TY - JOUR
T1 - A panel of biomarkers including caspase-3 and d-dimer may differentiate acute stroke from stroke-mimicking conditions in the emergency department
AU - Montaner, J.
AU - Mendioroz, M.
AU - Ribó, M.
AU - Delgado, P.
AU - Quintana, M.
AU - Penalba, A.
AU - Chacón, P.
AU - Molina, C.
AU - Fernández-Cadenas, I.
AU - Rosell, A.
AU - Alvarez-Sabín, J.
PY - 2011/8/1
Y1 - 2011/8/1
N2 - Background and aims. At present, a rapid and widely available diagnostic test for stroke remains elusive. The aim of this study was to examine the predictive value of a panel of blood-borne biochemical markers for stroke diagnosis. Design. Consecutive patients with strokes or stroke-mimicking conditions (mimics) were evaluated within 24h from symptom onset (915 strokes and 90 mimics). Blood samples were analysed by enzyme-linked immunosorbent assay for C-reactive protein, d-dimer, soluble receptor for advanced glycation end products (sRAGE), metalloproteinase 9 (MMP-9), S100B, brain natriuretic peptide, caspase-3, neurotrophin-3, chimerin and secretagogin. Results. The main independent predictors of stroke versus mimics were caspase-3 >1.96ngmL-1 [odds ratio (OR)=3.32; 95% confidence interval (CI) 1.88-5.88, P<0.0001], d-dimer >0.27μgmL-1 (OR = 2.97; 95% CI 1.72-5.16, P=0.0001), sRAGE >0.91 ngmL-1 (OR=2.19; 95% CI 1.26-3.83, P=0.006), chimerin <1.11ngmL-1 (OR=0.4; 95% CI 0.19-0.81, P=0.011), secretagogin <0.24 ngmL-1 (OR=0.51; 95% CI 0.27-0.97, P=0.041) and MMP-9>199ngmL-1 (OR=1.66; 95% CI 1.01-2.73, P=0.046). The model's predictive probability of stroke when the six biomarkers are above/below these cut-off levels was 99.01%. The best combination of biomarkers in the model was caspase-3 and d-dimer. Moreover, a model developed for samples obtained within the first 3h showed high sensitivity (Se) and specificity (Sp) (threshold at 25th percentile: Se 0.87, Sp 0.55; threshold at 75th percentile: Se 0.28, Sp 0.99). Conclusions. A combination of biomarkers including caspase-3 and d-dimer appears to be the most promising to achieve a rapid biochemical diagnosis of stroke. If replicated, this approach could be used as a tool for urgent referral of stroke patients to hospitals in which acute treatments are available. © 2010 The Association for the Publication of the Journal of Internal Medicine.
AB - Background and aims. At present, a rapid and widely available diagnostic test for stroke remains elusive. The aim of this study was to examine the predictive value of a panel of blood-borne biochemical markers for stroke diagnosis. Design. Consecutive patients with strokes or stroke-mimicking conditions (mimics) were evaluated within 24h from symptom onset (915 strokes and 90 mimics). Blood samples were analysed by enzyme-linked immunosorbent assay for C-reactive protein, d-dimer, soluble receptor for advanced glycation end products (sRAGE), metalloproteinase 9 (MMP-9), S100B, brain natriuretic peptide, caspase-3, neurotrophin-3, chimerin and secretagogin. Results. The main independent predictors of stroke versus mimics were caspase-3 >1.96ngmL-1 [odds ratio (OR)=3.32; 95% confidence interval (CI) 1.88-5.88, P<0.0001], d-dimer >0.27μgmL-1 (OR = 2.97; 95% CI 1.72-5.16, P=0.0001), sRAGE >0.91 ngmL-1 (OR=2.19; 95% CI 1.26-3.83, P=0.006), chimerin <1.11ngmL-1 (OR=0.4; 95% CI 0.19-0.81, P=0.011), secretagogin <0.24 ngmL-1 (OR=0.51; 95% CI 0.27-0.97, P=0.041) and MMP-9>199ngmL-1 (OR=1.66; 95% CI 1.01-2.73, P=0.046). The model's predictive probability of stroke when the six biomarkers are above/below these cut-off levels was 99.01%. The best combination of biomarkers in the model was caspase-3 and d-dimer. Moreover, a model developed for samples obtained within the first 3h showed high sensitivity (Se) and specificity (Sp) (threshold at 25th percentile: Se 0.87, Sp 0.55; threshold at 75th percentile: Se 0.28, Sp 0.99). Conclusions. A combination of biomarkers including caspase-3 and d-dimer appears to be the most promising to achieve a rapid biochemical diagnosis of stroke. If replicated, this approach could be used as a tool for urgent referral of stroke patients to hospitals in which acute treatments are available. © 2010 The Association for the Publication of the Journal of Internal Medicine.
KW - Biomarkers
KW - Caspase-3
KW - Cerebral ischaemia
KW - d-dimer
KW - Stroke
U2 - 10.1111/j.1365-2796.2010.02329.x
DO - 10.1111/j.1365-2796.2010.02329.x
M3 - Article
VL - 270
SP - 166
EP - 174
IS - 2
ER -