The Usefulness and Difference of Serum Biomarkers BNP, d-dimer, MMP-9, and S100beta for Diagnosing Stroke in Patients with Altered Mental Status

ABSTRACT

PURPOSE: An altered mental state is a common chief complain at the emergency departments (EDs). But it is difficult to find out the reason for this mental change. Serum biomarkers are an alternative way to diagnose the reason for mental change. We determined the values of four biomarker for diagnosing the mental changes of the patients seen at the ED BNP, d-dimer, MMP-9 and S100beta. METHODS: From September 2007 to March 2008, we prospectively enrolled 42 adult patients who visited the ED of Hospital because of an altered mental status. We categorized the patient's mental state into 5 steps (alert to coma), and we took samples of blood at the time of visiting the ED. We then measured the 4 serum markers. The clinical records were reviewed to analyze the usefulness of these 4 serum markers. RESULTS: We enrolled 42 patients (24 females and 18 males). Thirty-three people were diagnosed with stroke and 7 people were diagnosed to not have stroke. The measurements of BNP, d-dimer and MMP-9 were on average 136.5+/-231.7 pg/mL, 2052.2+/-2071.8 ng/mL and 294.9+/-311.7 ng/mL, respectively, and S100beta was mostly measured below 100 pg/mL. After statistic analysis, only MMP-9 had diagnostic value for stroke, and BNP & d-dimer had a negative relation to making the diagnosis of stroke. CONCLUSION: MMP-9 is useful for making the different diagnosis of acute stroke in patients with an altered mental status at the ER. There is the probability of metabolic causes for ED patients' depressed mentality when the BNP and ddimer levels are highly elevated, but further study is needed to confirm this.