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1 Accident and Emergency Medicine Academic Unit and Departments of
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Medicine and Therapeutics,
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Diagnostic Radiology and Organ Imaging, and
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Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region.
aAddress correspondence to this author at: Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Room 38023, 1/F Clinical Sciences Bldg., 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong Special Administrative Region. E-mail loym{at}cuhk.edu.hk.
Background: At present there is no simple, accurate blood test that may be used to determine the severity of stroke or to predict mortality and morbidity in stroke patients presenting to emergency departments.
Methods: Patients with stroke-like symptoms who presented to an emergency department of a university hospital in Hong Kong were recruited for the study. DNA extracted from patients’ plasma was analyzed for the ß-globin gene with a fluorescent-based PCR test. The primary outcome measures were in-hospital and 6-month mortality and morbidity using the post-stroke modified Rankin Score.
Results: Among the 88 consecutive patients recruited to the study, 70 (80%) had ischemic stroke, 11 (13%) had intracerebral hemorrhage, and 7 (8%) had transient ischemic attacks. Median plasma DNA concentrations taken within 3 h of symptom onset were higher in patients who died compared with those who survived at discharge (6205 vs 1334 kilogenome-equivalents/L; P = 0.03). Among patients with NIH Stroke Scale scores >8, median plasma DNA concentrations were higher in patients who died compared with those who survived to 6 months (2273 vs 968 kilogenome-equivalents/L; P = 0.002). Plasma DNA concentrations correlated with the volume of cerebral hematoma (r = 0.66; P = 0.03). Plasma DNA concentrations >1400 kilogenome-equivalents/L had a sensitivity of 100% and a specificity of 74.4% for predicting hospital mortality after stroke, and the area under the ROC curve was 0.89 (95% confidence interval, 0.80–0.94). The adjusted odds ratio for plasma DNA concentrations predicting 6-month mortality was 1.6 (1.1–2.4; P = 0.03) and for predicting 6-month post-Rankin Score >2 was 1.8 (1.0–3.3; P = 0.05).
Conclusion: Plasma DNA concentrations correlate with stroke severity and may be used to predict mortality and morbidity in the emergency room.
The following articles in journals at HighWire Press have cited this article:
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  K. Saukkonen, P. Lakkisto, V. Pettila, M. Varpula, S. Karlsson, E. Ruokonen, K. Pulkki, and for the Finnsepsis Study Group Cell-Free Plasma DNA as a Predictor of Outcome in Severe Sepsis and Septic Shock Clin. Chem., June 1, 2008; 54(6): 1000 - 1007. [Abstract] [Full Text] [PDF]
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 O. Lapaire, T. Volgmann, D. Huang, S. Hahn, W. Holzgreve, and Y. Xiao Zhong Maternal Smoking: Effect on Circulating Cell-Free Fetal and Total DNA Levels in Maternal Plasma From the Second Trimester Obstet. Gynecol., December 1, 2007; 110(6): 1358 - 1363. [Abstract] [Full Text] [PDF]
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T. H RAINER and N. Y.L LAM Circulating Nucleic Acids and Critical Illness. Ann. N.Y. Acad. Sci., September 1, 2006; 1075: 271 - 277. [Abstract] [Full Text] [PDF]
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I. G. Fatouros, A. Destouni, K. Margonis, A. Z. Jamurtas, C. Vrettou, D. Kouretas, G. Mastorakos, A. Mitrakou, K. Taxildaris, E. Kanavakis, et al. Cell-Free Plasma DNA as a Novel Marker of Aseptic Inflammation Severity Related to Exercise Overtraining Clin. Chem., September 1, 2006; 52(9): 1820 - 1824. [Abstract] [Full Text] [PDF]
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M. D. Hill Diagnostic Biomarkers for Stroke: A Stroke Neurologist's Perspective Clin. Chem., November 1, 2005; 51(11): 2001 - 2002. [Full Text] [PDF]
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E. Orlandi, A. Butt, D. Goldsmith, and R. Swaminathan Factors Affecting Circulating mRNA for Nephrin Clin. Chem., October 1, 2005; 51(10): 1982 - 1983. [Full Text] [PDF]
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S. Holdenrieder, P. Stieber, L. Y.S. Chan, S. Geiger, A. Kremer, D. Nagel, and Y.M. D. Lo Cell-Free DNA in Serum and Plasma: Comparison of ELISA and Quantitative PCR Clin. Chem., August 1, 2005; 51(8): 1544 - 1546. [Full Text] [PDF]
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S. Holdenrieder, S. Mueller, and P. Stieber Stability of Nucleosomal DNA Fragments in Serum Clin. Chem., June 1, 2005; 51(6): 1026 - 1029. [Full Text] [PDF]
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T. R. Gingeras, R. Higuchi, L. J. Kricka, Y.M. D. Lo, and C. T. Wittwer Fifty Years of Molecular (DNA/RNA) Diagnostics Clin. Chem., March 1, 2005; 51(3): 661 - 671. [Full Text] [PDF]
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K. Hamaoui, A. Butt, J. Powrie, and R. Swaminathan Concentration of Circulating Rhodopsin mRNA in Diabetic Retinopathy Clin. Chem., November 1, 2004; 50(11): 2152 - 2155. [Full Text] [PDF]
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Y M D. LO and R. W.K. CHIU The Biology and Diagnostic Applications of Plasma RNA Ann. N.Y. Acad. Sci., June 1, 2004; 1022(1): 135 - 139. [Abstract] [Full Text] [PDF]
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K. HAMAOUI, A. BUTT, J. POWRIE, and R SWAMINATHAN Real-Time Quantitative PCR Measurement of Circulatory Rhodopsin mRNA in Healthy Subjects and Patients with Diabetic Retinopathy Ann. N.Y. Acad. Sci., June 1, 2004; 1022(1): 152 - 156. [Abstract] [Full Text] [PDF]
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S WIJERATNE, A BUTT, S BURNS, K SHERWOOD, O BOYD, and R SWAMINATHAN Cell-Free Plasma DNA as a Prognostic Marker in Intensive Treatment Unit Patients Ann. N.Y. Acad. Sci., June 1, 2004; 1022(1): 232 - 238. [Abstract] [Full Text] [PDF]
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N. Y.L. Lam, T. H. Rainer, R. W.K. Chiu, G. M. Joynt, and Y.M. D. Lo Plasma Mitochondrial DNA Concentrations after Trauma Clin. Chem., January 1, 2004; 50(1): 213 - 216. [Full Text] [PDF]
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N. Y.L. Lam, T. H. Rainer, L. Y.S. Chan, G. M. Joynt, and Y.M. D. Lo Time Course of Early and Late Changes in Plasma DNA in Trauma Patients Clin. Chem., August 1, 2003; 49(8): 1286 - 1291. [Abstract] [Full Text] [PDF]
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