Novel diagnostic test for acute stroke. Stroke 2004 Jan;35(1):57-63
Date
12/13/2003Pubmed ID
14671250DOI
10.1161/01.STR.0000105927.62344.4CScopus ID
2-s2.0-0346095489 (requires institutional sign-in at Scopus site) 209 CitationsAbstract
BACKGROUND AND PURPOSE: The absence of a widely available and sensitive diagnostic test for acute cerebral ischemia remains a significant limitation in the diagnosis and management of stroke. The objective of this study was to examine the feasibility of developing a diagnostic panel of blood-borne biochemical markers of cerebral ischemia.
METHODS: Serial blood samples were obtained from patients (n=65 with suspected ischemic stroke, n=157 control subjects) presenting to an academic medical center emergency department. We analyzed 26 blood-borne markers believed to play a role in the ischemic cascade and created a 3-variable logistic regression model to predict the clinical diagnosis of stroke, defined as persistent neurological symptoms of cerebral ischemia lasting >24 hours.
RESULTS: Of the 26 blood-borne markers analyzed, univariate logistic analysis revealed that 4 were highly correlated with stroke (P<0.001): a marker of glial activation (S100beta), 2 markers of inflammation (matrix metalloproteinase-9 and vascular cell adhesion molecule), and 1 marker of thrombosis (von Willebrand factor). When the outcome level was set to a cutoff of P=0.1, our logistic model provided a sensitivity and specificity of 90% for predicting stroke.
CONCLUSIONS: A panel of blood-borne biochemical markers may be helpful in identifying patients with acute cerebral ischemia who could benefit from urgent care. Such a test may also be helpful in identifying stroke patients in the prehospital setting so that they could be fast-tracked to an institution equipped to care for patients with acute stroke.
Author List
Lynch JR, Blessing R, White WD, Grocott HP, Newman MF, Laskowitz DTMESH terms used to index this publication - Major topics in bold
Acute DiseaseBiomarkers
Brain Ischemia
Diagnostic Techniques, Neurological
Diagnostic Tests, Routine
Feasibility Studies
Female
Humans
Logistic Models
Male
Matrix Metalloproteinase 9
Middle Aged
Nerve Growth Factors
Odds Ratio
Predictive Value of Tests
ROC Curve
Reproducibility of Results
S100 Calcium Binding Protein beta Subunit
S100 Proteins
Sensitivity and Specificity
Stroke
Time Factors
Vascular Cell Adhesion Molecule-1
von Willebrand Factor
