Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
World Neurosurg. 2022 Jul;163:e1-e42. doi: 10.1016/j.wneu.2021.10.157. Epub 2021 Oct 30.
The goal of this study was to systematically review the usefulness of serum biomarkers in the setting of ischemic stroke (IS) to predict long-term outcome.
A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986 and 2018. All studies assessing long-term functional outcome (defined as ≥30 days) after IS with respect to serum biomarkers were included. Data were extracted and pooled using a meta-analysis of odds ratios.
Of the 2928 articles in the original literature search, 183 studies were selected. A total of 127 serum biomarkers were included. Biomarkers were grouped into several categories: inflammatory (n = 32), peptide/enzymatic (n = 30), oxidative/metabolic (n = 28), hormone/steroid based (n = 23), and hematologic/vascular (n = 14). The most commonly studied biomarkers in each category were found to be CRP, S100β, albumin, copeptin, and D-dimer. With the exception of S100β, all were found to be statistically associated with >30-day outcome after ischemic stroke.
Serum-based biomarkers have the potential to predict functional outcome in patients with IS. This meta-analysis has identified C-reactive protein, albumin, copeptin, and D-dimer to be significantly associated with long-term outcome after IS. These biomarkers have the potential to serve as a platform for prognosticating stroke outcomes after 30 days. These serum biomarkers, some of which are routinely ordered, can be combined with imaging biomarkers and used in artificial intelligence algorithms to provide refined predictive outcomes after injury. These tools will assist physicians in providing guidance to families regarding long-term independence of patients.
本研究旨在系统回顾缺血性脑卒中（IS）患者血清生物标志物在预测长期预后方面的作用。
使用 PubMed 和 MEDLINE 数据库，对 1986 年至 2018 年间发表的研究进行了系统文献回顾。所有评估 IS 后血清生物标志物与长期功能结局（定义为≥30 天）相关性的研究均被纳入。使用比值比的荟萃分析提取和汇总数据。
在最初的文献检索中，共检索到 2928 篇文章，其中 183 篇研究被选中。共有 127 个血清生物标志物被纳入。这些生物标志物被分为几类：炎症（n=32）、肽/酶（n=30）、氧化/代谢（n=28）、激素/类固醇（n=23）和血液/血管（n=14）。每个类别中最常研究的生物标志物分别为 CRP、S100β、白蛋白、 copeptin 和 D-二聚体。除了 S100β，所有这些生物标志物都与缺血性脑卒中后 30 天以上的结局有统计学关联。
基于血清的生物标志物有可能预测 IS 患者的功能结局。本荟萃分析确定 C 反应蛋白、白蛋白、 copeptin 和 D-二聚体与 IS 后长期结局显著相关。这些生物标志物有可能成为预测 30 天后脑卒中结局的平台。这些血清生物标志物中的一些通常会被常规检测，它们可以与影像学生物标志物结合，并应用于人工智能算法，以提供更精确的预后结果。这些工具将有助于医生为患者家属提供关于患者长期独立的指导。
