Novel diagnostic test for acute stroke

Background and Purpose - The absence of a widely available and sensitive diagnostic test for acute cerebral ischemia remains a significant limitation in the diagnosis and management of stroke. The objective of this study was to examine the feasibility of developing a diagnostic panel of blood-borne biochemical markers of cerebral ischemia. Methods - Serial blood samples were obtained from patients (n = 65 with suspected ischemic stroke, n = 157 control subjects) presenting to an academic medical center emergency department. We analyzed 26 blood-borne markers believed to play a role in the ischemic cascade and created a 3-variable logistic regression model to predict the clinical diagnosis of stroke, defined as persistent neurological symptoms of cerebral ischemia lasting > 24 hours. Results - Of the 26 blood-borne markers analyzed, univariate logistic analysis revealed that 4 were highly correlated with stroke ( P < 0.001): a marker of glial activation (S100 beta), 2 markers of inflammation ( matrix metalloproteinase-9 and vascular cell adhesion molecule), and 1 marker of thrombosis (von Willebrand factor). When the outcome level was set to a cutoff of P = 0.1, our logistic model provided a sensitivity and specificity of 90% for predicting stroke. Conclusions - A panel of blood-borne biochemical markers may be helpful in identifying patients with acute cerebral ischemia who could benefit from urgent care. Such a test may also be helpful in identifying stroke patients in the prehospital setting so that they could be fast-tracked to an institution equipped to care for patients with acute stroke.