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Circulating Biomarkers in Long-Term Stroke Prognosis: A Scoping Review Focusing on the South African Setting
Juan Jansen van Vuuren1,2,3, Somasundram Pillay4, Ansuya Naidoo5,6
1Department of Neurology, Grey's Hospital, Pietermaritzburg, ZAF.
Insights
Stroke prognosis can be improved by identifying at-risk patients using blood biomarkers. However, cost and availability limit their use in South Africa, despite the high stroke burden.
Area of Science:
- Neurology
- Biomarker Research
- Public Health
Background:
- Cerebrovascular disease (stroke) is a leading cause of death and disability globally, disproportionately affecting developing nations like South Africa.
- Early identification of stroke patients with poor prognosis is crucial for improving outcomes.
- While neuroimaging is standard, prognostic blood biomarkers offer potential but lack data in the South African context.
Purpose of the Study:
- To review available data on blood biomarkers for long-term stroke prognostication.
- To assess the potential applicability of these biomarkers in South Africa.
Main Methods:
- A 6-stage scoping review process was employed.
- An initial search identified 1191 articles; 41 were included after rigorous review.
- Identified biomarkers were grouped by function or origin.
Main Results:
- Numerous potential prognostic biomarkers for stroke were identified.
- Most biomarkers demonstrated significant prognostic potential.
- High cost and limited availability are major barriers to their implementation in South Africa.
Conclusions:
- Blood biomarkers can significantly aid long-term stroke prognostication, especially where neuroimaging access is limited.
- The cost and availability of most reviewed biomarkers pose significant challenges for adoption in South Africa.
- Further research into cost-effective and accessible biomarkers is needed for the South African setting.
Abstract:
Cerebrovascular disease, including both ischaemic and haemorrhagic strokes, remains one of the highest causes of global morbidity and mortality. Developing nations, such as South Africa (SA), are affected disproportionately. Early identification of stroke patients at risk of poor clinical prognosis may result in improved outcomes. In addition to conventional neuroimaging, the role of predictive biomarkers has been shown to be important. Little data exist on their applicability within SA. This scoping review aimed to evaluate the currently available data pertaining to blood biomarkers that aid in the long-term prognostication of patients following stroke and its potential application in the South African setting. This scoping review followed a 6-stage process to identify and critically review currently available literature pertaining to prognostic biomarkers in stroke. An initial 1191 articles were identified and, following rigorous review, 41 articles were included for the purposes of the scoping review. A number of potential biomarkers were identified and grouped according to the function or origin of the marker. Although most biomarkers showed great prognostic potential, the cost and availability will likely limit their application within SA. The burden of stroke is increasing worldwide and appears to be affecting developing countries disproportionately. Access to neuroradiological services is not readily available in all settings and the addition of biomarkers to assist in the long-term prognostication of patients following a stroke can be of great clinical value. The cost and availability of many of the reviewed biomarkers will likely hinder their use in the South African setting.
