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

• Main Authors: Edoardo Gaude, 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, Christopher I. Price
• Format: Article
• Language: English
• Published: MDPI AG 2021-06-01
• Series: Diagnostics
• Subjects: stroke; biomarkers; large vessel occlusions
• Online Access: https://www.mdpi.com/2075-4418/11/7/1137

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; <i>p</i>-value < 0.001) and GFAP (OR 0.002, 95% CI 0–0.68; <i>p</i>-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 (<i>p</i>-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.