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Published on: September 22, 2020
Plasma midregional pro-adrenomedullin improves prediction of functional outcome in ischemic stroke
Thomas Seifert-Held1, Thomas Pekar, Thomas Gattringer
1Department of Neurology, Medical University of Graz, Graz, Austria. thomas.seifert@medunigraz.at
Background:
To evaluate if plasma levels of midregional pro-adrenomedullin (MR-proADM) improve prediction of functional outcome in ischemic stroke.
Methods:
In 168 consecutive ischemic stroke patients, plasma levels of MR-proADM were measured within 24 hours from symptom onset. Functional outcome was assessed by the modified Rankin Scale (mRS) at 90 days following stroke. Logistic regression, receiver operating characteristics (ROC) curve analysis, net reclassification improvement (NRI), and Kaplan-Meier survival analysis were applied.
Results:
Plasma MR-proADM levels were found significantly higher in patients with unfavourable (mRS 3-6) compared to favourable (mRS 0-2) outcomes. MR-proADM levels were entered into a predictive model including the patients' age, National Institutes of Health Stroke Scale (NIHSS), and the use of recanalization therapy. The area under the ROC curve did not increase significantly. However, category-free NRI of 0.577 (p<0.001) indicated a significant improvement in reclassification of patients. Furthermore, MR-proADM levels significantly improved reclassification of patients in the prediction of outcome by the Stroke Prognostication using Age and NIHSS-100 (SPAN-100; NRI = 0.175; p = 0.04). Kaplan-Meier survival analysis showed a rising risk of death with increasing MR-proADM quintiles.
Conclusions:
Plasma MR-proADM levels improve prediction of functional outcome in ischemic stroke when added to the patients' age, NIHSS on admission, and the use of recanalization therapy. Levels of MR-proADM in peripheral blood improve reclassification of patients when the SPAN-100 is used to predict the patients' functional outcome.
Insights
Plasma midregional pro-adrenomedullin (MR-proADM) levels enhance the prediction of functional outcomes in ischemic stroke patients. This biomarker improves patient reclassification, aiding in better prognostic assessments.
Area of Science:
- Biomarkers in Neurology
- Stroke Medicine
- Clinical Prognostics
Background:
- Ischemic stroke prognosis relies on clinical factors.
- Novel biomarkers are needed to refine outcome prediction.
- Midregional pro-adrenomedullin (MR-proADM) is a potential prognostic marker.
Purpose of the Study:
- To determine if plasma MR-proADM levels improve the prediction of functional outcomes in ischemic stroke.
- To assess the added value of MR-proADM to existing prognostic models.
Main Methods:
- Plasma MR-proADM levels were measured in 168 ischemic stroke patients within 24 hours of symptom onset.
- Functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days.
- Statistical analyses included logistic regression, ROC analysis, NRI, and Kaplan-Meier survival analysis.
Main Results:
- Higher MR-proADM levels correlated with unfavorable functional outcomes (mRS 3-6).
- MR-proADM significantly improved patient reclassification in predictive models (NRI=0.577, p<0.001).
- MR-proADM enhanced prediction when used with the SPAN-100 score (NRI=0.175, p=0.04) and indicated increased mortality risk.
Conclusions:
- Plasma MR-proADM levels significantly improve functional outcome prediction in ischemic stroke.
- MR-proADM enhances prognostic accuracy when combined with age, NIHSS, and recanalization therapy data.
- MR-proADM levels offer improved patient reclassification for predicting functional outcomes, especially with the SPAN-100 score.
