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Abstract Details

Diagnostic Accuracy of Glial Fibrillary Acidic Protein (GFAP) for Differentiating Ischemic Stroke from Intracerebral Hemorrhage: A Systematic Review and Meta-analysis
Cerebrovascular Disease and Interventional Neurology
P7 - Poster Session 7 (8:00 AM-9:00 AM)
4-001
To assess the diagnostic accuracy of glial fibrillary acidic protein (GFAP) for distinguishing intracerebral hemorrhage (ICH) from ischemic stroke (IS) in adults using systematic review and meta-analysis.

Rapidly distinguishing ICH from IS is crucial in stroke management, as treatments differ and neuroimaging is often delayed. GFAP, released into blood after brain injury—especially ICH—has emerged as a potential early biomarker. However, varying study methods and thresholds require systematic evidence on GFAP’s diagnostic value.

We systematically reviewed and meta-analyzed studies (PRISMA-DTA) to September 2025, including adults with radiologically confirmed ICH or IS. Two reviewers screened, extracted data, and assessed bias (QUADAS-2). Pooled diagnostic metrics and HSROC curves were calculated. Subgroup analyses compared assay types and sampling times.
Fourteen studies (1,967 patients: 536 ICH, 1,431 IS) were included. GFAP levels were consistently higher in ICH, especially within four hours of onset. Pooled sensitivity and specificity were 75.5% and 91.5%. Positive and negative likelihood ratios were 8.85 and 0.27, and diagnostic odds ratio was 33.0. HSROC area was 0.93, indicating excellent accuracy. SiMOA assays outperformed ELISA in specificity and DOR. Heterogeneity was low to moderate. Early sampling maximized discriminative accuracy, reflecting rapid astroglial destruction in ICH.

GFAP is a highly specific, moderately sensitive marker for distinguishing ICH from IS. Its rapid rise after hemorrhage supports use in early stroke triage, especially where neuroimaging is delayed. GFAP testing could improve decision-making and outcomes. Further research should standardize assays, validate cutoffs, and assess point-of-care use in large trials.
Authors/Disclosures
Nicholas Aderinto
PRESENTER 		Mr. Aderinto has nothing to disclose.
Faisal Aljamea, MBBS Mr. Aljamea has nothing to disclose.
Syed H. Ali, MBBS Dr. Ali has nothing to disclose.
Temitomi J. Oyedele, MBBS Miss Oyedele has nothing to disclose.
Emmanuel Egbunu, MBBS Dr. Egbunu has nothing to disclose.
Gbolahan Olatunji, MD Dr. Olatunji has nothing to disclose.
Emmanuel Kokori, MD Dr. Kokori has nothing to disclose.
Faith A. Adejumo, MBBS Dr. Adejumo has nothing to disclose.
Adetola E. Babalola, BDS Dr. Babalola has nothing to disclose.