Nucleosomes as a new prognostic marker in early cerebral stroke.
BACKGROUND
The prognostic relevance of blood markers in cerebral stroke is still a matter of controversial debate.


METHODS
In sera of 63 patients, nucleosomes, neuronspecific enolase (NSE), S100 protein, and C-reactive protein (CRP) were determined daily during the first week after cerebral stroke. Infarction volume was quantified by CT or MRI and the clinical status by Barthel Index (BI) at admission, discharge, and after 12 months (prognosis). All markers were evaluated by univariate and multivariate analysis on their prognostic relevance.


RESULTS
During observation time (12 months), three patients died and 33 reached complete recovery. Infarction volume, nucleosomes, NSE, S100, and CRP correlated significantly with clinical status at admission. The same markers except CRP and initial BI correlated with recovery after 12 months. Almost all patients with initial BI double dagger 50 reached complete recovery. In patients with initially severe defects (BI < 50), nucleosomes and S100, both at day 3, were found to be prognostically relevant. At 100%-specificity for non-recovery, only nucleosomes maintained their prognostic power (sensitivity 52.6%; p = 0.014), whereas S100 did not (sensitivity 16.7%; p = 0.25). In multivariate analysis, nucleosomes and BI at admission showed independent prognostic relevance (p = 0.039).


CONCLUSIONS
Circulating nucleosomes and clinical scores provide independent prognostic information concerning the later outcome in patients with initially severe defects after stroke.
Geiger
Sandra
S
Institute of Clinical Chemistry, University Hospital Munich-Grosshadern, Marchioninistr. 15, 81366, Munich, Germany.
Holdenrieder
Stefan
S
Stieber
Petra
P
Hamann
Gerhard F
GF
Bruening
Roland
R
Ma
Jun
J
Nagel
Dorothea
D
Seidel
Dietrich
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009707:Nucleosomes / Q000378:metabolism*; D010751:Phosphopyruvate Hydratase / Q000378:metabolism; D011379:Prognosis; D009418:S100 Proteins / Q000097:blood; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000097:blood* / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
D015415:Biomarkers; D009707:Nucleosomes; D009418:S100 Proteins; D002097:C-Reactive Protein; D010751:Phosphopyruvate Hydratase