Abstract 31: The Development and Validation of a Biochemical Biomarker Panel to Detect Acute Stroke: A Preliminary Study
A Biochemical Biomarker Panel Detects Acute Ischemic Stroke and Intracerebral Hemorrhage
INTRODUCTION: The accurate diagnosis of acute ischemic stroke(IS), intracranial hemorrhage(ICH), and stroke mimics is essential for administering appropriate time-sensitive therapies which are currently underutilized due to diagnostic uncertainty.
HYPOTHESIS: We hypothesize that a panel of biomarkers which singly predict inflammation, neuronal injury, and glial activation together may be diagnostic of acute cerebral ischemia with clinically relevant discriminative capacity.
METHODS: Serum samples were collected from 167 patients presenting with acute neurologic deficits within 24 hours of symptom onset. Patients were classified as IS if symptoms fit a vascular distribution, if they had either a radiographically apparent lesion, and/or symptoms persisting more than 24 hours. Presentation CT determined ICH. Mimics were those with confirmed non-vascular etiologies of neurologic deficits. Of the 262 biomarkers measured, those significant in univariate analyses underwent stepwise selection from which a 5-biomarker multivariate logistic model was built and internally validated by bootstrapping. Its capacity to discriminate IS versus mimic, IS versus ICH, and IS plus ICH versus mimic was evaluated by area under the receiver operating characteristic, equivalent to concordance index (c-index) in logistic regression analysis.
RESULTS: The 5-biomarker model consisted of eotaxin, epidermal growth factor receptor(EGFR), S100A12, metalloproteinase inhibitor-4(MPI-4), and prolactin. When discriminating between IS and mimics, eotaxin (c=0.812), EGFR(c=0.690), S100A12 (c=0.605), MPI-4 (c=0.588), and prolactin (c=0.645) together yielded a c-index of 0.918. With age, race, and gender, the sensitivity, specificity, and negative predictive value of the model were 90.3%, 85.2%, and 92.0%, respectively. This model also predicted IS plus ICH versus mimic (c= 0.927), and IS versus ICH (c = 0.896).
CONCLUSIONS: The biomarkers identified in this study are essentially novel and show promise in acutely distinguishing IS, ICH, and mimics. Such a biomarker panel may assist in the early evaluation and management of patients with stroke-like symptoms.
- © 2012 by American Heart Association, Inc.