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. 2022 Jun;29(6):1630-1642.
doi: 10.1111/ene.15273. Epub 2022 Feb 20.

Early plasma biomarker dynamic profiles are associated with acute ischemic stroke outcomes

Manuel Correia  1   2 , Isabel Silva  1   3   4 , Denis Gabriel  1 , Joel Simrén  5   6 , Angelo Carneiro  7 , Sara Ribeiro  8 , Hugo Mota Dória  7 , Ricardo Varela  1 , Ana Aires  9 , Karolina Minta  5   10 , Rui Antunes  11 , Rui Felgueiras  1 , Pedro Castro  9 , Kaj Blenow  5   6 , Rui Magalhães  12 , Henrik Zetterberg  5   6   10   13   14 , Luis F Maia  1   2   3   4
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Early plasma biomarker dynamic profiles are associated with acute ischemic stroke outcomes

Manuel Correia et al. Eur J Neurol. 2022 Jun.

Abstract

Background: Early outcome prediction after acute ischemic stroke (AIS) might be improved with blood-based biomarkers. We investigated whether the longitudinal profile of a multi-marker panel could predict the outcome of successfully recanalized AIS patients.

Methods: We used ultrasensitive single-molecule array (Simoa) to measure glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), total-tau (t-tau) and ELISA for brevican in a prospective study of AIS patients with anterior circulation large vessel occlusion successfully submitted to thrombectomy. Plasma was obtained at admission, upon treatment, 24 h and 72 h after treatment. Clinical and neuroimaging outcomes were assessed independently.

Results: Thirty-five patients (64.8%) had good early clinical or neuroimaging outcome. Baseline biomarker levels did not distinguish between outcomes. However, longitudinal intra-individual biomarker changes followed different dynamic profiles with time and according to outcome. GFAP levels exhibited an early and prominent increase between admission and just after treatment. NfL increase was less pronounced between admission and up to 24 h. T-tau increased between treatment and 24 h. Interestingly, GFAP rate-of-change (pg/ml/h) between admission and immediately after recanalization had a good discriminative capacity between clinical outcomes (AUC = 0.88, p < 0.001), which was higher than admission CT-ASPECTS (AUC = 0.75, p < 0.01). T-tau rate-of-change provided moderate discriminative capacity (AUC = 0.71, p < 0.05). Moreover, in AIS patients with admission CT-ASPECTS <9 both GFAP and NfL rate-of-change were good outcome predictors (AUC = 0.82 and 0.77, p < 0.05).

Conclusion: Early GFAP, t-tau and NfL rate-of-change in plasma can predict AIS clinical and neuroimaging outcome after successful recanalization. Such dynamic measures match and anticipate neuroimaging predictive capacity, potentially improving AIS patient stratification for treatment, and targeting individualized stroke care.

Keywords: GFAP; NfL; outcome; plasma biomarkers; stroke; thrombectomy; total-tau.

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References

REFERENCES

    1. GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439-458. doi:10.1016/S1474-4422(19)30034-1
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211
    1. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11-21. doi:10.1056/NEJMoa1706442
    1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731. doi:10.1016/S0140-6736(16)00163-X
    1. Wollenweber FA, Tiedt S, Alegiani A, et al. Functional outcome following stroke thrombectomy in clinical practice. Stroke. 2019;50(9):2500-2506. doi:10.1161/STROKEAHA.119.026005

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