The prognostic value of biomarkers in stroke

Abstract

BackgroundIschemic injury triggers inflammatory cascades and changes in the protein synthesis, neurotransmitters and neuro-hormones in the brain parenchyma that may further amplify the tissue damage. The “Triage® Stroke Panel”, a biochemical multimarker assay, detects Brain Natriuretic Peptide (BNP), D-Dimers (DD), Matrix-Metalloproteinase-9 (MMP-9), and S100β protein generating a Multimarker index of these values (MMX). The aims of this prospective study in consecutive patients with ischemic or hemorrhagic stroke were to assess: 1) the rate of an increase of biomarkers (BNP, D-dimer, MMP-9 and S-100β) tested with the Triage Stroke Panel; 2) the correlation between the increase of these biomarkers and functional outcome at 4 months; 3) the risk factors for the increase of biomarkers.MethodsThe outcome of the study was 120-day mortality and it was compared in patients with Stroke Panel >4 and ≤4. Multiple logistic regression analyses were performed to identify independent predictors for death and for the increase of biomarkers.Results244 consecutive patients (mean age 73.02 years; 53.7 % males) were included in the study; 210 ischemic strokes and 34 hemorrhagic strokes. 161/244 (66.0 %) had an increase of biomarkers. At 120 days, 85 patients had died (34.8 %). Death was seen in 68/161 patients with an increase of biomarkers (42.2 %) compared with 17/83 patients without (20.5 %). Regression logistic analysis found that a Stroke Panel >4 (OR 3.1; 95 % CI 1.5–6.2, p = 0.002) was associated with mortality. The increase of biomarkers was independently predicted by an increase of PCR on admission (OR 2.9, 95 CI 1.4–6.0, p = 0.003).ConclusionsAn increase of biochemical markers such as BNP, D-Dimers, MMP-9, and S100β tested with a Triage Stroke Panel (>4) was correlated with mortality at 120 days from stroke onset.

Elevation of high‐sensitivity cardiac troponin T at admission is associated with increased 3‐month mortality in acute ischemic stroke patients treated with thrombolysis

“…Instant biomarkers with desirable prognostic values can be of great help in distinguishing patients most likely to benefit from, or be harmed by, a particular therapy, including IV thrombolysis in AIS patients. In this regard, many blood biomarkers have been investigated, with proven potential in stroke diagnosis and recovery . Multiple studies have demonstrated changes in a number of blood biomarkers, such as N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP), copeptin, matrix metalloproteinase‐9 (MMP‐9), and S100 β, are all independently associated with various clinical outcomes .…”

“…A very recent study showed an externally validated copeptin‐based risk score is strongly associated with several unfavorable outcomes, including death . Moreover, a panel of multiple biomarkers consisting of BNP, d ‐dimers, MMP‐9, and S100 β protein was also shown to be valuable in detecting increased mortality after stroke . Unfortunately, to date, no blood biomarker in the field of stroke has been unequivocally considered as a validated surrogate marker, which can substitute for a clinical evaluation .…”

“…32 Moreover, a panel of multiple biomarkers consisting of BNP, D-dimers, MMP-9, and S100 β protein was also shown to be valuable in detecting increased mortality after stroke. 31 Unfortunately, to date, no blood biomarker in the field of stroke has been unequivocally considered as a validated surrogate marker, which can substitute for a clinical evaluation. 28 Specifically, in this study, we found that a cutoff value of 15.4 ng/L for serum hs-cTnT predicted both 30 and 90-day mortality in AIS patients receiving IV thrombolysis.…”

“…In this regard, many blood biomarkers have been investigated, with proven potential in stroke diagnosis and recovery. 28,[30][31][32] Multiple studies have demonstrated changes in a number of blood biomarkers, such as N-terminal prohormone of brain natriuretic peptide (NT-proBNP), copeptin, matrix metalloproteinase-9 (MMP-9), and S100 β, are all independently associated with various clinical outcomes. 28 For instance, MMP-9 is predictive of HT after IV thrombolysis, with higher MMP-9…”

Clinical and biochemical predictors of late-outcome in patients after ischemic stroke

“…Accurate prognosis concerning the outcome can help to plan the rehabilitation process and determine the need for care of caregivers. Many factors including demographic features, clinical scales and biochemical parameters have been assessed until the present according to their usefulness as predictors [1,2,3].…”