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Blood biomarkers for ischemic stroke subtype differentiation: A systematic review.

Background Blood biomarkers are a cost-effective and valid method to diagnose ischemic stroke and differentiate it's subtypes in countries with poor resources. Objective To perform a systematic review of published literature evaluating diagnostic utility of blood based biomarkers to diagnose and differentiate 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 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 B-type natriuretic peptide (BNP) and D-dimer 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 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 till 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 ischemic stroke.

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