytotoxic T lymphocytes take on a leading role in many immune‐related diseases. They function as key effector immune cells fighting cancer cells, but they are also considerably involved in autoimmune diseases. Common to both situations, CD8 + T cells need to adapt their metabolism and effector function to the harsh and nutrient‐deprived conditions of the disease‐associated microenvironment. Methods We used an in vitro starvation as well as rapamycin treatment protocol mimicking nutrient deprivation to generate CD8 Low versus CD8 High T cells and performed FACS‐Sorting followed by transcriptomic profiling of the cytotoxic T cell subsets. Prominent markers identified in the CD8 Low versus the CD8 High T cells were then used to investigate the presence of these cell subsets in immune‐related human diseases. Employing cancer tissue microarrays and PhenOptics multispectral imaging as well as flow cytometry, we studied these CD8 + T cell subsets in cancer and relapsing‐remitting multiple sclerosis patients. Results Starvation induced a decreased expression of CD8, yielding a CD8 Low T cell subpopulation with an altered transcriptomic signature and reduced effector function. CD8 Low T cell showed enhanced ST2L and IL6ST (CD130) expression compared to CD8 High T cells which expressed elevated KLRD1 (CD94) and granzyme B levels within the tumour microenvironment (TME). Spatial analysis revealed the presence of CD8 High T cells in close proximity to tumour cells, while the CD8 Low T cells resided at the tumour boundaries. Importantly, the number of tumour‐infiltrating CD8 Low T lymphocytes correlated with a poor prognosis as well as with enhanced cancer progression in human mammary carcinoma. We also found a reduced frequency of CD8 Low T lymphocytes in a cohort of relapse (disease active) multiple sclerosis patients compared to healthy subjects during immune cell starvation in vitro. Conclusions In summary, our data show that functionally distinct cytotoxic T lymphocytes can be identified based on their expression of CD8. Indicating a more general role in CD8 T cell immunity, these cells may play opposing roles in the TME, and also in the pathophysiology of autoimmune diseases such as multiple sclerosis.
    Materialart: Online-Ressource
    ISSN: 2001-1326 , 2001-1326
    URL: Issue
    URL: Article
    DOI: 10.1002/ctm2.v12.12
    DOI: 10.1002/ctm2.1068
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2022
    ZDB Id: 2697013-2
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  • 6
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    Abstract TP413: Prediction of Dysphagia Using the Alberta Stroke Program Early CT Score
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Kurzfassung: Background: Dysphagia is common in patients with acute middle cerebral artery (MCA) stroke, and associated with malnutrition, pneumonia and mortality. Hence, identification of patients with swallowing disorder early after stroke onset is important. Besides bedside screening tools, brain imaging findings including lesion size and location may be of value. We investigated whether The Alberta stroke program early CT score (ASPECTS) can be used to predict dysphagia, and whether differences exist herein between the left and the right hemisphere. Methods: The analysis was based on a prospective dataset of 113 patients with acute ischemic stroke in the MCA territory. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed within 24 h after admission for validation of dysphagia. Brain imaging (CT or MRI) was rated for ischemic changes according to the ASPECT score. Results: 62 patients (54.9%) had FEES-proven dysphagia. In left hemispheric strokes the strongest associations between the ASPECTS sectors and dysphagia were found for the lentiform nucleus (ExpB 0.113 [CI 0.028-0.433; p=0.001), the insula (0.275 [0.102-0.742]; p=0.011) and the frontal operculum (0.280 [CI 0.094-0.834] ; p=0.022). For right hemispheric strokes, only non-significant associations were found which were strongest for the insula region (0.385 [0.107-1.384]; p=0.144). For the left hemisphere multivariate logistic regression analysis revealed lower ASPECT scores to be independently associated with dysphagia, whereas for the right hemisphere this association was not present. Conclusion: The distribution and extent of early ischemic changes in brain imaging according to ASPECTS allows a reliable prediction of dysphagia in MCA-stroke patients, particularly for the left hemisphere.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.TP413
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2019
    ZDB Id: 1467823-8
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  • 7
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    Prescription Frequency and Predictors for the Use of Novel Direct Oral Anticoagulants for Secondary Stroke Prevention in the First Year after Their Marketing in Europe – A Multicentric Evaluation
    SAGE Publications ; 2014
    In:  International Journal of Stroke Vol. 9, No. 5 ( 2014-07), p. 569-575
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 9, No. 5 ( 2014-07), p. 569-575
    Kurzfassung: Direct oral anticoagulants (DOAC) are alternatives to the use of vitamin K antagonists (VKA) as oral anticoagulant therapies to prevent stroke in patients with atrial fibrillation. Aims We assembled a representative secondary prevention cohort from four tertiary care stroke centers to identify factors that independently influence therapeutic decision making 1) not to anticoagulate with either VKA or DOAC and 2) to use DOAC if the patient appears suitable for oral anticoagulant therapy. Methods We identified all patients discharged with the diagnoses ‘ischemic stroke’ (ICD-10 code 163) or ‘transient ischemic attack’ (G45) in combination with ‘atrial fibrillation’ (148) during 1 year. We performed binary logistic regression analyses to identify factors independently influencing the aforementioned decisions. Results Our cohort comprised 758 patients. At discharge from the stroke service, 374 patients (49·3%) received oral anticoagulant therapy. Older age, severe stroke, poor recovery in the acute phase, and higher serum creatinine were independent factors to withhold oral anticoagulant therapy, whereas prior oral anticoagulant therapy favored the decision to anticoagulate. Among patients who were anticoagulated, prescription was balanced for VKA (50·3%) and DOAC (49·7%). Renal function and prior oral anticoagulant therapies were the most important factors in this decision. Conclusions Shortly after their marketing, DOAC are used as frequently as VKA for secondary stroke prevention in patients with atrial fibrillation. The decision between VKA and DOAC is mainly determined by the patient's renal function and the absence or presence of prior oral anticoagulant therapy.
    Materialart: Online-Ressource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1111/ijs.12289
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2014
    ZDB Id: 2211666-7
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  • 8
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    Role of S100B Serum Concentration as a Surrogate Outcome Parameter After Mechanical Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology Vol. 97, No. 22 ( 2021-11-30), p. e2185-e2194
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 97, No. 22 ( 2021-11-30), p. e2185-e2194
    Kurzfassung: To establish serum concentration of protein S100B as an objective biomarker surrogate for astroglial tissue damage after mechanical thrombectomy in patients with acute ischemic stroke. Methods This prospective 2-center study recruited patients with acute middle cerebral artery infarctions caused by large vessel occlusion treated with mechanical thrombectomy. Blood samples were collected at day 2 after intervention and analyzed for S100B serum concentrations using ELISA techniques. Infarct size was determined on follow-up brain imaging and functional outcome according to modified Rankin Scale (mRS) was assessed at 90 days. Results A total of 171 patients were included (mean age ± SD: 70 ± 14 years, 42% female). S100B levels correlated with infarct size. Median S100B concentrations at day 2 after intervention were lower in patients with favorable outcome (mRS score 0–1) at 90 days compared to patients with unfavorable outcome (mRS score 2–6) (median 0.10 µg/L [interquartile range 0.07–0.14] vs 0.20 µg/L [0.11–0.48] , p 〈 0.001). Younger age (odds ratio [OR] 1.120 [confidence interval (CI) 1.068–1.174] ; p 〈 0.001), lower National Institutes of Health Stroke Scale score 24 hours after symptom onset (OR 1.232 [CI 1.106–1.372]; p 〈 0.001), and lower S100B serum concentrations (OR 1.364 [CI 1.105–1.683]; p = 0.004) were independently associated with a favorable outcome. S100B was able to eliminate the lateralization bias associated with the use of mRS for functional outcome assessment at 90 days after stroke. Discussion S100B serum concentrations after mechanical thrombectomy indicate the extent of ischemic tissue damage. This can be assessed rapidly, independent of brain imaging and clinical outcome scales. Following prospective validation in further studies, this may provide an objective surrogate outcome measure both in clinical routine and interventional trials. Classification of Evidence This study provides Class I evidence that S100B 2 days following mechanical thrombectomy for acute ischemic stroke accurately distinguishes favorable from unfavorable functional outcome.
    Materialart: Online-Ressource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000012918
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2021
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  • 9
    Online-Ressource
    Online-Ressource
    Ischemic Lesion Location Based on the ASPECT Score for Risk Assessment of Neurogenic Dysphagia
    Springer Science and Business Media LLC ; 2021
    In:  Dysphagia Vol. 36, No. 5 ( 2021-10), p. 882-890
    Details
    In: Dysphagia, Springer Science and Business Media LLC, Vol. 36, No. 5 ( 2021-10), p. 882-890
    Kurzfassung: Dysphagia is common in patients with middle cerebral artery (MCA) infarctions and associated with malnutrition, pneumonia, and mortality. Besides bedside screening tools, brain imaging findings may help to timely identify patients with swallowing disorders. We investigated whether the Alberta stroke program early CT score (ASPECTS) allows for the correlation of distinct ischemic lesion patterns with dysphagia. We prospectively examined 113 consecutive patients with acute MCA infarctions. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed within 24 h after admission for validation of dysphagia. Brain imaging (CT or MRI) was rated for ischemic changes according to the ASPECT score. 62 patients (54.9%) had FEES-proven dysphagia. In left hemispheric strokes, the strongest associations between the ASPECTS sectors and dysphagia were found for the lentiform nucleus (odds ratio 0.113 [CI 0.028–0.433; p  = 0.001), the insula (0.275 [0.102–0.742]; p  = 0.011), and the frontal operculum (0.280 [CI 0.094–0.834]; p  = 0.022). A combination of two or even all three of these sectors together increased relative dysphagia frequency up to 100%. For right hemispheric strokes, only non-significant associations were found which were strongest for the insula region. The distribution of early ischemic changes in the MCA territory according to ASPECTS may be used as risk indicator of neurogenic dysphagia in MCA infarction, particularly when the left hemisphere is affected. However, due to the exploratory nature of this research, external validation studies of these findings are warranted in future.
    Materialart: Online-Ressource
    ISSN: 0179-051X , 1432-0460
    URL: Article
    DOI: 10.1007/s00455-020-10204-0
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2021
    ZDB Id: 1459017-7
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  • 10
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    Online-Ressource
    Diagnostic Accuracy of Glial Fibrillary Acidic Protein and Ubiquitin Carboxy-Terminal Hydrolase-L1 Serum Concentrations for Differentiating Acute Intracerebral Hemorrhage from Ischemic Stroke
    Springer Science and Business Media LLC ; 2020
    In:  Neurocritical Care Vol. 33, No. 1 ( 2020-08), p. 39-48
    Details
    In: Neurocritical Care, Springer Science and Business Media LLC, Vol. 33, No. 1 ( 2020-08), p. 39-48
    Materialart: Online-Ressource
    ISSN: 1541-6933 , 1556-0961
    URL: Article
    DOI: 10.1007/s12028-020-00931-5
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2020
    ZDB Id: 2176033-0
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