Scientific article
English

Blood biomarkers to differentiate ischemic and hemorrhagic strokes

Published inNeurology, vol. 96, no. 15, p. e1928-e1939
Publication date2021-04-13
First online date2021-03-05
Abstract

Objective: To validate a panel of blood biomarkers to differentiate between ischemic stroke (IS) and intracerebral hemorrhage (ICH) in patients with suspected stroke.

Methods: Patients with suspected stroke admitted within 4.5 hours after onset were enrolled. Blood samples were collected at hospital admission. Glial fibrillary acid protein (GFAP), retinol binding protein 4 (RBP-4), N-terminal proB-type natriuretic peptide (NT-proBNP), and endostatin were measured by immunoassays. Cutoff points were obtained for 100% specificity for IS. A high-sensitivity assay to measure GFAP and rapid point-of-care tests (POCTs) to measure RBP-4 and NT-proBNP were used in subsets of patients. Biomarker panels were evaluated in another cohort of 62 stroke mimics.

Results: A total of 189 patients (154 IS and 35 ICH) were enrolled. Patients with IS had higher RBP-4, NT-proBNP, and endostatin and lower GFAP levels than patients with ICH. The best biomarker combination for the identification of IS was RBP-4+NT-proBNP, which was able to identify 29.7% of patients with IS with 100% specificity. In the subset of patients for whom GFAP was measured with the high-sensitivity assay, RBP-4, NT-proBNP, and GFAP identified 51.5% of patients with IS with 100% specificity. When stroke mimics were included, specificities were reduced to 98.4 and 96.8%, respectively. POCTs of RBP-4 and NT-proBNP showed results similar results to those of conventional ELISAs.

Conclusions: A biomarker panel including RBP-4, NT-proBNP, and GFAP provided moderate but potentially useful sensitivity rates at 100% specificity for IS diagnosis. If confirmed in future studies, this strategy might allow prehospital treatment in selected patients.

Classification of evidence: This study provides Class I evidence that a biomarker panel including RBP-4, NT-proBNP, and GFAP distinguishes IS from ICH with moderate accuracy.

Keywords
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Female
  • Hemorrhagic Stroke / blood
  • Hemorrhagic Stroke / diagnosis
  • Humans
  • Ischemic Stroke / blood
  • Ischemic Stroke / diagnosis
  • Male
  • Sensitivity and Specificity
Research groups
Citation (ISO format)
BUSTAMANTE, Alejandro et al. Blood biomarkers to differentiate ischemic and hemorrhagic strokes. In: Neurology, 2021, vol. 96, n° 15, p. e1928–e1939. doi: 10.1212/WNL.0000000000011742
Main files (1)
Article (Accepted version)
accessLevelRestricted
Identifiers
Journal ISSN0028-3878
136views
0downloads

Technical informations

Creation13/03/2022 12:04:00
First validation13/03/2022 12:04:00
Update time09/01/2025 16:57:17
Status update09/01/2025 16:57:17
Last indexation09/01/2025 17:02:09
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack