Endogenous tPA levels: A biomarker for discriminating hemorrhagic stroke from ischemic stroke and stroke mimics.

Autor: Jauquet M; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France., Gagnepain P; Normandie University, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France., La Porte E; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France., Thiebaut AM; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France., Rochey A; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France., Legros H; Centre de Ressources Biologiques InnovaBIO, Caen University Hospital, Caen, France., Laine B; Department of Clinical Research, Caen University Hospital, Caen, France., Berthelot M; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France., Roussel V; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France., Montaner J; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain., Casolla B; UR2CA-URRIS, Stroke Unit, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France., Vivien D; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France.; Department of Clinical Research, Caen University Hospital, Caen, France., Lemarchand E; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France., Macrez R; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France.; Department of Emergency Medicine, Caen University Hospital, Caen, France., Roussel BD; Normandie University, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institute Blood and Brain @Caen-Normandie (BB@C), GIP Cyceron, Caen, France.
Jazyk: angličtina
Zdroj: Annals of clinical and translational neurology [Ann Clin Transl Neurol] 2024 Nov; Vol. 11 (11), pp. 2877-2890. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1002/acn3.52197
Abstrakt: Objective: Stroke is the leading cause of death and disability. Timely differentiation between ischemic stroke, hemorrhagic stroke, and stroke mimics is critical for tailored treatment and triage. To accelerate the identification of stroke's subtype, we propose to use the levels of circulating tPA as a biomarker.
Methods: Biostroke is an observational study performed at the Caen Hospital. We quantified tPA levels in 110 patients with ischemic strokes, 30 patients with hemorrhagic strokes, and 67 stroke mimic patients upon their arrival at the emergency. Two logistic regression models were formulated: one with parameters measurable in an ambulance (Model A) and one with parameters measurable at the hospital (Model H). These models were both tested with or without plasma tPA measurements. Our initial assessment involved evaluating the effectiveness of both models in distinguishing between hemorrhagic strokes, ischemic strokes, and stroke mimics within our study cohort.
Results: Plasmatic tPA levels exhibit significant distinctions between hemorrhagic, ischemic, and mimic stroke patients (1.8; 2.5; 2.4 ng/mL, respectively). The inclusion of tPA in model A significantly enhances the classification accuracy of hemorrhagic patients only, increasing identification from 0.67 (95% CI, 0.59 to 0.75) to 0.78 (95% CI, 0.7 to 0.85) (p = 0.0098). Similarly, in model H, classification accuracy of hemorrhagic patients significantly increased with the addition of tPA, rising from 0.75 (95% CI, 0.67 to 0.83) without tPA to 0.86 (95% CI, 0.81 to 0.91) with tPA (p = 0.024).
Interpretations: Our findings underscore the valuable role of tPA levels in distinguishing between stroke subtypes.
(© 2024 The Author(s). Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)
Databáze: MEDLINE
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