Plasma Glial Fibrillary Acidic Protein, D-Dimer and S100β Protein: A Panel for Differential Diagnosis of Acute Stroke

Objectives: To explore the diagnostic utility of glial fibrillary acidic protein (GFAP), S100β protein and dDimer for differentiation between cases of acute stroke compared to CT findings as a gold-standard diagnostic modality. Patients & Methods: The study included 80 patients; 51 males and 29 females with mean age of 49.6±6.8 years. Mean time lapsed since occurrence of symptoms till sampling was 8.3±2.7; range: 2-12 hours. All patients underwent clinical injury severity evaluation using the National Institute of Health Stroke Scale (NIHSS), neuroimaging and gave blood samples for ELISA estimation of plasma levels of GFAP, S100β protein and d-Dimer. Results: Radiodiagnosis depended on computed tomography (CT) alone in 54 patients, magnetic resonance imaging (MRI) alone 17 patients and both CT and MRI in 9 patients and defined intracranial hemorrhage (ICH) in 12 patients, ischemic stroke (IS) in 31 patients, transient ischemic attack (TIA) in 19 patients and stroke mimic (S mimic) attack in 18 patients. Mean NIHSS score of ICH patients was significantly higher in patients had ICH and IS compared to TIA and S mimic patients. Mean at admission plasma levels of S100β protein and GFAP were significantly higher in ICH patients compared to all other patients and in IS patients compared to those had TIA and S mimic with significantly higher plasma levels of GFAP and significantly lower S100β in TIA compared to S mimic patients. Mean at admission levels of d-Dimer were significantly higher in IS patients compared to other groups. Stepwise regression and ROC curve analyses revealed that high GFAP and S100β levels are specific predictors for ICH, while high GFAP and dDimer could differentiate between acute IS from S mimics and TIA. Conclusion: High plasma levels of GFAP and S100β protein in association with short time lapsed till presentation and high clinical severity score could identify cases of hemorrhagic stroke, while high plasma levels of d-Dimer and GFAP in association with high clinical severity score could identify IS cases among cases of non-hemorrhagic stroke, so a panel of the three parameters; GFAP, d-Dimer and S100β protein could be used as a differentiating modality among cases of stroke and could be applied wherever neuroimaging facilities are unavailable or if patient's transfer is hazardous. [Mamdouh Z. Abadier, Gamal H. Eliwa, Mohamed Abdel-Moneim Mohamed, Zakaria M. Ahmed and Osama A. Abdel-Salam. Plasma Glial Fibrillary Acidic Protein, D-Dimer and S100β Protein: A Panel for Differential Diagnosis of Acute Stroke. J Am Sci. 2012;8(5):267-272]. (ISSN: 1545-1003). http://www.americanscience.org. 34