22. European Stroke Conference 9 Stroke prognosis 9:50 - 10:00 Glial Fibrillary Acidic Protein (GFAP) in intracerebral haemorrhage (ICH): friend or foe? M. Florczak-Rzepka1, Th. Steiner2 on behalf of VISTA Collaboration Department of Neurology, Medical University of Warsaw, Poland, Warsaw, PO-LAND1, Department of Neurology, Klinikum Frankfurt Höchst; Universitätsklinik Heidelberg, Germany, Frankfurt, GERMANY2 Background: GFAP – a structural protein of astroglia was shown to be elevated in serum of stroke patients. In ICH its level was proved to increase rapidly immediately after ICH onset. Nevertheless little is known about the associations of the biomarker with the disease course and outcome. We aimed to assess the relation between GFAP and neurologic and radiological outcomes fol-lowing ICH. Methods: All ICH patients enrolled to placebo arm of one of the ICH trials were considered for the analysis (N=384). Serum level of GFAP was measured on admission. Neurological assess-ment was done by means of the National Health Institute Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) on admission, in 1, 24 and 72 hours as well as 15 and 90 days after the ICH onset. Modified Rankin Scale (mRS) was used for assessment on day 15 and 90 after ICH. Vol-umes of hematoma and perihematomal edema as well as IVH were measured on brain CT scans on admission, 24 and 72 hours afterwards. Survival probability was calculated using Cox re-gression model including age, baseline GCS score as well as ICH and IVH size. Results: Serum level of GFAP was measured in 167 patients with supratentorial ICH. Case fatality in this group was 18%. GFAP level correlated significantly with neurologic outcomes (baseline GCS: p=0,006, GCS and NIHSS at 1, 24 and 72 hours as well as on day 15 and 90: p<0,001; mRS on day 15 and 90: p<0,001) and with hematoma volume (p=0,03) and total lesion volume (hematoma+edema) (p=0,045) as measured on admission. In Cox regression GFAP was shown to predict death 90 days after ICH (p=0,001, Exp(B)=1,112, 95%CI 1,047- 1,181). Conclusion: GFAP correlates with neurological deficit over 3 months after ICH and with ICH volume on admission. GFAP and baseline GCS score predict death 90 days form ICH. GFAP seems to be a powerful biomarker of ICH but more well-powered studies are needed for its ulti-mate assessment. 8 Stroke prognosis 9:40 - 9:50 Quality of life after hemicraniectomy for a malignant infarct (QOLAH) T. van Middelaar1, E. Richard2, P. van den Munckhof3, H.B. van der Worp4, P.T. Nieuwkerk5, M.C. Visser6, J. Stam7, P.J. Nederkoorn8 Academic Medical Center (AMC), Amsterdam, THE NETHERLANDS1,Academic Med-ical Center (AMC), Amsterdam, THE NETHERLANDS2, Academic Medical Center (AMC), Amsterdam, THE NETHERLANDS3, University Medical Center Utrecht (UMCU), Utrecht, THE NETHERLANDS4, Academic Medical Center (AMC), Amsterdam, THE NETHER-LANDS5, VU University Medical Center, Amsterdam, THE NETHERLANDS6, Academ-ic Medical Center (AMC), Amsterdam, THE NETHERLANDS7, Academic Medical Center (AMC), Amsterdam, THE NETHERLANDS8 Background In patients with space-occupying hemispheric infarction, hemicraniectomy strong-ly reduces the risk of death. Unfortunately, this comes at the cost of an increase in severely disabled patients. Data from selected populations suggest an acceptable quality of life (QoL) in the majority of survivors. The aim of this study was to assess QoL, functional outcome, depres-sion, and caregiver burden in patients who survived a malignant infarct after hemicraniectomy. Methods Cohort study of patients operated between October 2007 and December 2011 in two university hospitals. Patients and caregivers were interviewed separately. Functional outcome was assessed with the modified Rankin Scale (mRS); QoL with the Medical Outcomes Study 36-item Short-Form health survey (SF-36), Stroke Impact Scale 3.0, and a Visual Analogue Scale (VAS); depression with the Hospital Anxiety and Depression Scale (HADS); caregiver burden with the Caregiver Strain Index (CSI). In aphasic patients QoL was assessed by proxy. Results Of 45 patients who had a hemicraniectomy, 11 (24%) died during follow-up. 25 of 34 eligible patients were included at a mean of 28 months (range, 6-54) after the infarct, of whom seven had a left-sided infarct. Of the surviving patients, 14 (56%) had a good functional out-come defined as mRS ≤3. Mean QoL score on SF-36 was 52 out of 100 and mean QoL on VAS was 44%. Scores on SF-36 were comparable between patients with left or right-sided infarct (respectively 52 and 51). 15 patients (75%) and 13 caregivers (59%) were satisfied with the treatment received. Five patients (26%) had signs of depression. 14 caregivers (64%) experi-enced high level of burden, defined as CSI ≥7. Conclusion Over half of the surviving patients of a malignant infarct after hemicraniectomy have a favourable functional outcome, and three quarters are satisfied with the treatment received. QoL appears acceptable in the majority of pa-tients, but the majority of caregivers experience high level of burden. 20 © 2013 S. Karger AG, Basel Scientific Programme
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