The prognostic power of blood biomarkers in ischemic stroke: a systematic review

Background: Blood biomarkers have emerged as potential indicators of poor outcomes following ischemic stroke, helping to monitor the onset of stroke-related processes. Identifying reliable and accessible biomarkers for assessing the prognosis of ischemic stroke patients remains a significant clinical challenge. One of the most difficult areas of research in cerebrovascular disease is the discovery and validation of dependable biomarkers to track the clinical progression of ischemic stroke and predict patient outcomes. Therefore, this article aims to systematically compile evidence on blood-based biomarkers for ischemic stroke prognosis and their clinical outcomes. Methods: Three
\nelectronic search engines PubMed, Scopus and Cochrane Library used to search for articles related to the study by following PRISMA-P guidelines using specific keywords covering from January 2018 to December 2023. Seventeen studies were selected from 545 articles based on specific inclusion and exclusion criteria, and their quality was assessed using the Crowe Critical Appraisal Tool (CCAT). Results: A total of 545 articles were screened and 17 full-text articles were evaluated. The pathophysiological mechanism(s) involved in ischemic stroke are inflammation marker, angiogenesis marker, oxidative stress marker, neurofilament light chain marker and glial fibrillary acidic protein marker. The clinical outcomes of the biomarkers for ischemic stroke prognosis depend much on the
\nperformance of diagnostic accuracy. The study also highlights the importance of the timing of biomarker measurements post-event such as within 24 hours after stroke which is crucial for accurate prognosis. The clinical factors also contribute to the progress of prognostication of ischemic stroke such as age, medical history, particularly hypertension and diabetes which could impact stroke
\noutcomes. Conclusion: Blood biomarkers alongside clinical factors, offer valuable insights into ischemic stroke outcomes. This review emphasizes their potential to improve stroke prognosis and management.