title: Differentiating ischemic from hemorrhagic stroke using plasma biomarkers: the S100B/RAGE pathway.
abstract: Although neuroimaging is useful in differentiating ischemic (IS) from hemorrhagic (ICH) stroke in the Emergency Department, a wide-available rapid biochemical test would add advantages in the pre-hospital triage and management of stroke patients. Our aim was to examine the predictive value of a panel of blood-borne biomarkers to differentiate IS from ICH. Admission blood samples obtained within 24h from stroke symptoms onset were tested by ELISA for CRP, D-dimer, sRAGE, MMP9, S100B, BNP, NT-3, caspase-3, chimerin-II, secretagogin, cerebellin and NPY. The complete protocol was achieved in 915 patients (776 IS, 139 ICH). Among blood samples obtained <6 h from symptoms onset (n=337), S100B levels were increased in ICH (107.58 vs 58.70 pg/mL; p<0.001) whereas sRAGE levels were decreased (0.77 vs 1.02 ng/mL; p=0.009) as compared to IS. In this subset of patients S100B (OR 3.97 95% CI 1.82-8.68; p=0.001) and sRAGE (OR 0.22 95% CI 0.10-0.52; p<0.001) were independently associated with ICH. A regression tree was created by CART method showing good classification ability (AUC=0.762). Similar results were found for samples obtained within 3 h. In conclusion, a combination of biomarkers including those of the S100B/RAGE pathway seems promising to achieve a rapid biochemical diagnosis of IS versus ICH in the first hours from symptoms onset. This article is part of a Special Issue entitled: Translational Proteomics.
authors.affiliation: Neurovascular Research Laboratory, Vall d'Hebron University Hospital, Research Institut, Universitat Autònoma de Barcelona, Barcelona, Spain. 31862jmv@comb.cat
authors.forename: Joan
authors.initials: J
authors.lastname: Montaner
authors.forename: Maite
authors.initials: M
authors.lastname: Mendioroz
authors.forename: Pilar
authors.initials: P
authors.lastname: Delgado
authors.forename: Teresa
authors.initials: T
authors.lastname: García-Berrocoso
authors.forename: Dolors
authors.initials: D
authors.lastname: Giralt
authors.forename: Cristina
authors.initials: C
authors.lastname: Merino
authors.forename: Marc
authors.initials: M
authors.lastname: Ribó
authors.forename: Anna
authors.initials: A
authors.lastname: Rosell
authors.forename: Anna
authors.initials: A
authors.lastname: Penalba
authors.forename: Israel
authors.initials: I
authors.lastname: Fernández-Cadenas
authors.forename: Francisco
authors.initials: F
authors.lastname: Romero
authors.forename: Carlos
authors.initials: C
authors.lastname: Molina
authors.forename: Jose
authors.initials: J
authors.lastname: Alvarez-Sabín
authors.forename: Mar
authors.initials: M
authors.lastname: Hernández-Guillamon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000097:blood*; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D020521:Stroke / Q000097:blood* / Q000175:diagnosis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D009414:Nerve Growth Factors; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human