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Online Short Courses

Blood Biomarkers for the Diagnosis of Acute Cerebrovascular Diseases: A Prospective Cohort Study

Author(s): W. Whiteley, J. Wardlaw, M. Dennis, G. Lowe, A. Rumley, N. Sattar, P. Welsh, A. Green, M. Andrews, C. Graham, P. Sandercock

Background: The diagnosis of stroke or TIA in the emergency department is difficult, though important for early treatment. Circulating biomarkers might improve upon clinical assessment at admission. Methods: We recruited symptomatic patients with suspected stroke or TIA and drew blood soon after admission. Each patient was assessed with the Face Arm Speech Test (FAST). We measured a panel of 15 circulating inflammatory, thrombotic, cardiac, and cerebral tissue damage biomarkers. Improvement in diagnostic performance was assessed by adding biomarkers to the FAST in logistic regression models to predict a final diagnosis of stroke or TIA (verified by expert review and imaging). Results: 405 patients had suspected stroke: 285 with TIA or stroke (230 definite or probable ischemic stroke, 40 TIA, 15 hemorrhagic stroke) and 120 with other diagnoses. Only the markers t-PA and NT-proBNP were associated positively and significantly (p < 0.01) with a diagnosis of TIA or stroke. The FAST had a sensitivity of 82% (95% CI 78-87) and specificity of 38% (95% CI 29-46) for the diagnosis of TIA or stroke. No biomarker individually improved the sensitivity or specificity of the FAST. A model containing the FAST, age, systolic blood pressure, NT-proBNP and t-PA had a better sensitivity (88%, p < 0.006) and a better specificity (48%, p = 0.04) than the FAST test alone. Conclusions: No single blood marker improved the diagnostic performance of a validated clinical stroke scale. Panels of biomarkers may marginally improve diagnosis, but their practicability is uncertain, and requires further study. Copyright (C) 2011 S. Karger AG, Basel

Full version: Available here

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ISBN: 1015-9770
Publication Year: 2011
Periodical: Cerebrovascular Diseases
Periodical Number: 2
Volume: 32
Pages: 141-147
Author Address: Whiteley, W Univ Edinburgh, Dept Clin Neurosci, Western Gen Hosp, Crewe Rd, Edinburgh EH4 2XU, Midlothian, Scotland Univ Edinburgh, Dept Clin Neurosci, Western Gen Hosp, Edinburgh EH4 2XU, Midlothian, Scotland Univ Edinburgh, SFC Brain Imaging Res Ctr, SINAPSE Collaborat, Edinburgh EH4 2XU, Midlothian, Scotland Western Gen Hosp, Wellcome Trust Clin Res Facil, Edinburgh EH4 2XU, Midlothian, Scotland Univ Glasgow, Div Cardiovasc & Med Sci, Royal Infirm, Glasgow, Lanark, Scotland