Blood biomarkers for the diagnosis of acute cerebrovascular diseases: a prospective cohort study

Whiteley, W. et al. (2011) Blood biomarkers for the diagnosis of acute cerebrovascular diseases: a prospective cohort study. Cerebrovascular Diseases, 32(2), pp. 141-147. (doi:10.1159/000328517)

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Publisher's URL: http://dx.doi.org/10.1159/000328517

Abstract

Background: The diagnosis of stroke or TIA in the emergency department is difficult, though important for early treatment. Circulating biomarkers might improve upon clinical assessment at admission.

Methods: We recruited symptomatic patients with suspected stroke or TIA and drew blood soon after admission. Each patient was assessed with the Face Arm Speech Test (FAST). We measured a panel of 15 circulating inflammatory, thrombotic, cardiac, and cerebral tissue damage biomarkers. Improvement in diagnostic performance was assessed by adding biomarkers to the FAST in logistic regression models to predict a final diagnosis of stroke or TIA (verified by expert review and imaging).

Results: 405 patients had suspected stroke: 285 with TIA or stroke (230 definite or probable ischemic stroke, 40 TIA, 15 hemorrhagic stroke) and 120 with other diagnoses. Only the markers t-PA and NT-proBNP were associated positively and significantly (p < 0.01) with a diagnosis of TIA or stroke. The FAST had a sensitivity of 82% (95% CI 78-87) and specificity of 38% (95% CI 29-46) for the diagnosis of TIA or stroke. No biomarker individually improved the sensitivity or specificity of the FAST. A model containing the FAST, age, systolic blood pressure, NT-proBNP and t-PA had a better sensitivity (88%, p < 0.006) and a better specificity (48%, p = 0.04) than the FAST test alone.

Conclusions: No single blood marker improved the diagnostic performance of a validated clinical stroke scale. Panels of biomarkers may marginally improve diagnosis, but their practicability is uncertain, and requires further study.

Item Type:Articles
Keywords:Stroke, biomarker, diagnosis, sensitivity, specificity
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and Rumley, Dr Ann and Lowe, Professor Gordon and Sattar, Professor Naveed
Authors: Whiteley, W., Wardlaw, J., Dennis, M., Lowe, G., Rumley, A., Sattar, N., Welsh, P., Green, A., Andrews, M., Graham, C., and Sandercock, P.
Subjects:R Medicine > RC Internal medicine
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Cerebrovascular Diseases
ISSN:1015-9770
ISSN (Online):1421-9786
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