Han Eunhee, Kim Hyejeong, Cho Bongrae, Lee Jeong-Joong, Shin Soyoung, Oh Eun-Jee, Chae Hyojin
Department of Laboratory Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Diagnostics (Basel). 2023 Aug 25;13(17):2757. doi: 10.3390/diagnostics13172757.
Acute stroke management is critically time-sensitive and challenging. Blood-based biomarkers that can differentiate acute ischemic stroke (IS) from hemorrhagic stroke (HS) can greatly facilitate triage and early management. Admission blood samples obtained within 6 h of stroke symptom onset were analyzed in a derivation/validation design. GFAP, N-FL, NT-proBNP, copeptin, neutrophils (%), NLR, and platelet counts were assessed in the derivation cohort. The informative markers and the derived cutoff values were evaluated in the validation cohort. GFAP > 703 pg/mL showed a PPV of 76.9% and NPV of 95.8% for differentiating HS from IS. Multiple logistic regression analysis showed that GFAP and NT-proBNP were independent variables associated with IS and HS differentiation. Furthermore, applying a combined cutoff (GFAP > 703 pg/mL and NT-proBNP ≤ 125 pg/mL) for HS detection increased the PPV in both the derivation and validation cohorts (93.3% and 100%, respectively). GFAP and NT-proBNP levels were validated as informative blood biomarkers in the differentiation of IS and HS and using a combination of GFAP and NT-proBNP is suggested as a feasible strategy to differentiate stroke subtypes in the hyperacute phase of stroke.
急性卒中的管理对时间极为敏感且具有挑战性。能够区分急性缺血性卒中（IS）和出血性卒中（HS）的血液生物标志物可极大地促进分诊和早期管理。采用推导/验证设计对卒中症状发作6小时内采集的入院血样进行分析。在推导队列中评估了胶质纤维酸性蛋白（GFAP）、神经丝轻链（N-FL）、N末端脑钠肽原（NT-proBNP）、 copeptin、中性粒细胞百分比（%）、中性粒细胞与淋巴细胞比值（NLR）以及血小板计数。在验证队列中评估了信息性标志物和推导的临界值。GFAP>703 pg/mL区分HS与IS的阳性预测值为76.9%，阴性预测值为95.8%。多因素logistic回归分析表明，GFAP和NT-proBNP是与IS和HS区分相关的独立变量。此外，应用联合临界值（GFAP>703 pg/mL且NT-proBNP≤125 pg/mL）进行HS检测可提高推导队列和验证队列中的阳性预测值（分别为93.3%和100%）。GFAP和NT-proBNP水平在IS和HS的鉴别中被验证为信息性血液生物标志物，建议联合使用GFAP和NT-proBNP作为在卒中超急性期区分卒中亚型的可行策略。
