ISSN: 0034-8376
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ABSTRACT

Distinguishing Intracerebral Hemorrhage from Acute Cerebral Infarction through Metabolomics

VOLUME 69 - NUMBER 6 / November-December (Original Article)  doi: 10.24875/RIC.17002348

Xuxin Zhang, Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
Yanzhao Li, Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
Yan Liang, Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
Pitong Sun, Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
Xue Wu, Key Laborotary of Liaoning Tumor Clinical Metabolomics (KLLTCM), the First Affiliated Hospital of Liaoning Medical University, and RSKT Biopharma Inc., JinZhou, Liaoning, China
Jinhui Song, Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
Xiaoyu Sun, Key Laborotary of Liaoning Tumor Clinical Metabolomics (KLLTCM), the First Affiliated Hospital of Liaoning Medical University, and RSKT Biopharma Inc., JinZhou, Liaoning, China
Mo Hong, Key Laborotary of Liaoning Tumor Clinical Metabolomics (KLLTCM), the First Affiliated Hospital of Liaoning Medical University, and RSKT Biopharma Inc., JinZhou, Liaoning, China
Peng Gao, Key Laborotary of Liaoning Tumor Clinical Metabolomics (KLLTCM), the First Affiliated Hospital of Liaoning Medical University; Department of SICU, Affiliated Zhongshan Hospital of Dalian University; 5Department of Biotechnology, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, Liaoning, China
Dongfeng Deng, Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China

Background: Acute cerebral infarction (ACI) and intracerebral hemorrhage (ICH) are potentially lethal cerebrovascular diseases that seriously impact public health. ACI and ICH share several common clinical manifestations but have totally divergent therapeutic strategies. A poor diagnosis can affect stroke treatment. Objective: To screen for biomarkers to differentiate ICH from ACI, we enrolled 129 ACI and 128 ICH patients and 65 healthy individuals as controls. Methods: Patients with stroke were diagnosed by computed tomography/magnetic resonance imaging, and their blood samples were obtained by fingertip puncture within 2-12 h after stroke initiation. We compared changes in metabolites between ACI and ICH using dried blood spot-based direct infusion mass spectrometry technology for differentiating ICH from ACI. Results: Through multivariate statistical approaches, 11 biomarkers including 3-hydroxylbutyrylcarnitine, glutarylcarnitine (C5DC), myristoylcarnitine, 3-hydroxypalmitoylcarnitine, tyrosine/citrulline (Cit), valine/phenylalanine, C5DC/3-hydroxyisovalerylcarnitine, C5DC/palmitoylcarnitine, hydroxystearoylcarnitine, ratio of sum of C0, C2, C3, C16, and C18:1 to Cit, and propionylcarnitine/methionine were screened. An artificial neural network model was constructed based on these parameters. A training set was evaluated by cross-validation method. The accuracy of this model was checked by an external test set showing a sensitivity of 0.8400 (95% confidence interval [CI], 0.7394-0.9406) and specificity of 0.7692 (95% CI, 0.6536-0.8848). Conclusion: This study confirmed that metabolomic analysis is a promising tool for rapid and timely stroke differentiation and prediction based on differential metabolites.

Keywords: Acute cerebral infarction. Artificial neural network. Intracerebral hemorrhage. Mass spectrometry. Metabolomics.

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