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Explorative investigation of biomarkers of brain damage and coagulation system activation in clinical stroke differentiation

Unden, Johan; Strandberg, Karin LU ; Malm, Jan; Campbell, Eric; Rosengren, Lars; Stenflo, Johan LU ; Norrving, Bo LU ; Romner, Bertil; Lindgren, Arne and Andsberg, Gunnar (2009) In Journal of Neurology 256(1). p.72-77
Abstract
A simple and accurate method of differentiating ischemic stroke and intracerebral hemorrhage (ICH) is potentially useful to facilitate acute therapeutic management. Blood measurements of biomarkers of brain damage and activation of the coagulation system may potentially serve as novel diagnostic tools for stroke subtypes. Ninety-seven stroke patients were prospectively investigated in a multicenter design with blood levels of brain biomarkers S100B, neuron specific enolase (NSE), glial fibrillary acidic protein (GFAP) as well as a coagulation biomarker, activated protein C - protein C inhibitor complex (APC-PCI), within 24 hours of symptom onset. Eighty-three patients (86 %) had ischemic stroke and fourteen patients (14 %) had ICH. There... (More)
A simple and accurate method of differentiating ischemic stroke and intracerebral hemorrhage (ICH) is potentially useful to facilitate acute therapeutic management. Blood measurements of biomarkers of brain damage and activation of the coagulation system may potentially serve as novel diagnostic tools for stroke subtypes. Ninety-seven stroke patients were prospectively investigated in a multicenter design with blood levels of brain biomarkers S100B, neuron specific enolase (NSE), glial fibrillary acidic protein (GFAP) as well as a coagulation biomarker, activated protein C - protein C inhibitor complex (APC-PCI), within 24 hours of symptom onset. Eighty-three patients (86 %) had ischemic stroke and fourteen patients (14 %) had ICH. There were no differences in S100B (p = 0.13) and NSE (p = 0.67) levels between patients with ischemic stroke or ICH. However, GFAP levels were significantly higher in ICH patients (p = 0.0057). APC-PCI levels were higher in larger ischemic strokes (p = 0.020). The combination of GFAP and APC-PCI levels, in patients with NIHSS score more than 3, had a sensitivity and negative predictive value of 100 % for ICH in our material (p = 0.0052). This exploratory study indicated that blood levels of biomarkers GFAP and APC-PCI, prior to neuroimaging, may rule out ICH in a mixed stroke population. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hemorrhagic, hemorrhage, acute stroke, APC-PCI, NSE, S100, GFAP, differentiation, brain damage
in
Journal of Neurology
volume
256
issue
1
pages
72 - 77
publisher
Steinkopff
external identifiers
  • wos:000263978100009
  • scopus:62149117266
ISSN
1432-1459
DOI
10.1007/s00415-009-0054-8
language
English
LU publication?
yes
id
e0fff6e1-b48e-43af-a1a3-dcb774026fd8 (old id 1404685)
date added to LUP
2009-06-15 09:45:54
date last changed
2017-11-05 03:55:23
@article{e0fff6e1-b48e-43af-a1a3-dcb774026fd8,
  abstract     = {A simple and accurate method of differentiating ischemic stroke and intracerebral hemorrhage (ICH) is potentially useful to facilitate acute therapeutic management. Blood measurements of biomarkers of brain damage and activation of the coagulation system may potentially serve as novel diagnostic tools for stroke subtypes. Ninety-seven stroke patients were prospectively investigated in a multicenter design with blood levels of brain biomarkers S100B, neuron specific enolase (NSE), glial fibrillary acidic protein (GFAP) as well as a coagulation biomarker, activated protein C - protein C inhibitor complex (APC-PCI), within 24 hours of symptom onset. Eighty-three patients (86 %) had ischemic stroke and fourteen patients (14 %) had ICH. There were no differences in S100B (p = 0.13) and NSE (p = 0.67) levels between patients with ischemic stroke or ICH. However, GFAP levels were significantly higher in ICH patients (p = 0.0057). APC-PCI levels were higher in larger ischemic strokes (p = 0.020). The combination of GFAP and APC-PCI levels, in patients with NIHSS score more than 3, had a sensitivity and negative predictive value of 100 % for ICH in our material (p = 0.0052). This exploratory study indicated that blood levels of biomarkers GFAP and APC-PCI, prior to neuroimaging, may rule out ICH in a mixed stroke population.},
  author       = {Unden, Johan and Strandberg, Karin and Malm, Jan and Campbell, Eric and Rosengren, Lars and Stenflo, Johan and Norrving, Bo and Romner, Bertil and Lindgren, Arne and Andsberg, Gunnar},
  issn         = {1432-1459},
  keyword      = {hemorrhagic,hemorrhage,acute stroke,APC-PCI,NSE,S100,GFAP,differentiation,brain damage},
  language     = {eng},
  number       = {1},
  pages        = {72--77},
  publisher    = {Steinkopff},
  series       = {Journal of Neurology},
  title        = {Explorative investigation of biomarkers of brain damage and coagulation system activation in clinical stroke differentiation},
  url          = {http://dx.doi.org/10.1007/s00415-009-0054-8},
  volume       = {256},
  year         = {2009},
}