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Biomarkers to improve functional outcome prediction after ischemic stroke: Results from the SICFAIL, STRAWINSKI, and PREDICT studies.
Montellano, Felipe A; Rücker, Viktoria; Ungethüm, Kathrin; Penalba, Anna; Hotter, Benjamin; Giralt, Marina; Wiedmann, Silke; Mackenrodt, Daniel; Morbach, Caroline; Frantz, Stefan; Störk, Stefan; Whiteley, William N; Kleinschnitz, Christoph; Meisel, Andreas; Montaner, Joan; Haeusler, Karl Georg; Heuschmann, Peter U.
Afiliación
  • Montellano FA; Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany.
  • Rücker V; Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
  • Ungethüm K; Interdisciplinary Center for Clinical Research, University Hospital Würzburg, Würzburg, Germany.
  • Penalba A; Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany.
  • Hotter B; Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany.
  • Giralt M; Institute of Medical Data Science, University Hospital Würzburg, Würzburg, Germany.
  • Wiedmann S; Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Mackenrodt D; Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Morbach C; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Frantz S; NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Störk S; Department of Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain.
  • Whiteley WN; Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany.
  • Kleinschnitz C; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
  • Meisel A; Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany.
  • Montaner J; Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
  • Haeusler KG; Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.
  • Heuschmann PU; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.
Eur Stroke J ; : 23969873241250272, 2024 May 06.
Article en En | MEDLINE | ID: mdl-38711254
ABSTRACT
BACKGROUND AND

AIMS:

Acute ischemic stroke (AIS) outcome prognostication remains challenging despite available prognostic models. We investigated whether a biomarker panel improves the predictive performance of established prognostic scores.

METHODS:

We investigated the improvement in discrimination, calibration, and overall performance by adding five biomarkers (procalcitonin, copeptin, cortisol, mid-regional pro-atrial natriuretic peptide (MR-proANP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)) to the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and age/NIHSS scores using data from two prospective cohort studies (SICFAIL, PREDICT) and one clinical trial (STRAWINSKI). Poor outcome was defined as mRS > 2 at 12 (SICFAIL, derivation dataset) or 3 months (PREDICT/STRAWINSKI, pooled external validation dataset).

RESULTS:

Among 412 SICFAIL participants (median age 70 years, quartiles 59-78; 63% male; median NIHSS score 3, quartiles 1-5), 29% had a poor outcome. Area under the curve of the ASTRAL and age/NIHSS were 0.76 (95% CI 0.71-0.81) and 0.77 (95% CI 0.73-0.82), respectively. Copeptin (0.79, 95% CI 0.74-0.84), NT-proBNP (0.80, 95% CI 0.76-0.84), and MR-proANP (0.79, 95% CI 0.75-0.84) significantly improved ASTRAL score's discrimination, calibration, and overall performance. Copeptin improved age/NIHSS model's discrimination, copeptin, MR-proANP, and NT-proBNP improved its calibration and overall performance. In the validation dataset (450 patients, median age 73 years, quartiles 66-81; 54% men; median NIHSS score 8, quartiles 3-14), copeptin was independently associated with various definitions of poor outcome and also mortality. Copeptin did not increase model's discrimination but it did improve calibration and overall model performance.

DISCUSSION:

Copeptin, NT-proBNP, and MR-proANP improved modest but consistently the predictive performance of established prognostic scores in patients with mild AIS. Copeptin was most consistently associated with poor outcome in patients with moderate to severe AIS, although its added prognostic value was less obvious.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Stroke J Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Stroke J Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido