ABSTRACT NUMBER: ESOC2026A452 BRAIN-DERIVED TAU FOR ASSESSING BRAIN INJURY IN INTRACEREBRAL HEMORRHAGE

Abstract Background and aims Accurate assessment of brain injury in the acute phase of intracerebral hemorrhage (ICH) is essential for treatment decisions and early risk stratification. Plasma brain-derived tau has emerged as a promising biomarker of brain injury in acute ischemic stroke. Here, we evaluated BD-tau as a biomarker in patients with spontaneous ICH. Methods We quantified plasma BD-tau and, for comparison, glial fibrillary acidic protein (GFAP), in a derivation cohort of 126 ICH patients with serial blood sampling from admission to day 7 and in 102 healthy controls (HC). We determined the relation of BD-tau with clinical severity, imaging metrics of ICH severity, and 90-day functional outcome. Findings were validated in an independent cohort of 80 ICH patients. Results In the derivation cohort, admission BD-tau concentrations (median time-from-onset 2.6h) were higher in ICH patients than in HC (Fig. 1A; p<0.0001) and associated with hematoma volume (Fig. 2A; p<0.0001). Admission BD-tau was associated with NIHSS scores (Fig. 2B; p<0.008) and outperformed GFAP and hematoma volume in predicting 90-day mRS scores (Fig. 2C-D). Greater perihematomal edema (PE) and hematoma expansion (HE) were associated with higher BD-tau at day 7 (PE: rho=0.34, p=0.02; HE: rho=0.47, p=0.007). Similar results were obtained in the validation cohort: BD-tau correlated with hematoma volume, predicted day 2 NIHSS and outperformed GFAP and hematoma volume in predicting 90-day mRS scores (Fig. 3A-D; all p<0.001). Conclusions Our findings suggest that BD-tau may serve as a biomarker for ICH-related brain injury with potential to understand patient trajectories and help with risk stratification. Conflict of interest NLK, MD, NV, and ST report a patent on the use of BD-tau (PCT/EP2024/075417). ST reports compensation from Quanterix for consultant services. No other potential conflicts of interests were reported. Figure 1 - belongs to Results Figure 2 - belongs to Results Figure 3 - belongs to Results