title: Multiple biomarkers for the prediction of ischemic stroke: the PRIME study.
abstract: OBJECTIVE
  To simultaneously evaluate 14 biomarkers from distinct biological pathways for risk prediction of ischemic stroke, including biomarkers of hemostasis, inflammation, and endothelial activation as well as chemokines and adipocytokines.
  
  
  RESULTS
  The Prospective Epidemiological Study on Myocardial Infarction (PRIME) is a cohort of 9771 healthy men 50 to 59 years of age who were followed up over 10 years. In a nested case-control study, 95 ischemic stroke cases were matched with 190 controls. After multivariable adjustment for traditional risk factors, fibrinogen (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.03-2.28), E-selectin (OR, 1.76; 95% CI, 1.06-2.93), interferon-γ-inducible-protein-10 (OR, 1.72; 95% CI, 1.06-2.78), resistin (OR, 2.86; 95% CI, 1.30-6.27), and total adiponectin (OR, 1.82; 95% CI, 1.04-3.19) were significantly associated with ischemic stroke. Adding E-selectin and resistin to a traditional risk factor model significantly increased the area under the receiver-operating characteristic curve from 0.679 (95% CI, 0.612-0.745) to 0.785 and 0.788, respectively, and yielded a categorical net reclassification improvement of 29.9% (P=0.001) and 28.4% (P=0.002), respectively. Their simultaneous inclusion in the traditional risk factor model increased the area under the receiver-operating characteristic curve to 0.824 (95% CI, 0.770-0.877) and resulted in an net reclassification improvement of 41.4% (P<0.001). Results were confirmed when using continuous net reclassification improvement.
  
  
  CONCLUSIONS
  Among multiple biomarkers from distinct biological pathways, E-selectin and resistin provided incremental and additive value to traditional risk factors in predicting ischemic stroke.
authors: Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France. christof.prugger@inserm.fr
authors: Christof
authors: C
authors: Prugger
authors: Gérald
authors: G
authors: Luc
authors: Bernadette
authors: B
authors: Haas
authors: Pierre-Emmanuel
authors: PE
authors: Morange
authors: Jean
authors: J
authors: Ferrieres
authors: Philippe
authors: P
authors: Amouyel
authors: Frank
authors: F
authors: Kee
authors: Pierre
authors: P
authors: Ducimetiere
authors: Jean-Philippe
authors: JP
authors: Empana
mesh_terms: D054392:Adipokines / Q000097:blood; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology; D016022:Case-Control Studies; D018925:Chemokines / Q000097:blood; D019040:E-Selectin / Q000097:blood*; D004730:Endothelium, Vascular / Q000378:metabolism; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006487:Hemostasis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D009660:Northern Ireland / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D052243:Resistin / Q000097:blood*; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology; D013997:Time Factors
chemical_list: D054392:Adipokines; D015415:Biomarkers; D018925:Chemokines; D019040:E-Selectin; D018836:Inflammation Mediators; C499624:RETN protein, human; D052243:Resistin; C546936:SELE protein, human