title: The prognostic value of biomarkers in stroke.
abstract: BACKGROUND
  Ischemic injury triggers inflammatory cascades and changes in the protein synthesis, neurotransmitters and neuro-hormones in the brain parenchyma that may further amplify the tissue damage. The "Triage® Stroke Panel", a biochemical multimarker assay, detects Brain Natriuretic Peptide (BNP), D-Dimers (DD), Matrix-Metalloproteinase-9 (MMP-9), and S100β protein generating a Multimarker index of these values (MMX). The aims of this prospective study in consecutive patients with ischemic or hemorrhagic stroke were to assess: 1) the rate of an increase of biomarkers (BNP, D-dimer, MMP-9 and S-100β) tested with the Triage Stroke Panel; 2) the correlation between the increase of these biomarkers and functional outcome at 4 months; 3) the risk factors for the increase of biomarkers.
  
  
  METHODS
  The outcome of the study was 120-day mortality and it was compared in patients with Stroke Panel >4 and ≤4. Multiple logistic regression analyses were performed to identify independent predictors for death and for the increase of biomarkers.
  
  
  RESULTS
  244 consecutive patients (mean age 73.02 years; 53.7 % males) were included in the study; 210 ischemic strokes and 34 hemorrhagic strokes. 161/244 (66.0 %) had an increase of biomarkers. At 120 days, 85 patients had died (34.8 %). Death was seen in 68/161 patients with an increase of biomarkers (42.2 %) compared with 17/83 patients without (20.5 %). Regression logistic analysis found that a Stroke Panel >4 (OR 3.1; 95 % CI 1.5-6.2, p = 0.002) was associated with mortality. The increase of biomarkers was independently predicted by an increase of PCR on admission (OR 2.9, 95 CI 1.4-6.0, p = 0.003).
  
  
  CONCLUSIONS
  An increase of biochemical markers such as BNP, D-Dimers, MMP-9, and S100β tested with a Triage Stroke Panel (>4) was correlated with mortality at 120 days from stroke onset.
authors.affiliation: Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council, Palermo, Italy ; Department of Neurology, "R. Guzzardi" Hospital-ASP Ragusa, Via Papa Giovanni XXIII, Vittoria (Ragusa), Italy ; Department of Neuroscience, University of Catania, Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Iemolo
authors.affiliation: Department of Neurology, "R. Guzzardi" Hospital-ASP Ragusa, Via Papa Giovanni XXIII, Vittoria (Ragusa), Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Sanzaro
authors.affiliation: Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Duro
authors.affiliation: Department of Neurology, "R. Guzzardi" Hospital-ASP Ragusa, Via Papa Giovanni XXIII, Vittoria (Ragusa), Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni