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

Research output: Contribution to journalArticle

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.

Details

Authors
  • Johan Unden
  • Karin Strandberg
  • Jan Malm
  • Eric Campbell
  • Lars Rosengren
  • Johan Stenflo
  • Bo Norrving
  • Bertil Romner
  • Arne Lindgren
  • Gunnar Andsberg
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurology

Keywords

  • hemorrhagic, hemorrhage, acute stroke, APC-PCI, NSE, S100, GFAP, differentiation, brain damage
Original languageEnglish
Pages (from-to)72-77
JournalJournal of Neurology
Volume256
Issue number1
Publication statusPublished - 2009
Publication categoryResearch
Peer-reviewedYes