Background: Early differentiation between transient ischemic attack (TIA) and minor
ischemic stroke (MIS) impacts on the patient’s individual diagnostic work-up and
treatment. Furthermore, estimations regarding persisting impairments after MIS are
essential to guide rehabilitation programs. This study evaluated a combined clinical- and
serum biomarker-based approach for the differentiation between TIA and MIS as well as
the mid-term prognostication of the functional outcome, which is applicable within the
first 24 h after symptom onset.
Methods: Prospectively collected data were used for a retrospective analysis including
the neurological deficit at admission (National Institutes of Health Stroke Scale, NIHSS)
and the following serum biomarkers covering different pathophysiological aspects of
stroke: Coagulation (fibrinogen, antithrombin), inflammation (C reactive protein), neuronal
damage in the cellular [neuron specific enolase], and the extracellular compartment
[matrix metalloproteinase-9, hyaluronic acid]. Further, cerebral magnetic resonance
imaging was performed at baseline and day 7, while functional outcome was evaluated
with the modified Rankin Scale (mRS) after 3, 6, and 12 months.
Results: Based on data from 96 patients (age 64 ± 14 years), 23 TIA patients (NIHSS
0.6 ± 1.1) were compared with 73 MIS patients (NIHSS 2.4 ± 2.0). In a binary logistic
regression analysis, the combination of NIHSS and serum biomarkers differentiated MIS
from TIA with a sensitivity of 91.8% and a specificity of 60.9% [area under the curve
(AUC) 0.84]. In patients with NIHSS 0 at admission, this panel resulted in a still acceptable
sensitivity of 81.3% (specificity 71.4%, AUC 0.69) for the differentiation between MIS (n =
16) and TIA (n = 14). By adding age, remarkable sensitivities of 98.4, 100, and 98.2% for
the prediction of an excellent outcome (mRS 0 or 1) were achieved with respect to time
points investigated within the 1-year follow-up. However, the specificity was moderate
and decreased over time (83.3, 70, 58.3%; AUC 0.96, 0.92, 0.91).
Conclusion: This pilot study provides evidence that the NIHSS combined with selected
serum biomarkers covering pathophysiological aspects of stroke may represent a useful
tool to differentiate between MIS and TIA within 24 h after symptom onset. Further, this
approach may accurately predict the mid-term outcome in minor stroke patients, which
might help to allocate rehabilitative resources.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:84341 |
| Date | 27 March 2023 |
| Creators | Pelz, Johann Otto, Kubitz, Katharina, Kamprad-Lachmann, Manja, Harms, Kristian, Federbusch, Martin, Hobohm, Carsten, Michalski, Dominik |
| Publisher | Frontiers Research Foundation |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 1664-2295, 724490 |
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