title: A blood-based biomarker panel to detect acute stroke.
abstract: BACKGROUND
  The aim of this study was to develop an adjunctive, peripheral biomarker test to differentiate ischemic strokes, intracranial hemorrhages (ICHs), and stroke mimics in the acute setting.
  
  
  METHODS
  Serum samples were collected from 167 patients who presented with an acute neurologic deficit within 24 hours of symptom onset. Patients were adjudicated to ischemic stroke, ICH, and mimic pathology groups based on clinical and radiographic findings. Samples were tested for levels of 262 potential markers. A multivariate Cox proportional hazards regression model of 5 biomarkers was built by stepwise selection and validated by bootstrapping. Its discriminative capacity was quantified by C index and net reclassification improvement (NRI).
  
  
  RESULTS
  The final model consisted of eotaxin, epidermal growth factor receptor, S100A12, metalloproteinase inhibitor-4, and prolactin. It demonstrated a discriminative capacity for ischemic stroke versus mimic (C = .92), ischemic stroke and ICH versus mimic (C = .93), and ischemic stroke versus ICH (C = .82). The inclusion of biomarkers to a model consisting of age, race, and gender resulted in an NRI of 161% when detecting ischemic stroke versus mimic (P < .0001), an improvement of 171% when detecting ischemic strokes plus ICH versus mimic (P < .0001), and an improvement of 56% when detecting ischemic strokes versus ICH (P = .1419).
  
  
  CONCLUSIONS
  These results suggest that information obtained from a 5-biomarker panel may add valuable information in the early evaluation and management of patients with stroke-like symptoms.
authors.affiliation: Duke University School of Medicine, Durham, North Carolina.
authors.forename: Richa
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Medicine (Neurology), Duke University Medical Center, Durham, North Carolina.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Macy
authors.affiliation: Department of Medicine (Neurology), Duke University Medical Center, Durham, North Carolina.
authors.forename: Kara
authors.initials: K
authors.lastname: Richardson
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Lokhnygina
authors.affiliation: Duke University School of Medicine, Durham, North Carolina; Department of Medicine (Neurology), Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: danl@neuro.duke.edu.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Laskowitz
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D054413:Chemokine CCL11 / Q000097:blood; D002630:Chemotactic Factors / Q000097:blood; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D016002:Discriminant Analysis; D066246:ErbB Receptors / Q000097:blood; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood* / Q000175:diagnosis* / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011388:Prolactin / Q000097:blood; D016016:Proportional Hazards Models; D044469:Racial Groups; D015203:Reproducibility of Results; D012307:Risk Factors; D009418:S100 Proteins / Q000097:blood; D012737:Sex Factors; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000208:ethnology; D019714:Tissue Inhibitor of Metalloproteinases / Q000097:blood; D000097792:Tissue Inhibitor of Metalloproteinase-4
chemical_list: D015415:Biomarkers; D054413:Chemokine CCL11; D002630:Chemotactic Factors; D066246:ErbB Receptors; D011388:Prolactin; D009418:S100 Proteins; D019714:Tissue Inhibitor of Metalloproteinases; D000097792:Tissue Inhibitor of Metalloproteinase-4; C515456:CCL11 protein, human; C098997:S100A2 protein, human; C512478:EGFR protein, human
keywords: Ischemic stroke; diagnostic biomarkers; intracranial hemorrhage; stroke mimic