The association between early neurological deterioration and whole blood purine concentration during acute stroke.

BACKGROUND

Early neurological deterioration (END) is common after stroke. Prediction could identify patients requiring additional monitoring and intervention. Purines, breakdown products of adenosine triphosphate which accumulate during acute hypoxia, may reflect the subclinical presence of vulnerable tissue. We considered whether whole blood purine concentration (WBPC) measurements during acute stroke were associated with subsequent END.

METHODS

Patients within 4.5 h of stroke onset underwent point-of-care finger-prick measurement of WBPC and blinded assessment of symptom severity using the National Institutes of Health Stroke Scale (NIHSS). END was defined as an NIHSS increase ≥2 points at 24-36 h compared to baseline.

RESULTS

15/152 (9.8%) patients experienced END with a median [IQR] NIHSS increase of 4 [2-7] points. There were no strong associations between END and baseline NIHSS, clinical stroke subtype, thrombolytic therapy, physiological characteristics or time to assay. The median [IQR] WBPC concentration (uM) was higher before the occurrence of END but without statistical significance (7.21 [4.77-10.65] versus 4.83 [3.00-9.02];

CONCLUSION

Although the study lacked statistical power, early WBPC measurement could be a convenient biomarker for identifying acute stroke patients at risk of END, but further evaluation is required.

Déclaration de conflit d'intérêts

Ethics approval was granted by the National Research Ethics Service in England (reference 16/WM/0164). All participants or their personal consultee gave informed consent consistent with the principles of the Declaration of Helsinki.Not applicable.Faming Tian is an employee of Sarissa Biomedical Ltd., manufacturer of the biosensor used, and is named on patents that are owned or licensed by Sarissa Biomedical. Nicholas Dale is a Director and Founder of Sarissa Biomedical Ltd., holds equity in that company and is named on patents that are owned or licensed by Sarissa Biomedical. All other authors declare that they have no competing interest.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.