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

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 adm... Full description

Journal Title: Cerebrovascular diseases (Basel Switzerland), 2011-08, Vol.32 (2), p.141-147
Main Author: Whiteley, William
Other Authors: Wardlaw, Joanna , Dennis, Martin , Lowe, Gordon , Rumley, Ann , Sattar, Naveed , Welsh, Paul , Green, Alison , Andrews, Mary , Graham, Catriona , Sandercock, Peter
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: Basel, Switzerland: S. Karger AG
ID: ISSN: 1015-9770
Link: https://www.ncbi.nlm.nih.gov/pubmed/21778711
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recordid: cdi_proquest_miscellaneous_884424297
title: Blood Biomarkers for the Diagnosis of Acute Cerebrovascular Diseases: A Prospective Cohort Study
format: Article
creator:
  • Whiteley, William
  • Wardlaw, Joanna
  • Dennis, Martin
  • Lowe, Gordon
  • Rumley, Ann
  • Sattar, Naveed
  • Welsh, Paul
  • Green, Alison
  • Andrews, Mary
  • Graham, Catriona
  • Sandercock, Peter
subjects:
  • Aged
  • Aged, 80 and over
  • Biomarkers - blood
  • Cohort Studies
  • Female
  • Humans
  • Ischemic Attack, Transient - blood
  • Ischemic Attack, Transient - diagnosis
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain - blood
  • Original Paper
  • Peptide Fragments - blood
  • Predictive Value of Tests
  • Prospective Studies
  • Retrospective Studies
  • Sensitivity and Specificity
  • Stroke - blood
  • Stroke - diagnosis
  • Tissue Plasminogen Activator - blood
ispartof: Cerebrovascular diseases (Basel, Switzerland), 2011-08, Vol.32 (2), p.141-147
description: 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.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1015-9770
fulltext: fulltext
issn:
  • 1015-9770
  • 1421-9786
url: Link


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descriptionBackground: 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.
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subjectAged ; Aged, 80 and over ; Biomarkers - blood ; Cohort Studies ; Female ; Humans ; Ischemic Attack, Transient - blood ; Ischemic Attack, Transient - diagnosis ; Male ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Original Paper ; Peptide Fragments - blood ; Predictive Value of Tests ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity ; Stroke - blood ; Stroke - diagnosis ; Tissue Plasminogen Activator - blood
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descriptionBackground: 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.
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abstractBackground: 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.
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