The diagnostic and prognostic value of serum neurogranin in acute ischemic stroke



      Stroke is a frequently encountered life-threatening medical condition in emergency departments (EDs). Despite all worldwide efforts, a reliable circulating biomarker has not been identified yet. This study investigates the diagnostic and prognostic value of neurogranin (Ng) in acute ischemic stroke (AIS).


      This prospective case-control study was conducted on ED patients with AIS and healthy volunteers. We collected the basic demographics, measured serum Ng levels of the patients vs. controls, and followed up the patient group for 6-month by phone or clinical notes to assess the functional outcomes.


      Data analysis was completed with 142 subjects (86 patients vs. 55 controls). The groups did not differ in terms of age and gender. The median serum Ng level of the patient group was significantly higher compared to the control group [160.00 (75.93) vs. 121.26 (90.35) ng/mL and p ˂ 0.001, respectively]. Serum Ng level of 25 patients admitted to the ED within the first 6 hours from the onset of AIS was 177.93 (24.03) ng/mL, while serum Ng level of 61 patients admitted to the ED within 6-24 hours was 131.84 (76.44) ng/mL. AUROC results were 0.717 vs. 0.868 vs. 0.874 for stroke patients admitted during the first 24 hours, 6 hours, and 4.5 hours after the onset, respectively. Lesion volume, NIHSS, and modified Rankin Scale scores (mRS) at admission showed no significant correlation with Ng levels as well as 6-month mortality and 6-month mRS.


      Timely AIS diagnosis is still a challenge for emergency departments due to the dependency on imaging. Serum Ng can be a promising diagnostic biomarker for AIS patients admitted in the first 24 hours. Even it outperformed in the first 4.5 and 6-hour time windows. However, it did not show a significant prognostic value.



      ED (emergency department), CT (computed tomography), MRI (magnetic resonance imaging), HS (hemorrhagic stroke), SAH (subarachnoid hemorrhage), IS (ischemic stroke), AIS (acute ischemic stroke), IV tPA (thrombolysis with intravenous tissue-type plasminogen activator), MT (mechanical thrombectomy), Ng (Neurogranin), GCS (Glasgow coma scale), NIHSS (national institutes of health stroke scale), mRS (modified rankin scale), DWI (diffusion-weighted imaging), ELISA (enzyme-related immunosorbent assay), HT (hypertension), DM (diabetes mellitus), AF (atrial fibrillation), LV (lesion volume), SD (standard deviation), IQR (interquartile range), AUROC (area under the receiver operating characteristic curve), CI (confidence interval), CSF (cerebrospinal fluid), CNS (central nervous system), AD (Alzheimer's disease), TBI (traumatic brain injury)
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