The potential role of blood biomarkers in patients with ischemic stroke

Abstract

Blood biomarkers are increasingly beginning to play a role in the diagnosis, management, and prognostication of patients with acute ischemic stroke. While imaging biomarkers have played the largest role in determining acute therapies, bloodbased biomarkers may have important contributions to make in settings where imaging is not readily available, or when making predictions about future complications and recurrent stroke. Though more research in large, diverse patient populations are needed before blood-based biomarkers become widely accepted for stroke management, preliminary reports suggest their value in several settings and the use of biomarkers is gaining traction. This article discusses the role of several selected readily available protein biomarkers in stroke diagnosis, acute management decisions, and prognosis. Protein biomarkers were primarily selected based on the fact that they have been evaluated in cohort studies and ideally that they have been validated by independent groups.

Elevation of high‐sensitivity cardiac troponin T at admission is associated with increased 3‐month mortality in acute ischemic stroke patients treated with thrombolysis

“…31 Unfortunately, to date, no blood biomarker in the field of stroke has been unequivocally considered as a validated surrogate marker, which can substitute for a clinical evaluation. 28 Specifically, in this study, we found that a cutoff value of 15.4 ng/L for serum hs-cTnT predicted both 30 and 90-day mortality in AIS patients receiving IV thrombolysis. Because the level of hs-cTnT can be affected by many comorbid conditions, we suggest the prediction model should be applied on an individual basis, weighing age, comorbidities, stroke severity, location of lesions, stroke etiology, and bleeding risk.…”

“…Moreover, a panel of multiple biomarkers consisting of BNP, d ‐dimers, MMP‐9, and S100 β protein was also shown to be valuable in detecting increased mortality after stroke . Unfortunately, to date, no blood biomarker in the field of stroke has been unequivocally considered as a validated surrogate marker, which can substitute for a clinical evaluation . Specifically, in this study, we found that a cutoff value of 15.4 ng/L for serum hs‐cTnT predicted both 30 and 90‐day mortality in AIS patients receiving IV thrombolysis.…”

“…Instant biomarkers with desirable prognostic values can be of great help in distinguishing patients most likely to benefit from, or be harmed by, a particular therapy, including IV thrombolysis in AIS patients. In this regard, many blood biomarkers have been investigated, with proven potential in stroke diagnosis and recovery . Multiple studies have demonstrated changes in a number of blood biomarkers, such as N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP), copeptin, matrix metalloproteinase‐9 (MMP‐9), and S100 β, are all independently associated with various clinical outcomes .…”

“…In this regard, many blood biomarkers have been investigated, with proven potential in stroke diagnosis and recovery . Multiple studies have demonstrated changes in a number of blood biomarkers, such as N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP), copeptin, matrix metalloproteinase‐9 (MMP‐9), and S100 β, are all independently associated with various clinical outcomes . For instance, MMP‐9 is predictive of HT after IV thrombolysis, with higher MMP‐9 indicating more severe HT .…”

“…Prognosis of AIS is critical for not only patients and relatives but also physicians who have critical decision-making power to optimize and allocate stroke care and resources. 28 Instant biomarkers with desirable prognostic values can be of great help in distinguishing patients most likely to benefit from, or be harmed by, a particular therapy, 29 including IV thrombolysis in AIS patients. In this regard, many blood biomarkers have been investigated, with proven potential in stroke diagnosis and recovery.…”