Abstract
The aim of this study was to evaluate the diagnostic value of the serum biochemical markers high-sensitivity C-reactive protein (hs-CRP), D-dimer (DD) and fibrinogen (Fg) in differentiating etiological subtypes of ischemic stroke. This study was a retrospective case-only study, consecutively including patients with acute ischemic stroke. All patients were classified into subtypes using the TOAST classification system. A total of 317 patients were evaluated. Hs-CRP and DD levels were significantly different among the subtypes and were the highest in CE, followed by LAA and SAA; no significant difference between the subtypes was found for Fg. Hs-CRP > 6.96 mg/L was classified as the CE subtype, with a sensitivity of 41% and a specificity of 74%; DD > 791.30 ng/mL was classified as CE, with a sensitivity of 58% and a specificity of 78%. The combination of hs-CRP and DD classification as CE yielded a sensitivity of 65% and a specificity of 91%. DD > 791.30 ng/mL was considered an independent predictive factor of CE. Hs-CRP and DD could be useful for identifying the etiological subtypes of acute ischemic stroke, especially for predicting CE. The diagnostic value of DD was higher than that of hs-CRP.
Highlights
Ischemic stroke is not a single disease but a group of diseases with many different etiologies
The proportion of patients with hypertension was higher in the large-artery atherosclerosis (LAA) group, and the proportion of females was higher in the CE group
All patients were classified into five subtypes, including 162 cases (51.10%) of LAA, 37 cases (11.67%) of CE, 62 cases (19.56%) of smallartery occlusion (SAA), 3 cases (0.95%) of stroke of other determined etiology (SOE), and 53 cases (16.72%) of stroke of undetermined etiology (SUE) (Table 1)
Summary
Ischemic stroke is not a single disease but a group of diseases with many different etiologies. The etiological classification of ischemic stroke is important for choosing the appropriate patient care and secondary prevention programs. Precise etiological classification depends heavily on the results of auxiliary examination, such as cranial imaging, echocardiography, carotid vascular ultrasound and transesophageal echocardiography. Most of these examinations are difficult to complete at the early onset of a stroke. These factors plus a lack of appropriate equipment in the primary hospital can make timely and accurate classification impossible. Cardiogenic cerebral embolism has a lower diagnostic rate and a higher missed diagnosis rate in Chinese clinical
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