Dynamic Changes in Serum Glial Fibrillary Acidic Protein Levels Predicts Early Neurological Deterioration After Intravenous Thrombolysis in Minor Stroke

ABSTRACT Objective Minor strokes may be associated with early neurological deterioration (END) and disabilities. The objective was to investigate the role of serum glial fibrillary acidic protein (GFAP) levels in predicting END. Methods Data originated from a multicenter cohort study conducted prospectively. ΔGFAP was calculated as the ratio of post‐thrombolysis GFAP at 24 h to baseline GFAP. Univariable and multivariable binary logistic regression analyses were performed to assess the association between ∆GFAP and END, and a nomogram was established to illustrate its predictive value. Results END occurred in 20 (7.35%) of the 272 patients with minor stroke who underwent intravenous thrombolysis (IVT). Elevated ∆GFAP was independently associated with END (OR, 3.50; 95% CI, 1.67 to 7.31; p < 0.001), even after adjusting for confounders (adjusted OR, 4.64; 95% CI, 1.86 to 11.54; p < 0.001). Furthermore, a model combining ∆GFAP, age, and National Institutes of Health Stroke Scale (NIHSS) score at admission demonstrated a good predictive value for END (AUC = 0.77; 95% CI, 0.67 to 0.89). Interpretation ∆GFAP is a strong, independent predictor of END in patients with minor strokes. Integrating ∆GFAP, age, and NIHSS score into a prognostic model results in a good discriminative ability for predicting END.