A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke

Background: Early neurological deterioration (END) following acute stroke is associated with poorer long-term outcomes. Identification of patients at risk could assist early monitoring and treatment decisions. This review summarised the evidence describing non-radiological biomarkers for END.Summary: Electronic searches from January 1990 to March 2017 identified studies reporting a blood/cerebrospinal fluid (CSF)/urine biomarker measurement within 24 h of acute stroke and at least 2 serial assessments of clinical neurological status (#x3c; 24 h and #x3c; 7 days). Out of 12,895 citations, 82 studies were included, mostly focusing on ischaemic stroke. Using higher neurological thresholds, the n-weighted END incidence for ischaemic stroke was 11.9% (95% CI 11.4 –12.4%) and 18.6% (17.9–19.2%) for lower thresholds. Incidence decreased with advancing study publication year (Pearson r-squared 0.23 and 0.15 for higher and lower threshold studies). After classification into 3 broad categories, meta-analysis showed that biomarkers associated with increased EN D risk (n; fixed-effects mean difference; 95% CI) were “metabolic” (glucose [n = 9,481; 0.90 mmol/L; 0.74 –1.06], glycosylated haemoglobin [n = 3,146; 0.33%; 0.19 –0.46], low-density lipoprotein [n = 4,839; 0.13 mmol/L; 0.06 –0.21], total cholesterol [n = 4,762; 0.21 mmol/L; 0.11 –0.31], triglycerides [n = 4,820; 0.11 mmol/L; 0.06 –0.17], urea [n = 1,351; 0.55 mmol/L; 0.14 –0.96], decreasing albumin [n = 513; 0...
Source: Cerebrovascular Diseases - Category: Neurology Source Type: research