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A panel of biomarkers including caspase‐3 and D‐dimer may differentiate acute stroke from stroke‐mimicking conditions in the emergency department
Author(s) -
Montaner J.,
Mendioroz M.,
Ribó M.,
Delgado P.,
Quintana M.,
Penalba A.,
Chacón P.,
Molina C.,
FernándezCadenas I.,
Rosell A.,
AlvarezSabín J.
Publication year - 2011
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2010.02329.x
Subject(s) - medicine , stroke (engine) , d dimer , odds ratio , confidence interval , emergency department , natriuretic peptide , gastroenterology , heart failure , mechanical engineering , psychiatry , engineering
Abstract. Montaner J, Mendioroz M, Ribó M, Delgado P, Quintana M, Penalba A, Chacón P, Molina C, Fernández‐Cadenas I, Rosell A, Alvarez‐Sabín J (Universitat Autònoma de Barcelona, Vall d’Hebron Hospital, Barcelona, Spain). A panel of biomarkers including caspase‐3 and d ‐dimer may differentiate acute stroke from stroke‐mimicking conditions in the emergency department. J Intern Med 2011; 270 : 166–174. 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 24 h 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 >1.96 ng mL −1 [odds ratio (OR) = 3.32; 95% confidence interval (CI) 1.88–5.88, P < 0.0001], d ‐dimer >0.27 μg mL −1 (OR = 2.97; 95% CI 1.72–5.16, P = 0.0001), sRAGE >0.91 ng mL −1 (OR = 2.19; 95% CI 1.26–3.83, P = 0.006), chimerin <1.11 ng mL −1 (OR = 0.4; 95% CI 0.19–0.81, P = 0.011), secretagogin <0.24 ng mL −1 (OR = 0.51; 95% CI 0.27–0.97, P = 0.041) and MMP‐9 > 199 ng mL −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 3 h 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.