TY - JOUR
T1 - Biomarkers of Hypercoagulability and Inflammation in Childhood-Onset Arterial Ischemic Stroke
AU - Bernard, Timothy J.
AU - Fenton, Laura Z.
AU - Apkon, Susan D.
AU - Boada, Richard
AU - Wilkening, Greta N.
AU - Wilkinson, C. Corbett
AU - Soep, Jennifer B.
AU - Miyamoto, Shelley D.
AU - Tripputi, Mark
AU - Armstrong-Wells, Jennifer
AU - Benke, Timothy A.
AU - Manco-Johnson, Marilyn J.
AU - Goldenberg, Neil A.
N1 - Funding Information:
Supported by grants from the National Institutes of Health, National Center For Research, Colorado Clinical and Translational Science Institute ( KL2RR025779 , to T.J.B), Centers for Disease Control and Prevention ( UR6/CCU820552 , to M.J.M.-J.), and National Institutes of Health, National Heart, Lung, and Blood Institute ( 1K23HL084055-01A1 , to N.A.G.). The authors declare no conflicts of interest.
PY - 2010/4
Y1 - 2010/4
N2 - Objective: To test the hypothesis that acute elevations of biomarkers of hypercoagulability and inflammation are common in children with arterial ischemic stroke (AIS), particularly among etiologic subtypes that carry an increased risk of recurrent stroke. Study design: In this prospective/retrospective institutional-based cohort study of acute childhood-onset AIS (n = 50) conducted between 2005 and 2009, D-dimer, factor VIII (FVIII) activity, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were serially evaluated at the time of clinical blood sampling. Patients were classified by stroke subtype as cardioembolic, moyamoya, non-moyamoya arteriopathy, or other. Results: Both D-dimer and CRP were frequently elevated in acute childhood-onset AIS and exhibited a decreasing trend with time. Acute D-dimer levels were significantly higher in cardioembolic AIS compared with noncardioembolic AIS (median, 2.04 μg/mL [range 0.54-4.54 μg/mL] vs 0.32 μg/mL [0.22-3.18 μg/mL]; P = .002). At an optimal threshold of ≥ 0.50 μg/mL, the sensitivity and specificity of D-dimer for cardioembolic subtype were 78% and 79%, respectively. Conclusions: Our findings identify D-dimer and CRP as candidate biomarkers for etiology and prognosis in childhood-onset AIS. Further studies should investigate the role of these and other biomarkers of hypercoagulability and inflammation in childhood-onset AIS.
AB - Objective: To test the hypothesis that acute elevations of biomarkers of hypercoagulability and inflammation are common in children with arterial ischemic stroke (AIS), particularly among etiologic subtypes that carry an increased risk of recurrent stroke. Study design: In this prospective/retrospective institutional-based cohort study of acute childhood-onset AIS (n = 50) conducted between 2005 and 2009, D-dimer, factor VIII (FVIII) activity, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were serially evaluated at the time of clinical blood sampling. Patients were classified by stroke subtype as cardioembolic, moyamoya, non-moyamoya arteriopathy, or other. Results: Both D-dimer and CRP were frequently elevated in acute childhood-onset AIS and exhibited a decreasing trend with time. Acute D-dimer levels were significantly higher in cardioembolic AIS compared with noncardioembolic AIS (median, 2.04 μg/mL [range 0.54-4.54 μg/mL] vs 0.32 μg/mL [0.22-3.18 μg/mL]; P = .002). At an optimal threshold of ≥ 0.50 μg/mL, the sensitivity and specificity of D-dimer for cardioembolic subtype were 78% and 79%, respectively. Conclusions: Our findings identify D-dimer and CRP as candidate biomarkers for etiology and prognosis in childhood-onset AIS. Further studies should investigate the role of these and other biomarkers of hypercoagulability and inflammation in childhood-onset AIS.
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U2 - 10.1016/j.jpeds.2009.10.034
DO - 10.1016/j.jpeds.2009.10.034
M3 - Article
C2 - 20022340
AN - SCOPUS:77949653926
SN - 0022-3476
VL - 156
SP - 651
EP - 656
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 4
ER -