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GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma.
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.
Afiliação
  • Zylyftari S; Department of Neurology, RKH Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Germany.
  • Luger S; Department of Neurology, RKH Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Germany.
  • Blums K; Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
  • Barthelmes S; Department of Neurology, RKH Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Germany.
  • Humm S; Department of Neurology, RKH Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Germany.
  • Baum H; Department of Neurology, RKH Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Germany.
  • Meckel S; Institute for Laboratory Medicine and Transfusion Medicine, RKH Regionale Kliniken Holding Und Services GmbH, Ludwigsburg, Germany.
  • Braun J; Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum, Ludwigsburg, Germany.
  • Lichy G; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, RKH Klinikum, Ludwigsburg, Germany.
  • Heilgeist A; DRF Luftrettung, Stuttgart, Germany.
  • Kalra LP; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, RKH Klinikum, Ludwigsburg, Germany.
  • Foerch C; DRF Luftrettung, Stuttgart, Germany.
Crit Care ; 28(1): 109, 2024 04 05.
Article em En | MEDLINE | ID: mdl-38581002
ABSTRACT

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Coma / Sistemas Automatizados de Assistência Junto ao Leito / Hemorragias Intracranianas / Proteína Glial Fibrilar Ácida Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Alemanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Coma / Sistemas Automatizados de Assistência Junto ao Leito / Hemorragias Intracranianas / Proteína Glial Fibrilar Ácida Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Alemanha