title: A biochemical marker panel in MRI-proven hyperacute ischemic stroke-a prospective study.
abstract: BACKGROUND
  Computer tomography (CT) is still the fastest and most robust technique to rule out ICH in acute stroke. However CT-sensitivity for detection of ischemic stroke in the hyperacute phase is still relatively low. Moreover the validity of pure clinical judgment is diminished by several stroke imitating diseases (mimics). The "Triage® Stroke Panel", a biochemical multimarker assay, detects Brain Natriuretic Peptide (BNP), D-Dimers (DD), Matrix-Metalloproteinase-9 (MMP-9), and S100B protein and promptly generates a Multimarkerindex of these values (MMX). This index has been licensed for diagnostic purposes as it might increase the validity of the clinical diagnosis to differentiate between stroke imitating diseases and true ischemic strokes. Our aim was to prove whether the panel is a reliable indicating device for the diagnosis of ischemic stroke in a time window of 6 h to fasten the pre- and intrahospital pathway to fibrinolysis.
  
  
  METHODS
  We investigated all consecutive patients admitted to our stroke unit during a time period of 5 months. Only patients with clinical investigation, blood sample collection and MRI within six hours from symptom onset were included. Values of biochemical markers were analyzed according to the results of diffusion weighted MR-imaging. In addition MMX-values in ischemic strokes were correlated with the TOAST-criteria. For statistical analysis the SAS Analyst software was used. Correlation coefficients were analyzed and comparison tests for two or more groups were performed. Statistical significance was assumed in case of p < 0.05. Finally a ROC-analysis was performed for the MMX-Index.
  
  
  RESULTS
  In total 174 patients were included into this study (n = 100 strokes, n = 49 mimics, n = 25 transitoric ischemic attacks). In patients with ischemic strokes the mean NIHSS was 7.6 ± 6.2, while the mean DWI-lesion volume was 20.6 ml (range 186.9 to 4.2 ml). According to the MMX or the individual markers there was no statistically significant difference between the group of ischemic strokes and the group of mimics. Moreover the correlation of the index and the DWI-lesion-volume was poor (p = 0.2).
  
  
  CONCLUSIONS
  In our setting of acute MRI-proven ischemic stroke the used multimarker-assay (Triage® Stroke Panel) was not of diagnostic validity. We do not recommend to perform this assay as this might lead to a unjustified time delay.
authors.affiliation: Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89075 Ulm, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Knauer
authors.forename: Katharina
authors.initials: K
authors.lastname: Knauer
authors.forename: Susanne
authors.initials: S
authors.lastname: Müller
authors.forename: Albert C
authors.initials: AC
authors.lastname: Ludolph
authors.forename: Dietmar
authors.initials: D
authors.lastname: Bengel
authors.forename: Hans P
authors.initials: HP
authors.lastname: Müller
authors.forename: Roman
authors.initials: R
authors.lastname: Huber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000097:blood*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D009419:Nerve Tissue Proteins