GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma
Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospect...
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| Veröffentlicht in: | Critical care (London, England) England), 2024-04, Vol.28 (1), p.109-109, Article 109 |
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| creator | Zylyftari, Sabina Luger, Sebastian Blums, Kristaps Barthelmes, Stephan Humm, Sebastian Baum, Hannsjörg Meckel, Stephan Braun, Jörg Lichy, Gregor Heilgeist, Andreas Kalra, Love-Preet Foerch, Christian |
| description | Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospective study was to test whether prehospital GFAP measurements on a point-of-care device have the potential to rapidly differentiate intracranial hemorrhage from other causes of acute coma.
This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min) shortly after hospital admission.
143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613-10001] vs. 43 pg/mL [IQR 29-91.25], p |
| doi_str_mv | 10.1186/s13054-024-04892-5 |
| format | Article |
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This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min) shortly after hospital admission.
143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613-10001] vs. 43 pg/mL [IQR 29-91.25], p < 0.001). When using an optimal cut-off value of 101 pg/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). In-hospital mortality risk was associated with prehospital GFAP values.
Increased GFAP plasma concentrations in patients with acute coma identify intracranial hemorrhage with high diagnostic accuracy. Prehospital GFAP measurements on a point-of-care platform 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.</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>EISSN: 1366-609X</identifier><identifier>DOI: 10.1186/s13054-024-04892-5</identifier><identifier>PMID: 38581002</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Analysis ; Anticoagulants ; Biological markers ; Biomarkers ; Brain ; Brain cancer ; Causes of ; Coma ; Convulsions & seizures ; Epidural ; Epilepsy ; Etiology ; Health aspects ; Hematoma ; Hemorrhage ; Hospitals ; Identification and classification ; Infections ; Ischemia ; Medical diagnosis ; Metabolism ; Patients ; Plasma ; Proteins ; Stroke ; Trauma ; Traumatic brain injury</subject><ispartof>Critical care (London, England), 2024-04, Vol.28 (1), p.109-109, Article 109</ispartof><rights>2024. The Author(s).</rights><rights>COPYRIGHT 2024 BioMed Central Ltd.</rights><rights>2024. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c393t-52606f493cf6ce5debf554bb452022e8f09e26cbecdb1ac1cbde6c64e63728033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38581002$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zylyftari, Sabina</creatorcontrib><creatorcontrib>Luger, Sebastian</creatorcontrib><creatorcontrib>Blums, Kristaps</creatorcontrib><creatorcontrib>Barthelmes, Stephan</creatorcontrib><creatorcontrib>Humm, Sebastian</creatorcontrib><creatorcontrib>Baum, Hannsjörg</creatorcontrib><creatorcontrib>Meckel, Stephan</creatorcontrib><creatorcontrib>Braun, Jörg</creatorcontrib><creatorcontrib>Lichy, Gregor</creatorcontrib><creatorcontrib>Heilgeist, Andreas</creatorcontrib><creatorcontrib>Kalra, Love-Preet</creatorcontrib><creatorcontrib>Foerch, Christian</creatorcontrib><title>GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma</title><title>Critical care (London, England)</title><addtitle>Crit Care</addtitle><description>Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospective study was to test whether prehospital GFAP measurements on a point-of-care device have the potential to rapidly differentiate intracranial hemorrhage from other causes of acute coma.
This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min) shortly after hospital admission.
143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613-10001] vs. 43 pg/mL [IQR 29-91.25], p < 0.001). When using an optimal cut-off value of 101 pg/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). In-hospital mortality risk was associated with prehospital GFAP values.
Increased GFAP plasma concentrations in patients with acute coma identify intracranial hemorrhage with high diagnostic accuracy. Prehospital GFAP measurements on a point-of-care platform 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.</description><subject>Analysis</subject><subject>Anticoagulants</subject><subject>Biological markers</subject><subject>Biomarkers</subject><subject>Brain</subject><subject>Brain cancer</subject><subject>Causes of</subject><subject>Coma</subject><subject>Convulsions & seizures</subject><subject>Epidural</subject><subject>Epilepsy</subject><subject>Etiology</subject><subject>Health aspects</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Hospitals</subject><subject>Identification and classification</subject><subject>Infections</subject><subject>Ischemia</subject><subject>Medical diagnosis</subject><subject>Metabolism</subject><subject>Patients</subject><subject>Plasma</subject><subject>Proteins</subject><subject>Stroke</subject><subject>Trauma</subject><subject>Traumatic brain injury</subject><issn>1364-8535</issn><issn>1466-609X</issn><issn>1364-8535</issn><issn>1366-609X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkU1r3DAQhkVpyVf7B3IIglx6UarvlY9LaNJCoD00kJuQ5dGugm05kn3ov4_cTVNaihgkRu8zmtGL0DmjV4wZ_akwQZUklNeQpuFEvUEnTGpNNG0e3taz0JIYJdQxOi3lkVK2MVocoWNhlGGU8hPkbm-23_GU4jiTFIh3GfAAriwZBhhnHFLGU4Z9KlOcXY-76HZjKrHgFHCFsvPZjbHe7GFIOe_dDmoeO7_MgH0a3Hv0Lri-wIeX_Qzd33z-cf2F3H27_Xq9vSNeNGImimuqg2yED9qD6qANSsm2lYpTzsEE2gDXvgXftcx55tsOtNcStNhwQ4U4Qx8PdaecnhYosx1i8dD3boS0FCuokFwKpk2VXv4jfUxLHmt3q6r-USM3-o9q53qwcQxpnXYtarcb09BGMrM-e_UfVV0dDNGnEUKs-b8AfgB8TqVkCHbKcXD5p2XUrr7ag6-2-mp_-WpVhS5eOl7aAbpX5LeR4hlccZzk</recordid><startdate>20240405</startdate><enddate>20240405</enddate><creator>Zylyftari, Sabina</creator><creator>Luger, Sebastian</creator><creator>Blums, Kristaps</creator><creator>Barthelmes, Stephan</creator><creator>Humm, Sebastian</creator><creator>Baum, Hannsjörg</creator><creator>Meckel, Stephan</creator><creator>Braun, Jörg</creator><creator>Lichy, Gregor</creator><creator>Heilgeist, Andreas</creator><creator>Kalra, Love-Preet</creator><creator>Foerch, Christian</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20240405</creationdate><title>GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma</title><author>Zylyftari, Sabina ; Luger, Sebastian ; Blums, Kristaps ; Barthelmes, Stephan ; Humm, Sebastian ; Baum, Hannsjörg ; Meckel, Stephan ; Braun, Jörg ; Lichy, Gregor ; Heilgeist, Andreas ; Kalra, Love-Preet ; Foerch, Christian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-52606f493cf6ce5debf554bb452022e8f09e26cbecdb1ac1cbde6c64e63728033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Analysis</topic><topic>Anticoagulants</topic><topic>Biological markers</topic><topic>Biomarkers</topic><topic>Brain</topic><topic>Brain cancer</topic><topic>Causes of</topic><topic>Coma</topic><topic>Convulsions & seizures</topic><topic>Epidural</topic><topic>Epilepsy</topic><topic>Etiology</topic><topic>Health aspects</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Hospitals</topic><topic>Identification and classification</topic><topic>Infections</topic><topic>Ischemia</topic><topic>Medical diagnosis</topic><topic>Metabolism</topic><topic>Patients</topic><topic>Plasma</topic><topic>Proteins</topic><topic>Stroke</topic><topic>Trauma</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zylyftari, Sabina</creatorcontrib><creatorcontrib>Luger, Sebastian</creatorcontrib><creatorcontrib>Blums, Kristaps</creatorcontrib><creatorcontrib>Barthelmes, Stephan</creatorcontrib><creatorcontrib>Humm, Sebastian</creatorcontrib><creatorcontrib>Baum, Hannsjörg</creatorcontrib><creatorcontrib>Meckel, Stephan</creatorcontrib><creatorcontrib>Braun, Jörg</creatorcontrib><creatorcontrib>Lichy, Gregor</creatorcontrib><creatorcontrib>Heilgeist, Andreas</creatorcontrib><creatorcontrib>Kalra, Love-Preet</creatorcontrib><creatorcontrib>Foerch, Christian</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zylyftari, Sabina</au><au>Luger, Sebastian</au><au>Blums, Kristaps</au><au>Barthelmes, Stephan</au><au>Humm, Sebastian</au><au>Baum, Hannsjörg</au><au>Meckel, Stephan</au><au>Braun, Jörg</au><au>Lichy, Gregor</au><au>Heilgeist, Andreas</au><au>Kalra, Love-Preet</au><au>Foerch, Christian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma</atitle><jtitle>Critical care (London, England)</jtitle><addtitle>Crit Care</addtitle><date>2024-04-05</date><risdate>2024</risdate><volume>28</volume><issue>1</issue><spage>109</spage><epage>109</epage><pages>109-109</pages><artnum>109</artnum><issn>1364-8535</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><eissn>1366-609X</eissn><abstract>Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospective study was to test whether prehospital GFAP measurements on a point-of-care device have the potential to rapidly differentiate intracranial hemorrhage from other causes of acute coma.
This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min) shortly after hospital admission.
143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613-10001] vs. 43 pg/mL [IQR 29-91.25], p < 0.001). When using an optimal cut-off value of 101 pg/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). In-hospital mortality risk was associated with prehospital GFAP values.
Increased GFAP plasma concentrations in patients with acute coma identify intracranial hemorrhage with high diagnostic accuracy. Prehospital GFAP measurements on a point-of-care platform 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.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>38581002</pmid><doi>10.1186/s13054-024-04892-5</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Anticoagulants Biological markers Biomarkers Brain Brain cancer Causes of Coma Convulsions & seizures Epidural Epilepsy Etiology Health aspects Hematoma Hemorrhage Hospitals Identification and classification Infections Ischemia Medical diagnosis Metabolism Patients Plasma Proteins Stroke Trauma Traumatic brain injury |
| title | GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma |
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