Role Of Blood Biomarkers In Differentiating Ischemic Stroke and Intracerebral Hemorrhage (P2.230)

Objective: To compare levels of individual blood markers S100 B, GFAP (glial fibrillary acidic protein), NMDA (N Methyl D Aspartate) receptor antibody nR2 subunit, BNP (brain natriuretic peptide), and cytokine IL6 (interleukin 6), between Ischemic stroke (IS) and Intracerebral hemorrhage (ICH). Background: A rapid diagnostic test to differentiate IS and ICH is vital for the further management and no definitive clinical parameter differentiates both these. Design/Methods: 251 consecutive acute stroke patients who attended the All India Institute of Medical Sciences (AIIMS), New Delhi emergency/outpatient/inpatient services who presented within 24hrs of the onset of stroke were recruited and the blood samples were drawn. The clinical and imaging data were recorded. Levels of S100, GFAP, nR2, BNP and IL-6 levels were estimated by ELSIA technique. Statistical analysis was performed. Results: 247 patients with mean age of 55.7(±13.8)yrs and mean NIHSS 11.7±5.5 were included in analysis with 75.7%(187/247) patients having IS and 24.3% (60/247) having ICH. The median S100 levels was 7.6 pg/ml(min 3.1, max of 265 ) in ICH patients vs 4.45pg/ml (min of 2.9, max of 540) in IS patients (p=0.004). ROC suggested a cut-off of 5pg/ml with S100 levels >5pg/ml having 71% odds of predicting an ICH, AUC-62.34%, sensitivity at 57% and specificity at 56%. IL-6 levels were found to be significantly higher in IS group (median values of 8 and 13 pg/ml in ICH and IS respectively with IQR of 4.8–15.3 vs 6.25–24.4 pg/ml respectively, p=0.007. ROC analysis showed levels of IL-6 ≥11pg/ml has 78% odds of predicting an IS as against ICH, AUC:59%, sensitivity 55%, specificity 53%. No significant difference in GFAP, BNP and nR2 (NMDA receptor antibody) levels were observed between IS and ICH groups. Conclusions: S 100 and IL6 are potential biomarkers for further exploration to differentiate ICH and IS. This may help in rapid and timely triage of patients to stroke centres. Study Supported by: Supported by intramural research grant from All India Institute of Medical Sciences. New Delhi. India. Disclosure: Dr. Bhatia has nothing to disclose. Dr. Warrier has nothing to disclose. Dr. Bali has nothing to disclose. Dr. Sisodia has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Vishnubhatla has nothing to disclose. Dr. Vivekanadhan has nothing to disclose. Dr. Hadakasira has nothing to disclose. Dr. Prasad has nothing to disclose.