Background: Blood biomarkers are a cost-effective and valid method to diagnose
ischemic stroke and differentiate its subtypes in countries with poor resources.
Objective: To perform a systematic review of published literature evaluating the diagnostic utility
of blood-based biomarkers to diagnose and differentiate the etiology of ischemic stroke.
Methods: A comprehensive literature search was carried out till December 2017 in major scientific
and medical databases including PubMed, Cochrane, OVID and Google Scholar. Modified Quality
Assessment of Diagnostic Accuracy Studies questionnaire was used to assess the methodological
quality of each study.
Results: Twenty-six studies were identified relevant to our systematic review. Various biomarkers
have been studied, though only few biomarkers such as a B-type natriuretic peptide (BNP) and Ddimer
have proved their clinical utility. None of the other tested biomarkers appeared to have
consistent results to diagnose ischemic stroke subtypes. Most of the studies had limitations in the
classification of ischemic stroke, sample size, sample collection time, methods, biomarker selection
and data analysis.
Conclusion: Our systematic review does not recommend the use of any blood biomarker for
clinical purposes based on the studies conducted to date. BNP and D-dimer may present optimal
biomarker for diagnosis and differentiation of ischemic stroke. However, large well-designed
clinical studies are required to validate utility of these biomarkers to differentiate subtypes of
Keywords: Biomarker, Ischemic Stroke, TOAST, Serum protein, Stroke
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