title: A bioclinical pattern for the early diagnosis of cardioembolic stroke.
abstract: Background and Scope. Early etiologic diagnosis of ischemic stroke subtype guides acute management and treatment. We aim to evaluate if plasma biomarkers can predict stroke subtypes in the early phase from stroke onset. Methods. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP), D-dimer, C-reactive protein, serum albumin, and globulin levels have been investigated in 114 consecutive patients presenting at the emergency room within 6 hours of the ischemic stroke onset. Plasma levels of biomarkers have been correlated with stroke aetiology (based on TOAST criteria) by multivariable logistic regression analysis, adjusted for several covariates. Results. Of the 114 patients, 34 (30%) had cardioembolic stroke, 27 (23%) atherothrombotic stroke, 19 (17%) lacunar stroke, and 34 (30%) stroke of undetermined origin. Patients with cardioembolic stroke had significantly higher levels of NT-proBNP and lower globulin/albumin (G/A) ratio compared with the other subgroups. At multiple logistic regression NT-proBNP > 200 pg/mL, G/A ratio > 0.70, and NIHSS score were independent predictors of cardioembolic stroke with high accuracy of the model, either including (AUC, 0.91) or excluding (AUC, 0.84) atrial fibrillation. Conclusions. A prediction model that includes NT-proBNP, G/A ratio, and NIHSS score can be useful for the early etiologic diagnosis of ischemic stroke.
authors.affiliation: Emergency Care Unit, Fondazione IRCCS Ca' Granda OspedaleMaggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Zecca
authors.affiliation: Emergency Care Unit, Fondazione IRCCS Ca' Granda OspedaleMaggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Mandelli
authors.affiliation: Università degli Studi di Milano, Via Festa del Perdono 7, 20100 Milan, Italy ; Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Maino
authors.affiliation: Emergency Care Unit, Fondazione IRCCS Ca' Granda OspedaleMaggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy ; Università degli Studi di Milano, Via Festa del Perdono 7, 20100 Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Casiraghi
authors.affiliation: Cardiovascular Disease Institute, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy.
authors.forename: Giovanbattista
authors.initials: G
authors.lastname: Bolla
authors.affiliation: Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Emergency Care Unit, Fondazione IRCCS Ca' Granda OspedaleMaggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy ; Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Santalucia
authors.affiliation: Emergency Care Unit, Fondazione IRCCS Ca' Granda OspedaleMaggiore Policlinico, Via F. Sforza 35, 20100 Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Torgano
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