A short-cut review was carried out to establish the diagnostic accuracy of blood biomarkers as an alternative to imaging for the diagnosis of ischaemic stroke. Nine studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that that blood biomarkers are currently not suitable for the diagnosis of acute ischaemic stroke.
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Three part question
In [adults with suspected stroke], can [blood biomarkers] [accurately diagnose ischemic stroke rapidly]?
A 63-year-old man with a history of hypertension comes to the emergency department complaining of sudden onset of right-sided weakness and slurring of speech 2 hours ago. You request an immediate non-contrast CT brain. However, you wonder if blood biomarkers could be used instead to diagnose a stroke, or more accurately, an ischaemic stroke.
CCTR, CDSR, EMBASE, Ovid MEDLINE 2011–2016 were searched with the following search criteria:
(biomarker[Title] OR marker[Title]) AND (cerebrovascular[Title] OR ischaemic stroke[Title] OR ischemic stroke[Title])) AND (("diagnosis"[Subheading] OR "diagnosis"[All Fields] OR "diagnosis"[MeSH Terms]) OR "sensitivity and specificity"[All Fields] OR ("probability"[MeSH Terms] OR "probability"[All Fields]))) NOT fibrillation[All Fields]) NOT (("infant, newborn"[MeSH Terms] OR ("infant"[All Fields] AND "newborn"[All Fields]) OR "newborn infant"[All Fields] OR "neonatal"[All Fields]) OR ("pediatrics"[MeSH Terms] OR "pediatrics"[All Fields] OR "pediatric"[All Fields]) OR ("pediatrics"[MeSH Terms] OR "pediatrics"[All Fields] OR "paediatric"[All Fields]) OR ("infant"[MeSH Terms] OR "infant"[All Fields] OR "infants"[All Fields]))) NOT FLAIR[All Fields] AND (("2011/01/01"[PDAT]: "2016/12/31"[PDAT]) AND "humans"[MeSH Terms] AND English[lang])
Of 72 papers found, 21 duplicates were removed and 9 papers were chosen by relevant title and abstract table 2.
This BestBET review updates previous work by Jie1 to explore the diagnostic possibility of any new-found biomarkers for ischaemic stroke.
Jie commented that biomarkers for acute ischaemic stroke (AIS) should be brain specific, plasmatic (not cerebrospinal fluid), early expressed and detected after symptom onset. This would suggest that while using these biomarkers the focus should be on shortening the time (possibly using point-of-care testing) required for accurate diagnosis and improving cost effectiveness.
Despite some relatively promising sensitivities, specificities and area under the curves observed in the nine studies reviewed here, none of the reported biomarkers are reliable enough as a single diagnostic tool due to the small sample sizes and lack of power. In future, adequately powered investigations are needed to validate the accuracy of these and other biomarkers.
Clinical bottom line
Blood biomarkers are not currently suitable for the rapid accurate diagnosis of acute ischaemic stroke.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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