Alejandro Bustamante1, Anna Penalba1, Cyrille Orset1, Leire Azurmendi1, Víctor Llombart1, Alba Simats1, Emili Pecharroman1, Oriol Ventura1, Marc Ribó1, Denis Vivien1, Jean Charles Sanchez1, Joan Montaner2. 1. From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France. 2. From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France. joan.montaner@vhir.org.
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.
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.
Authors: Elizabeth Parody-Rua; Alejandro Bustamante; Joan Montaner; Maria Rubio-Valera; David Serrano; Soledad Pérez-Sánchez; Alba Sánchez-Viñas; César Guevara-Cuellar; Antoni Serrano-Blanco Journal: Eur J Health Econ Date: 2022-07-27
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