Predicting functional outcome of ischemic stroke patients in Romania based on plasma CRP, sTNFR-1, D-Dimers, NGAL and NSE measured using a biochip array

Adina HUȚANU1,2, Mihaela IANCU3, Rodica BĂLAȘA4,5, Smaranda MAIER4,5, Minodora DOBREANU2,6
1 Laboratory Medicine, Emergency Clinical County Hospital, Tirgu Mures, Romania
2 Advanced Medical and Pharmaceutical Research Center, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania
3 Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj Napoca, Romania
4 First Neurological Clinic, Emergency Clinical County Hospital, Tirgu Mures, Romania
5 Department of Neurology, University of Medicine and Pharmacy
6 Department of Laboratory Medicine, University of Medicine and Pharmacy, Tîrgu Mures, Romania
Correspondence to: Adina HUȚANU:,
DOI: 10.1038/aps.2018.26
Received: 4 November 2017
Accepted: 19 February 2018
Advance online: 7 June 2018


In cerebral ischemia, evaluation of multiple biomarkers involved in various pathological pathways is a useful tool in assessing the outcome of the patients even from the early stages of the disease. In this study we investigated the utility of a panel of 5 peripheral biomarkers of inflammatory status, neuronal destruction and secondary fibrinolysis in the acute phase of ischemia, and evaluated the impact of these biomarkers on functional outcome after ischemic stroke. The 5 biomarkers (plasma CRP, D-Dimers, sTNFR-1, NGAL and NSE) were measured using a biochip array technology. Eighty nine patients in Romania were divided into 2 subgroups using
the modified Rankin Scale evaluated at 3 months after ischemic stroke; the possible impact of analyzed biomarkers on unfavorable functional outcome was tested by binomial logistic regression. The subgroup with unfavorable outcome had higher concentrations
of CRP, NGAL, sTNFR-1 and D-dimers, but CRP and NGAL values were not statistically different between the two subgroups. The univariate logistic regression analysis of plasma biomarkers revealed that CRP, D-Dimers, NGAL, sTNFR-1 were significant predictors of unfavorable clinical outcome. In the case of D-Dimers and sTNFR-1 we noticed an increased discrimination ability (versus baseline clinical model) to classify poor functional outcome with a tendency toward statistical signification. During the acute phase of the ischemic stroke, plasma concentrations of CRP, D-Dimers and sTNFR-1 were elevated in unfavorable outcome patients. D-Dimers and sTNFR-1 were independent predictors of poor outcome at 3 months after ischemic stroke. The biochip array technology offers the possibility to simultaneously measure several parameters involved in multiple pathophysiological pathways, in a small sample volume.
Keywords: stroke; biomarkers; C reactive protein (CRP); the soluble receptor 1 of TNF alfa (sTNFR-1); D-Dimers; neuron-specific enolase (NSE); neutrophil-gelatinase associated-lipocalin (NGAL); biochip array

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