The prognostic value of serum pregnancy-associated plasma protein A, S100 and high sensitivity C-reactive protein in acute ischemic stroke patients without heparin administration

Abstract

Objectives: The concerns regarding the pre-analytical bias caused by medicine treatments have been raised in the diagnosis and prognosis of ischemic stroke recently. The aim of this study was to examine the prognostic value of serum pregnancy-associated plasma protein A (PAPP-A), S100 and high sensitivity C-reactive protein (hs-CRP) in heparin-naïve patients of acute ischemic stroke.

Design and methods: Serum levels of PAPP-A, S100 and hs-CRP were determined in 205 heparin-naïve patients of acute ischemic stroke and 50 healthy controls. Clinical information and radiological information were collected. Unfavorable outcomes (stroke recurrence, myocardial infarction or death) were also recorded after six months. The associations between serum biomarker levels and stroke severity/outcome were assessed.

Results: Serum PAPP-A, S100 and hs-CRP levels increased in patients compared with controls (P<0.05). S100 and hs-CRP levels were significantly higher in patients with larger cerebral infarction sizes (P<0.05) and more severe neurological impairment (P<0.05). Serum PAPP-A level showed a progressive increase with the increase of stroke severity (P<0.05). Serum hs-CRP and National Institutes of Health Stroke Scale (NIHSS) scores were identified as independent predictors for unfavorable outcomes with odds ratios of 2.884 (1.154 to 7.210, P=0.023) and 2.887 (1.146 to 7.273, P=0.024), respectively.

Conclusion: Serum PAPP-A, S100 and hs-CRP were associated with stroke severity or outcome after ischemic stroke and may offer complementary information, essential for clinical decision making. Serum PAPP-A showed a potential value for the evaluation of stroke clinically.

Keywords: Biomarker; C-reactive protein; Pregnancy-associated plasma protein A; S100 proteins; Stroke.