Background: Studies have suggested promising evidence that glial fibrillary acidic protein (GFAP) could be used as a blood biomarker to distinguish between ischaemic stroke (IS) and intracerebral haemorrhage (ICH) in acute stage.Objective: To determine the available evidence for GFAP as a blood biomarker for differentiating ICH from IS and stroke mimics using a meta-analysis approach.Methods: Search terms were used for literature search: ("STROKE" [Mesh] OR "BIOMARKER" [Title/Abstract] OR "GFAP" [Title/Abstract])] OR "SPECIFICITY" OR "SENSTIVITY" at various search engines like PubMed, Google scholar, Trip database, clinicaltrial.gov for articles from 1990 to April 2019 using filter 'human subjects'. Data were analysed using software STATA version 13.Results: A pooled analysis including 12 studies suggested that GFAP if used as a biomarker to differentiate between different types of strokes (ICH from IS and mimics) had a sensitivity of 78% (95% CI: 67-86%) and a specificity of 95% (95% CI: 88-98%). Positive likelihood ratio (LR) was 14.4 and negative LR was 0.23. SROC with prediction and confidence contours suggests promising area under the curve 0.93, 95% CI ranges from 0.90 to 0.95. Diagnostic odds ratio with 95% CI was observed 63 (31-125).Conclusion: Our meta-analysis suggests that GFAP has a promising diagnostic accuracy for the differentiation of ICH from IS and mimics. Further, phase II and phase III diagnostic test studies are required to validate the findings before using GFAP as a blood based biomarker for clinical use. Trial Registration: This study was registered in OSF registries 10.17605/OSF.IO/B9JP4.

中文翻译：

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胶质纤维酸性蛋白作为生物标志物在区分脑出血与缺血性中风和中风模拟物中的作用：一项荟萃分析。

背景：研究表明，有希望的证据表明神经胶质纤维酸性蛋白（GFAP）可以用作区分急性期缺血性中风（IS）和脑出血（ICH）的血液生物标志物。方法：使用检索词进行文献检索：（“ STROKE” [Mesh]或“ BIOMARKER” [Title / Abstract]或“ GFAP” [Title / [摘要]）]在1990年至2019年4月间使用“人类受试者”过滤器的各种搜索引擎（例如PubMed，Google Scholar，Trip数据库，clinicaltrial.gov）中的“特殊性”或“敏感性”。使用STATA 13版软件分析数据。结果：一项包括12项研究的汇总分析表明，GFAP用作生物标志物以区分不同类型的中风（ICH是来自IS和模仿者）具有78％的敏感性（95％CI：67-86％）和95％的特异性（95％CI：88-98％）。正似然比（LR）为14.4，负LR为0.23。具有预测和置信度轮廓的SROC建议曲线0.93下有希望的面积，95％CI在0.90至0.95之间。观察到具有95％CI的诊断优势比63（31-125）。结论：我们的荟萃分析表明，GFAP对于将ICH与IS和模拟物区分开来具有良好的诊断准确性。此外，在将GFAP用作临床使用的基于血液的生物标记物之前，需要进行II期和III期诊断测试研究以验证发现。试用注册：该研究已在OSF注册管理机构10中注册。