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E-selectin and vascular cell adhesion molecule-1 as biomarkers of 3-month outcome in cerebrovascular diseases.

Richard S, Lagerstedt L, Burkhard PR, Debouverie M, Turck N, Sanchez JC - J Inflamm (Lond) (2015)

Bottom Line: During the first 6 h after stroke onset, E-selectin was found to be an independent predictor of 3-month outcome (odds ratio (OR) =24; 95 % confidence interval (95 % CI), 2-354; p = 0.022) (area under the curve (AUC) =78 %), as was VCAM-1 during the third week after onset (OR = 8; 95 % CI, 2-37; p = 0.01) (AUC = 73 %).The predictive capability of other biomarkers known to be indicators for prognosis also emerged, confirming the study's robustness.CAMs levels could be considered as objective biological criteria for prognosis in CVD.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Stroke Unit, Nancy University Hospital Center, 29 avenue du Marechal de Lattre de Tassigny-CO n° 34, 54035 Nancy, Cedex France ; Department of Human Protein Sciences, University Medical Center, Rue Michel Servet 1, 1211 Geneva, Switzerland.

ABSTRACT

Background: Inflammation is known to worsen cerebral damage at the acute phase of stroke. In this setting, cell adhesion molecules (CAMs) play a crucial role mediating migration of immune cells into the infarcted area. However, their value in long-term outcome prediction for patients with cerebrovascular diseases (CVD) is less described.

Methods: Levels of four CAMs (E-selectin, P-selectin glycoprotein ligand-1, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1 (VCAM-1)) and six other known biomarkers (C-reactive protein (CRP), interleukin-6 (IL-6), N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin I, vasopressin-neurophysin 2-copeptin, and S100 calcium-binding protein B) were measured in a population of patients presenting CVD. Blood collections for analysis were performed within different time windows after stroke onset: 0-6 h, 6-36 h, 2-3 days, 5-7 days, and 2-3 weeks. Independent associations with poor outcome at 3 months (modified Rankin Scale score > 2) were sought using univariate and multivariate analysis after adjustments for age and National Institute of Health Stroke Scale score. Predictive ability of each biomarker has also been assessed with ROC analysis.

Results: One hundred patients were prospectively included whom 75 presented with ischemic strokes, nine with hemorrhagic strokes and 16 with transient ischemic attacks. During the first 6 h after stroke onset, E-selectin was found to be an independent predictor of 3-month outcome (odds ratio (OR) =24; 95 % confidence interval (95 % CI), 2-354; p = 0.022) (area under the curve (AUC) =78 %), as was VCAM-1 during the third week after onset (OR = 8; 95 % CI, 2-37; p = 0.01) (AUC = 73 %). Associations remained after the exclusion of patients with hemorrhagic strokes and transient ischemic attacks. Independent associations with outcome were also found for CRP (OR = 5; 95 % CI, 1-22; p = 0.023) and IL-6 (OR = 5; 95 % CI, 1-17; p = 0.021) at 2-3 days and for NT-proBNP at 6-36 h (OR = 20; 95 % CI, 1-337; p = 0.04).

Conclusions: E-selectin and VCAM-1 were independent predictors of outcome in a population of patients with CVD. The predictive capability of other biomarkers known to be indicators for prognosis also emerged, confirming the study's robustness. CAMs levels could be considered as objective biological criteria for prognosis in CVD.

No MeSH data available.


Related in: MedlinePlus

ROC analysis for biomarkers to predict 3-month poor outcome in patients with cerebrovascular diseases. Results for E-selectin at 0–6 h (a), vascular cell adhesion molecule-1 at 2–3 weeks (b), N-terminal pro-brain natriuretic peptide at 6–36 h (c), C-reactive protein at 2–3 days (d), and interleukin-6 at 2–3 days (e) are described as cut-off determined with Youden index criterion, respective specificity and sensitivity, area under the curve (AUC) and 95 % confidence interval; poor outcome defined as modified Rankin Scale score > 2
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Fig3: ROC analysis for biomarkers to predict 3-month poor outcome in patients with cerebrovascular diseases. Results for E-selectin at 0–6 h (a), vascular cell adhesion molecule-1 at 2–3 weeks (b), N-terminal pro-brain natriuretic peptide at 6–36 h (c), C-reactive protein at 2–3 days (d), and interleukin-6 at 2–3 days (e) are described as cut-off determined with Youden index criterion, respective specificity and sensitivity, area under the curve (AUC) and 95 % confidence interval; poor outcome defined as modified Rankin Scale score > 2

Mentions: One hundred patients were included in this study, of whom 75 presented with ischemic strokes, nine with hemorrhagic strokes, and 16 with TIA. A good outcome was observed in 65 % of these patients. The population’s clinical characteristics and comparisons according to outcome are presented in the Table 1. Age (p = 0.007) and NIHSS score at admission (p < 0.001) were significantly higher in patients with a poor outcome. An initial blood sample was drawn from 35 patients during the first 6 h following onset. Of the 10 proteins measured, E-selectin, VCAM-1, CRP, IL-6, NT-proBNP, and S100B were at significantly higher levels in the group with a poor outcome in one of the different measuring times (Table 2, Fig. 1). After multivariate analysis, with adjustments made for age and NIHSS score at admission, expected independent associations with a poor outcome did indeed emerge for the known predictors of poor outcome: CRP (odds ratio (OR) =5; 95 % confidence interval (95 % CI), 1–22; p = 0.023) (area under the curve (AUC) =83 %) and IL-6 (OR = 5; 95 % CI, 1–17; p = 0.021) (AUC = 75 %) at 2–3 days, and NT-proBNP (OR = 20; 95 % CI, 1–337; p = 0.04) (AUC = 76 %) at 6–36 h (Figs. 2, 3).Table 1


E-selectin and vascular cell adhesion molecule-1 as biomarkers of 3-month outcome in cerebrovascular diseases.

Richard S, Lagerstedt L, Burkhard PR, Debouverie M, Turck N, Sanchez JC - J Inflamm (Lond) (2015)

ROC analysis for biomarkers to predict 3-month poor outcome in patients with cerebrovascular diseases. Results for E-selectin at 0–6 h (a), vascular cell adhesion molecule-1 at 2–3 weeks (b), N-terminal pro-brain natriuretic peptide at 6–36 h (c), C-reactive protein at 2–3 days (d), and interleukin-6 at 2–3 days (e) are described as cut-off determined with Youden index criterion, respective specificity and sensitivity, area under the curve (AUC) and 95 % confidence interval; poor outcome defined as modified Rankin Scale score > 2
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4634720&req=5

Fig3: ROC analysis for biomarkers to predict 3-month poor outcome in patients with cerebrovascular diseases. Results for E-selectin at 0–6 h (a), vascular cell adhesion molecule-1 at 2–3 weeks (b), N-terminal pro-brain natriuretic peptide at 6–36 h (c), C-reactive protein at 2–3 days (d), and interleukin-6 at 2–3 days (e) are described as cut-off determined with Youden index criterion, respective specificity and sensitivity, area under the curve (AUC) and 95 % confidence interval; poor outcome defined as modified Rankin Scale score > 2
Mentions: One hundred patients were included in this study, of whom 75 presented with ischemic strokes, nine with hemorrhagic strokes, and 16 with TIA. A good outcome was observed in 65 % of these patients. The population’s clinical characteristics and comparisons according to outcome are presented in the Table 1. Age (p = 0.007) and NIHSS score at admission (p < 0.001) were significantly higher in patients with a poor outcome. An initial blood sample was drawn from 35 patients during the first 6 h following onset. Of the 10 proteins measured, E-selectin, VCAM-1, CRP, IL-6, NT-proBNP, and S100B were at significantly higher levels in the group with a poor outcome in one of the different measuring times (Table 2, Fig. 1). After multivariate analysis, with adjustments made for age and NIHSS score at admission, expected independent associations with a poor outcome did indeed emerge for the known predictors of poor outcome: CRP (odds ratio (OR) =5; 95 % confidence interval (95 % CI), 1–22; p = 0.023) (area under the curve (AUC) =83 %) and IL-6 (OR = 5; 95 % CI, 1–17; p = 0.021) (AUC = 75 %) at 2–3 days, and NT-proBNP (OR = 20; 95 % CI, 1–337; p = 0.04) (AUC = 76 %) at 6–36 h (Figs. 2, 3).Table 1

Bottom Line: During the first 6 h after stroke onset, E-selectin was found to be an independent predictor of 3-month outcome (odds ratio (OR) =24; 95 % confidence interval (95 % CI), 2-354; p = 0.022) (area under the curve (AUC) =78 %), as was VCAM-1 during the third week after onset (OR = 8; 95 % CI, 2-37; p = 0.01) (AUC = 73 %).The predictive capability of other biomarkers known to be indicators for prognosis also emerged, confirming the study's robustness.CAMs levels could be considered as objective biological criteria for prognosis in CVD.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Stroke Unit, Nancy University Hospital Center, 29 avenue du Marechal de Lattre de Tassigny-CO n° 34, 54035 Nancy, Cedex France ; Department of Human Protein Sciences, University Medical Center, Rue Michel Servet 1, 1211 Geneva, Switzerland.

ABSTRACT

Background: Inflammation is known to worsen cerebral damage at the acute phase of stroke. In this setting, cell adhesion molecules (CAMs) play a crucial role mediating migration of immune cells into the infarcted area. However, their value in long-term outcome prediction for patients with cerebrovascular diseases (CVD) is less described.

Methods: Levels of four CAMs (E-selectin, P-selectin glycoprotein ligand-1, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1 (VCAM-1)) and six other known biomarkers (C-reactive protein (CRP), interleukin-6 (IL-6), N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin I, vasopressin-neurophysin 2-copeptin, and S100 calcium-binding protein B) were measured in a population of patients presenting CVD. Blood collections for analysis were performed within different time windows after stroke onset: 0-6 h, 6-36 h, 2-3 days, 5-7 days, and 2-3 weeks. Independent associations with poor outcome at 3 months (modified Rankin Scale score > 2) were sought using univariate and multivariate analysis after adjustments for age and National Institute of Health Stroke Scale score. Predictive ability of each biomarker has also been assessed with ROC analysis.

Results: One hundred patients were prospectively included whom 75 presented with ischemic strokes, nine with hemorrhagic strokes and 16 with transient ischemic attacks. During the first 6 h after stroke onset, E-selectin was found to be an independent predictor of 3-month outcome (odds ratio (OR) =24; 95 % confidence interval (95 % CI), 2-354; p = 0.022) (area under the curve (AUC) =78 %), as was VCAM-1 during the third week after onset (OR = 8; 95 % CI, 2-37; p = 0.01) (AUC = 73 %). Associations remained after the exclusion of patients with hemorrhagic strokes and transient ischemic attacks. Independent associations with outcome were also found for CRP (OR = 5; 95 % CI, 1-22; p = 0.023) and IL-6 (OR = 5; 95 % CI, 1-17; p = 0.021) at 2-3 days and for NT-proBNP at 6-36 h (OR = 20; 95 % CI, 1-337; p = 0.04).

Conclusions: E-selectin and VCAM-1 were independent predictors of outcome in a population of patients with CVD. The predictive capability of other biomarkers known to be indicators for prognosis also emerged, confirming the study's robustness. CAMs levels could be considered as objective biological criteria for prognosis in CVD.

No MeSH data available.


Related in: MedlinePlus