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The association between early neurological deterioration and whole blood purine concentration during acute stroke
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Martin, Alexander J., Dale, Nicholas, Imray, Christopher H. E., Roffe, Christine, Smith, Craig J., Tian, Faming and Price, Christopher I. (2019) The association between early neurological deterioration and whole blood purine concentration during acute stroke. Biomarker Research, 7 (1). doi:10.1186/s40364-019-0158-y
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Official URL: http://dx.doi.org/10.1186/s40364-019-0158-y
Abstract
Background
Early neurological deterioration (END) is common after stroke. Prediction could identify patients requiring additional monitoring and intervention. Purines, breakdown products of adenosine triphosphate which accumulate during acute hypoxia, may reflect the subclinical presence of vulnerable tissue. We considered whether whole blood purine concentration (WBPC) measurements during acute stroke were associated with subsequent END.
Methods
Patients within 4.5 h of stroke onset underwent point-of-care finger-prick measurement of WBPC and blinded assessment of symptom severity using the National Institutes of Health Stroke Scale (NIHSS). END was defined as an NIHSS increase ≥2 points at 24–36 h compared to baseline.
Results
15/152 (9.8%) patients experienced END with a median [IQR] NIHSS increase of 4 [2–7] points. There were no strong associations between END and baseline NIHSS, clinical stroke subtype, thrombolytic therapy, physiological characteristics or time to assay. The median [IQR] WBPC concentration (uM) was higher before the occurrence of END but without statistical significance (7.21 [4.77–10.65] versus 4.83 [3.00–9.02]; p = 0.1). Above a WBPC threshold of 6.05uM, the risk of END was significantly greater (odds ratio 3.7 (95% CI 1.1–12.4); p = 0.03).
Conclusion
Although the study lacked statistical power, early WBPC measurement could be a convenient biomarker for identifying acute stroke patients at risk of END, but further evaluation is required.
| Item Type: | Journal Article | ||||||||
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| Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science > Life Sciences (2010- ) | ||||||||
| Library of Congress Subject Headings (LCSH): | Cerebrovascular disease -- Physiological aspects, Purines | ||||||||
| Journal or Publication Title: | Biomarker Research | ||||||||
| Publisher: | BMC | ||||||||
| ISSN: | 2050-7771 | ||||||||
| Official Date: | 2019 | ||||||||
| Dates: |
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| Volume: | 7 | ||||||||
| Number: | 1 | ||||||||
| Number of Pages: | 7 | ||||||||
| DOI: | 10.1186/s40364-019-0158-y | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Publisher Statement: | The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| RIOXX Funder/Project Grant: |
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