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Diagnostics
Volume 11
Issue 7
10.3390/diagnostics11071137
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Article

A Novel Combination of Blood Biomarkers and Clinical Stroke Scales Facilitates Detection of Large Vessel Occlusion Ischemic Strokes

by
Edoardo Gaude
1,*,
Barbara Nogueira
1,
Marcos Ladreda Mochales
1,
Sheila Graham
2,
Sarah Smith
3,
Lisa Shaw
4,
Sara Graziadio
5,
Gonzalo Ladreda Mochales
1,
Philip Sloan
2,
Joshua D. Bernstock
6,
Shashank Shekhar
7,
Toby I. Gropen
8 and
Christopher I. Price
4
1
Pockit Diagnostics Ltd., Cambridge CB4 2HY, UK
2
CEPA Biobank, The Newcastle NHS Foundation Trust, Newcastle upon Tyne NE3 3HD, UK
3
NovoPath Biobank, Newcastle MRC Node, Newcastle NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
4
Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
5
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4HH, UK
6
Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
7
University of Mississippi Medical Center, Jackson, MS 39216, USA
8
University of Alabama at Birmingham, Birmingham, AL 35294, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Panagiotis Papanagiotou
Diagnostics 2021, 11(7), 1137; https://doi.org/10.3390/diagnostics11071137
Received: 11 May 2021 / Revised: 9 June 2021 / Accepted: 16 June 2021 / Published: 22 June 2021
(This article belongs to the Section Pathology and Molecular Diagnostics)
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Abstract

Acute ischemic stroke caused by large vessel occlusions (LVOs) is a major contributor to stroke deaths and disabilities; however, identification for emergency treatment is challenging. We recruited two separate cohorts of suspected stroke patients and screened a panel of blood-derived protein biomarkers for LVO detection. Diagnostic performance was estimated by using blood biomarkers in combination with NIHSS-derived stroke severity scales. Multivariable analysis demonstrated that D-dimer (OR 16, 95% CI 5–60; p-value < 0.001) and GFAP (OR 0.002, 95% CI 0–0.68; p-value < 0.05) comprised the optimal panel for LVO detection. Combinations of D-dimer and GFAP with a number of stroke severity scales increased the number of true positives, while reducing false positives due to hemorrhage, as compared to stroke scales alone (p-value < 0.001). A combination of the biomarkers with FAST-ED resulted in the highest accuracy at 95% (95% CI: 87–99%), with sensitivity of 91% (95% CI: 72–99%), and specificity of 96% (95% CI: 90–99%). Diagnostic accuracy was confirmed in an independent cohort, in which accuracy was again shown to be 95% (95% CI: 87–99%), with a sensitivity of 82% (95% CI: 57–96%), and specificity of 98% (95% CI: 92–100%). Accordingly, the combination of D-dimer and GFAP with stroke scales may provide a simple and highly accurate tool for identifying LVO patients, with a potential impact on time to treatment. View Full-Text
Keywords: stroke; biomarkers; large vessel occlusions stroke; biomarkers; large vessel occlusions
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MDPI and ACS Style

Gaude, E.; Nogueira, B.; Ladreda Mochales, M.; Graham, S.; Smith, S.; Shaw, L.; Graziadio, S.; Ladreda Mochales, G.; Sloan, P.; Bernstock, J.D.; Shekhar, S.; Gropen, T.I.; Price, C.I. A Novel Combination of Blood Biomarkers and Clinical Stroke Scales Facilitates Detection of Large Vessel Occlusion Ischemic Strokes. Diagnostics 2021, 11, 1137. https://doi.org/10.3390/diagnostics11071137

AMA Style

Gaude E, Nogueira B, Ladreda Mochales M, Graham S, Smith S, Shaw L, Graziadio S, Ladreda Mochales G, Sloan P, Bernstock JD, Shekhar S, Gropen TI, Price CI. A Novel Combination of Blood Biomarkers and Clinical Stroke Scales Facilitates Detection of Large Vessel Occlusion Ischemic Strokes. Diagnostics. 2021; 11(7):1137. https://doi.org/10.3390/diagnostics11071137

Chicago/Turabian Style

Gaude, Edoardo, Barbara Nogueira, Marcos Ladreda Mochales, Sheila Graham, Sarah Smith, Lisa Shaw, Sara Graziadio, Gonzalo Ladreda Mochales, Philip Sloan, Joshua D. Bernstock, Shashank Shekhar, Toby I. Gropen, and Christopher I. Price. 2021. "A Novel Combination of Blood Biomarkers and Clinical Stroke Scales Facilitates Detection of Large Vessel Occlusion Ischemic Strokes" Diagnostics 11, no. 7: 1137. https://doi.org/10.3390/diagnostics11071137

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