Comparison of plasma beta-globin DNA and S-100 protein concentrations in acute stroke.
BACKGROUND
This study aimed to compare changes in plasma beta-globin DNA and serum S100 protein to diagnose stroke and for predicting mortality and morbidity.


METHODS
Patients with stroke-like symptoms presenting to the emergency department of a Hong Kong hospital were recruited. Plasma DNA was analyzed for the beta-globin gene with fluorescent-based PCR. S100 concentrations were determined using ELISA. Primary outcomes were diagnosis of stroke, mortality, and modified Rankin Score (mRS) after 6 months.


RESULTS
One hundred ninety-seven consecutive patients recruited, 118 (60%) ischemic stroke, 35 (18%) hemorrhage and 44 (22%) with no acute neuroimaging changes. Serum S100 and plasma DNA were increased in 126 (p<0.0010) and 36 (p=0.21) stroke patients respectively vs. controls. Median plasma DNA was higher in hemorrhagic stroke than those without (1725 vs. 1050 kilogenome-equivalents/l, p=0.0104). Median plasma DNA was higher in mRS>2 vs. mRS<or=2 (1350 vs. 1025, p=0.0103), and higher in non-survivors vs. survivors (1625 vs. 1050, p=0.0070). Median serum S100 higher in mRS>2 patients vs. mRS<or=2 (0.152 vs. 0.131 microg/l, p=0.0003). The odds ratio (OR) of discriminating hemorrhagic from non-hemorrhagic stroke with DNA was 4.24 (95% CI 1.88-9.56); S100 and DNA together give an OR of 16.55.


CONCLUSIONS
For stroke diagnosis, S100 performs better than DNA; DNA is a better marker for hemorrhage. For diagnosis of hemorrhagic stroke, combined S100 and DNA performs better than either alone. Plasma DNA and serum S100 predict morbidity and mortality in stroke.
Rainer
Timothy H
TH
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
Wong
Ka Sing
KS
Lam
Wynnie
W
Lam
Nicole Y L
NY
Graham
Colin A
CA
Lo
Y M Dennis
YM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001483:Base Sequence; D004247:DNA / Q000097:blood* / Q000235:genetics; D005260:Female; D005914:Globins / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D009418:S100 Proteins / Q000097:blood*; D020521:Stroke / Q000097:blood* / Q000175:diagnosis*
D009418:S100 Proteins; D005914:Globins; D004247:DNA