Blood Biomarkers to Differentiate Ischemic and Hemorrhagic Strokes

Bustamante, Alejandro; Peñalba, Anna; Orset, Cyrille; Azurmendi, Leire; Llombart, Víctor; Simats, Alba; Pecharroman, Emili; Ventura, Oriol; Ribó, Marc; Vivien, Denis; Sánchez, Jean Charles; Montaner, Joan

doi:10.1212/wnl.0000000000011742

Cited by 50 publications

(65 citation statements)

References 24 publications

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“…Additionally, within 4 and 6 h after symptom onset, serum GFAP had an AUC of 0.866 for differentiating HS from IS and SM, with a sensitivity of 75.0% and specificity of 84.0% using an optimal cutoff point of 72 ng/l ( 14 ); another study reported an AUC of 0.872 with a sensitivity of 77.8% and specificity of 94.2% using a cutoff of 0.03 μg/l within 6 h after symptom onset ( 22 ). A recent clinical study reported that plasma GFAP within 4.5 h after symptom onset was higher in HS patients than in IS patients ( 23 ).…”

Section: Biomarkers Associated With Glial Activationmentioning

confidence: 99%

“…Moreover, the combination of RPB4 and GFAP improved the detection of IS ( 46 ). A recent clinical study reported that plasma RBP4 within 4.5 h after symptom onset was higher in IS patients than in HS patients ( 23 ).…”

Section: Biomarkers Associated With Inflammation and Oxidative Stressmentioning

confidence: 99%

“…Another study reported that a plasma endostatin concentration higher than 1.203 ng/ml within 6 h after symptom onset could predict the development of epilepsy after a hyperacute stroke event (include IS and HS) ( 29 ). A recent clinical study reported that plasma endostatin within 4.5 h after symptom onset was higher in IS patients than in HS patients ( 23 ). As mentioned above, endostatin may be a potential biomarker in assessing the prognosis and complications of hyperacute IS.…”

Section: Potential Biomarkers Associated With Vascular Injury and Angiogenesismentioning

confidence: 99%

“…Two fragments after the cleavage of a propeptide include N-terminal proBNP (NT-proBNP) which does not have biological activity, and formed-BNP which is biologically active ( 64 ). A recent clinical study reported that plasma NT-proBNP within 4.5 h after symptom onset was higher in IS patients than in HS patients ( 23 ).…”

Section: Potential Biomarkers Associated With Vascular Injury and Angiogenesismentioning

confidence: 99%

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Blood-Based Biomarkers: A Forgotten Friend of Hyperacute Ischemic Stroke

et al. 2021

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Ischemic stroke (IS) is the second leading cause of death worldwide. Multimodal neuroimaging techniques that have significantly facilitated the diagnosis of hyperacute IS are not widely used in underdeveloped areas and community hospitals owing to drawbacks such as high cost and lack of trained operators. Moreover, these methods do not have sufficient resolution to detect changes in the brain at the cellular and molecular levels after IS onset. In contrast, blood-based biomarkers can reflect molecular and biochemical alterations in both normal and pathophysiologic processes including angiogenesis, metabolism, inflammation, oxidative stress, coagulation, thrombosis, glial activation, and neuronal and vascular injury, and can thus provide information complementary to findings from routine examinations and neuroimaging that is useful for diagnosis. In this review, we summarize the current state of knowledge on blood-based biomarkers of hyperacute IS including those associated with neuronal injury, glial activation, inflammation and oxidative stress, vascular injury and angiogenesis, coagulation and thrombosis, and metabolism as well as genetic and genomic biomarkers. Meanwhile, the blood sampling time of the biomarkers which are cited and summarized in the review is within 6 h after the onset of IS. Additionally, we also discuss the diagnostic and prognostic value of blood-based biomarkers in stroke patients, and future directions for their clinical application and development.

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Section: Biomarkers Associated With Glial Activationmentioning

confidence: 99%

Section: Biomarkers Associated With Inflammation and Oxidative Stressmentioning

confidence: 99%

Section: Potential Biomarkers Associated With Vascular Injury and Angiogenesismentioning

confidence: 99%

Section: Potential Biomarkers Associated With Vascular Injury and Angiogenesismentioning

confidence: 99%

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Blood-Based Biomarkers: A Forgotten Friend of Hyperacute Ischemic Stroke

et al. 2021

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“…A strategy to improve stroke differential diagnosis (stroke vs. non-stroke) and type of stroke (IS vs. HS) can be achieved by including additional biomarkers to the current practice that include clinical and neuroimaging characteristics. In fact, recent studies have highlighted the potential of blood-derived biomarkers for timely patient triage, therapeutics, and in revealing stroke mechanisms [ 26 , 27 ]. Easily accessible fluid biomarkers can provide an objective evaluation of the real-time panorama, supporting stroke diagnosis or predicting the patient’s outcome, ultimately guiding clinical decisions [ 11 , 13 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Timely and Blood-Based Multiplex Molecular Profiling of Acute Stroke

Dias

Silva

Pinto

et al. 2021

Life

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Stroke is a leading cause of death and disability in the world. To address such a problem, early diagnosis and tailored acute treatment represent one of the major priorities in acute stroke care. Since the efficacy of reperfusion treatments is highly time-dependent, there is a critical need to optimize procedures for faster and more precise diagnosis. We provide a concise review of the most relevant and well-documented blood–protein biomarkers that exhibit greater potential for translational to clinical practice in stroke differential diagnosis and to differentiate ischemic stroke from hemorrhagic stroke, followed by an overview of the most recent point-of-care technological approaches to address this problem. The integration of fluid-based biomarker profiling, using point-of-care biosensors with demographic, clinical, and neuroimaging parameters in multi-dimensional clinical decision-making algorithms, will be the next step in personalized stroke care.

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Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage

Ramos-Pachón,

Rodríguez-Luna,

Martí-Fàbregas

et al. 2023

JAMA Neurol

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ImportancePrehospital transfer protocols are based on rapid access to reperfusion therapies for patients with ischemic stroke. The effect of different protocols among patients receiving a final diagnosis of intracerebral hemorrhage (ICH) is unknown.ObjectiveTo determine the effect of direct transport to an endovascular treatment (EVT)–capable stroke center vs transport to the nearest local stroke center.Design, Setting, and ParticipantsThis was a prespecified secondary analysis of RACECAT, a multicenter, population-based, cluster-randomized clinical trial conducted from March 2017 to June 2020 in Catalonia, Spain. Patients were evaluated by a blinded end point assessment. All consecutive patients suspected of experiencing a large vessel occlusion stroke (Rapid Arterial Occlusion Evaluation Scale [RACE] score in the field &gt;4 on a scale of 0 to 9, with lower to higher stroke severity) with final diagnosis of ICH were included. A total of 1401 patients were enrolled in RACECAT with suspicion of large vessel occlusion stroke. The current analysis was conducted in October 2022.InterventionDirect transport to an EVT-capable stroke center (n = 137) or to the closest local stroke center (n = 165).Main Outcomes and MeasuresThe primary outcome was tested using cumulative ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI of the shift analysis of disability at 90 days as assessed by the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) in the intention-to-treat population. Secondary outcomes, included 90-day mortality, death or severe functional dependency, early neurological deterioration, early mortality, ICH volume and enlargement, rate of neurosurgical treatment, rate of clinical complications during initial transport, and rate of adverse events until day 5.ResultsOf 1401 patients enrolled, 1099 were excluded from this analysis (32 rejected informed consent, 920 had ischemic stroke, 29 had transient ischemic attack, 12 had subarachnoid hemorrhage, and 106 had stroke mimic). Thus, 302 patients were included (204 [67.5%] men; mean [SD] age 71.7 [12.8] years; and median [IQR] RACE score, 7 [6-8]). For the primary outcome, direct transfer to an EVT-capable stroke center (mean [SD] mRS score, 4.93 [1.38]) resulted in worse functional outcome at 90 days compared with transfer to the nearest local stroke center (mean [SD] mRS score, 4.66 [1.39]; adjusted common OR, 0.63; 95% CI, 0.41-0.96). Direct transfer to an EVT-capable stroke center also suggested potentially higher 90-day mortality compared with transfer to the nearest local stroke center (67 of 137 [48.9%] vs 62 of 165 [37.6%]; adjusted hazard ratio, 1.40; 95% CI, 0.99-1.99). The rates of medical complications during the initial transfer (30 of 137 [22.6%] vs 9 of 165 patients [5.6%]; adjusted OR, 5.29; 95% CI, 2.38-11.73) and in-hospital pneumonia (49 of 137 patients [35.8%] vs 29 of 165 patients [17.6%]; OR, 2.61; 95% CI, 1.53-4.44) were higher in the EVT-capable stroke center group.Conclusions and RelevanceIn this secondary analysis of the RACECAT randomized clinical trial, bypassing the closest stroke center resulted in reduced chances of functional independence at 90 days for patients who received a final diagnosis of ICH.Trial RegistrationClinicalTrials.gov Identifier: NCT02795962

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Blood Biomarkers to Differentiate Ischemic and Hemorrhagic Strokes

Cited by 50 publications

References 24 publications

Blood-Based Biomarkers: A Forgotten Friend of Hyperacute Ischemic Stroke

Blood-Based Biomarkers: A Forgotten Friend of Hyperacute Ischemic Stroke

Timely and Blood-Based Multiplex Molecular Profiling of Acute Stroke

Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage

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