Incremental value of serum neurofilament light chain and glial fibrillary acidic protein as blood-based biomarkers for predicting functional outcome in severe acute ischemic stroke
Open accessAbstract
Introduction: Blood-based biomarkers may improve prediction of functional outcome in patients with acute ischemic stroke. The role of neurofilament light chain (NfL) and glial fibrillary acidic (GFAP) as potential biomarkers especially in severe stroke patients is unknown. Patients and Methods: Prospective, monocenter, cohort study including consecutive patients with severe ischemic stroke in the anterior circulation on admission (NIHSS score ⩾ 6 points or indication for mechanical thrombectomy). Outcome was assessed 3 months after the index stroke by the modified Rankin Scale (mRS). Serum biomarkers levels of NfL and GFAP were determined by ultrasensitive ELISA. Univariate and multivariate logistic regression models were performed to determine the association of biomarker levels and functional disability. Discrimination, calibration, and overall performance were analyzed in different models via AUROC, calibration plots (with Emax and Eavg), Brier-score and R2 using variables, identified as important covariates for functional outcome in previous studies. Results: Between 06/2020 and 08/2021, 213 patients were included [47% female, mean age 76 (SD ± 12) years, median NIHSS score 13 (interquartile range, IQR 9; 17)]. Biomarker serum levels were measured at a median of 1 [IQR, 1; 2] day after admission. Compared to patients with mRS 0–2 at 3 months, patients with mRS 3–6 had higher serum levels of NfL (median: 136 pg/ml vs 41 pg/ml; p < 0.0001) and GFAP (700 ng/ml vs 9.6 ng/ml; p < 0.0001). Both biomarkers were significantly associated with functional outcome [adjusted logistic regression, odds ratio (95% CI) for NfL: 2.63 (1.62; 4.56), GFAP: 2.16 (1.58; 3.09)]. In all models the addition of serum NfL led to a significant improvement in the AUROC, as did the addition of serum GFAP. Calibration plots showed high agreement between the predicted and observed outcomes and after addition of the two blood-based biomarkers there was an improvement of the overall performance. Conclusion: Prediction of functional outcome after severe acute ischemic stroke was improved by the blood-based biomarkers serum NfL and GFAP, measured in the acute phase of stroke. These findings have to be replicated in independent external cohorts. Study registration: DRKS00022064
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Plasma GFAP and NfL are not anticipated to serve as FTD-specific diagnostic markers.
“Given that plasma GFAP and NfL are elevated not only in FTD but also in other neurological diseases such as Alzheimer disease [7], stroke [50, 51], and TBI [6], these biomarkers are not anticipated to serve as FTD-specific diagnostic markers.”
From Comprehensive cross-sectional and longitudinal comparisons of plasma glial fibrillary acidic protein and neurofilament light across FTD spectrum disorders (2025) · cites this paper as [51]
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- Authors
- Vollmuth, C., Fiessler, C., Montellano, F. A., Kollikowski, A. M., Essig, F., Oeckl, P., Barba, L., Steinacker, P., Schulz, C., Ungethüm, K., Wolf, J., Pham, M., Schuhmann, M. K., Heuschmann, P. U., Haeusler, K. G., Stoll, G., Otto, M., & Neugebauer, H.
- Affiliations
- Universitätsklinikum Würzburg (DE)
- University of Würzburg (DE)
- German Center for Neurodegenerative Diseases (DE)
- Martin Luther University Halle-Wittenberg (DE)
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany 1
- Corresponding author
- Vollmuth, Christoph
- ORCID
- Venue
- European Stroke Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-09-01
- Volume
- 9
- Issue
- 3
- Pages
- 751-762
- ISSN
- 2396-9873 (ISSN-L)
- 2396-9881
- PMC
- PMC11418447
- OpenAlex
- W4392136668
- Cited by
- 38
- References
- 33
- Citations by year
- 2026: 29 · 2025: 8 · 2024: 1
- FWCI
- 11.60
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Stroke Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Online Publication Service of Würzburg University (Würzburg University) (submittedVersion, cc-by)
- DZNE Pub (submittedVersion, cc-by)
- Funders
- Christoph Vollmuth (Project No. 413657723)
- Markus Otto (MOODMARKER, SFB1279, D.3830 and D.5009)
- Alexander M. Kollikowski (Project No. 413657723)
- Fabian Essig (Project No. 413657723)
- Felipe A. Montellano (Project No. 413657723)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- neurofilament light chain, glial fibrillary acidic protein, blood-based biomarkers, acute ischemic stroke, severe stroke, functional outcome prediction, modified Rankin Scale, mechanical thrombectomy, anterior circulation stroke, prognostic factors, neurodegeneration biomarkers, elderly patients, ischemic penumbra, neuroinflammation
- MeSH terms
- Ischemic Stroke, Aged, Aged, 80 and over, Female, Glial Fibrillary Acidic Protein, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Severity of Illness Index, Biomarkers, Neurofilament Proteins
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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