The prognostic value of biomarkers in stroke

In this study, we found that an increase of biochemical markers as BNP, D-Dimers, MMP-9, S and 100? tested with a Triage Stroke Panel (4) was correlated with mortality at 120 days from stroke onset.

According to a significant increase of markers of inflammation, thrombosis and cellular death as well as myelin damage within 24 h from stroke onset this point-of-care immunoassay (Triage Stroke Panel®) has been developed to improve the reliability of the clinical diagnosis of stroke. Unfortunately, neither one marker nor combination of all markers was of significant benefit in acute stroke diagnostics. DWI-MRI is still the procedure with the highest diagnostic quality in case of acute cerebral ischemia [8]. Although the diagnostic accuracy of the current panel is clearly imperfect, the Triage Stroke Panel seems to have prognostic implications. Until now no study had been focusing on the MMX value as an index of poor prognosis in 120 days and the different parameters, separately studied, did not provide the same results [14–17]. Interestingly, aside from S100?, which is a marker of astrocyte activation, the biomarkers in this stroke panel are not specific to central nervous system tissues. Thus, although the majority of the markers used in this panel are not specific for cerebral ischemia, they represent different components of the ischemic cascade and when used in conjunction, they provide complementary information in the prognosis of stroke. In fact, these biomarkers may be elevated in the setting of medical comorbidities. For example, elevated levels of BNP are associated with congestive heart failure [18] and D-dimer [19] is elevated in any clinical circumstance in which both clot formation and subsequent fibrinolysis are increased, including deep venous thrombosis, pulmonary embolism, disseminated intravascular coagulation, acute myocardial infarction, surgery, and trauma. For these reasons, the Triage Stroke Panel could have more efficacy in defining stroke outcome than stroke diagnosis and its results should not be used as absolute evidence for cerebral ischemia. Patients who are experiencing a heart attack, patients who are candidates for renal dialysis or have had renal dialysis and patients with heart failure may have elevated MMX results. Results should be interpreted along with clinical findings and other test results. In 17 of the 83 patients without an increase of biomarkers, we have not observed the ischemic cascade and a rise of MMX, because the size of the lesion was modest and there were no significant comorbidities able to increase the values of biomarkers. Death has probably occurred for other causes or due to a re-stroke. Although ROC curve gave significant results, sensitivity and specificity values were minimally significant. Other limitations that it is necessary to mention are the residual confounding, the source of collection of data and the lack of MRI data.