A biochemical marker panel in MRI-proven hyperacute ischemic stroke-a prospective studyReport as inadecuate




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BMC Neurology

, 12:14

First Online: 08 March 2012Received: 07 September 2011Accepted: 08 March 2012

Abstract

BackgroundComputer tomography CT is still the fastest and most robust technique to rule out ICH in acute stroke. However CT-sensitivity for detection of ischemic stroke in the hyperacute phase is still relatively low. Moreover the validity of pure clinical judgment is diminished by several stroke imitating diseases mimics. The -Triage Stroke Panel-, a biochemical multimarker assay, detects Brain Natriuretic Peptide BNP, D-Dimers DD, Matrix-Metalloproteinase-9 MMP-9, and S100B protein and promptly generates a Multimarkerindex of these values MMX. This index has been licensed for diagnostic purposes as it might increase the validity of the clinical diagnosis to differentiate between stroke imitating diseases and true ischemic strokes. Our aim was to prove whether the panel is a reliable indicating device for the diagnosis of ischemic stroke in a time window of 6 h to fasten the pre- and intrahospital pathway to fibrinolysis.

MethodsWe investigated all consecutive patients admitted to our stroke unit during a time period of 5 months. Only patients with clinical investigation, blood sample collection and MRI within six hours from symptom onset were included. Values of biochemical markers were analyzed according to the results of diffusion weighted MR-imaging. In addition MMX-values in ischemic strokes were correlated with the TOAST-criteria. For statistical analysis the SAS Analyst software was used. Correlation coefficients were analyzed and comparison tests for two or more groups were performed. Statistical significance was assumed in case of p < 0.05. Finally a ROC-analysis was performed for the MMX-Index.

ResultsIn total 174 patients were included into this study n = 100 strokes, n = 49 mimics, n = 25 transitoric ischemic attacks. In patients with ischemic strokes the mean NIHSS was 7.6 ± 6.2, while the mean DWI-lesion volume was 20.6 ml range 186.9 to 4.2 ml. According to the MMX or the individual markers there was no statistically significant difference between the group of ischemic strokes and the group of mimics. Moreover the correlation of the index and the DWI-lesion-volume was poor p = 0.2.

ConclusionsIn our setting of acute MRI-proven ischemic stroke the used multimarker-assay Triage Stroke Panel was not of diagnostic validity. We do not recommend to perform this assay as this might lead to a unjustified time delay.

KeywordsStroke Biochemical marker Brain natriuretic peptide D-dimers Matrix-metalloproteinase-9 Electronic supplementary materialThe online version of this article doi:10.1186-1471-2377-12-14 contains supplementary material, which is available to authorized users.

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Author: Carolin Knauer - Katharina Knauer - Susanne Müller - Albert C Ludolph - Dietmar Bengel - Hans P Müller - Roman Huber

Source: https://link.springer.com/







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