title: Explorative investigation of biomarkers of brain damage and coagulation system activation in clinical stroke differentiation.
abstract: BACKGROUND
  A simple and accurate method of differentiating ischemic stroke and intracerebral hemorrhage (ICH) is potentially useful to facilitate acute therapeutic management. Blood measurements of biomarkers of brain damage and activation of the coagulation system may potentially serve as novel diagnostic tools for stroke subtypes.
  
  
  METHODS
  Ninety-seven stroke patients were prospectively investigated in a multicenter design with blood levels of brain biomarkers S100B, neuron specific enolase (NSE), glial fibrillary acidic protein (GFAP) as well as a coagulation biomarker, activated protein C-protein C inhibitor complex (APC-PCI), within 24 hours of symptom onset.
  
  
  RESULTS
  Eighty-three patients (86%) had ischemic stroke and fourteen patients (14%) had ICH. There were no differences in S100B (p=0.13) and NSE (p=0.67) levels between patients with ischemic stroke or ICH. However, GFAP levels were significantly higher in ICH patients (p=0.0057). APC-PCI levels were higher in larger ischemic strokes (p=0.020). The combination of GFAP and APC-PCI levels, in patients with NIHSS score more than 3, had a sensitivity and negative predictive value of 100% for ICH in our material (p=0.0052).
  
  
  CONCLUSIONS
  This exploratory study indicated that blood levels of biomarkers GFAP and APC-PCI, prior to neuroimaging, may rule out ICH in a mixed stroke population.
authors.affiliation: Dept. of Anaesthesiology and Intensive Care, Halmstad Regional Hospital, 30185 Halmstad, Sweden. johan.unden@lthalland.se
authors.forename: Johan
authors.initials: J
authors.lastname: Undén
authors.forename: Karin
authors.initials: K
authors.lastname: Strandberg
authors.forename: Jan
authors.initials: J
authors.lastname: Malm
authors.forename: Eric
authors.initials: E
authors.lastname: Campbell
authors.forename: Lars
authors.initials: L
authors.lastname: Rosengren
authors.forename: Johan
authors.initials: J
authors.lastname: Stenflo
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Bertil
authors.initials: B
authors.lastname: Romner
authors.forename: Arne
authors.initials: A
authors.lastname: Lindgren
authors.forename: Gunnar
authors.initials: G
authors.lastname: Andsberg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001921:Brain; D001930:Brain Injuries / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011446:Prospective Studies; D018046:Protein C Inhibitor / Q000097:blood*; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D009414:Nerve Growth Factors; D018046:Protein C Inhibitor; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D010751:Phosphopyruvate Hydratase