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Biomarcadores de prognóstico do AVC isquémico : revisão sistemática e estado da arte
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Introdução e Objetivo: O AVC isquémico tem uma prevalência de 423.9 por 100 000 habitantes/ano em Portugal e corresponde a uma das principais causas de incapacidade, dependência e mortalidade nos países desenvolvidos. A identificação de um biomarcador sanguíneo preditor de prognóstico funcional após o AVC poderia permitir determinar estratégias terapêuticas otimizadas.
Métodos e Resultados: Este trabalho consiste numa revisão sistemática da literatura acerca dos biomarcadores sanguíneos de prognóstico funcional do AVC isquémico. O outcome escolhido foi a independência funcional, avaliado pela escala modificada de Rankin (mRS). Desta pesquisa resultaram 39 artigos, dos quais 13 estudos foram considerados elegíveis para inclusão, reportando 14 biomarcadores distintos.
Discussão: Diversos biomarcadores mostram potencial aplicação clínica, contudo os estudos existentes até à data são de baixa a moderada qualidade e apresentam várias lacunas metodológicas. A superioridade destes biomarcadores em relação às escalas clínicas e neuro-imagiológicas ainda não foi provada. Assim, nenhum biomarcador tem atualmente utilidade clínica para predizer o prognóstico funcional após o AVC isquémico.
Conclusão: São necessários mais estudos com robustez metodológica para validar, generalizar e recomendar o uso destes biomarcadores na prática médica.
Background and Purpose: Ischemic stroke has a prevalence of 423.9 per 100 000 habitants/year in Portugal and represents one of the main causes of incapacity, disability and mortality in developed countries. The identification of a blood biomarker to predict the functional prognosis after stroke could allow access to the most appropriate therapy. Methods and Results: We systematically search databases and studies reporting prognostic biomarkers of ischemic stroke. The clinical outcome was functional independence and it was assessed using the modified Rankin Scale (mRS). A total of 39 articles were obtained, 13 studies were considered eligible for inclusion, reporting 14 distinct biomarkers. Discussion: Some biomarkers show promising results even though the studies available until now have low to moderate quality and present many methodological issues. The superiority of this biomarkers compared to the clinical and neuroimaging scales is yet to be proven. Thus, no biomarker currently appears to be effective in predicting the functional prognosis after ischemic stroke. Conclusion: We need more studies with better methodological design to validate, generalize and recommend the application of this biomarkers in medical practice.
Background and Purpose: Ischemic stroke has a prevalence of 423.9 per 100 000 habitants/year in Portugal and represents one of the main causes of incapacity, disability and mortality in developed countries. The identification of a blood biomarker to predict the functional prognosis after stroke could allow access to the most appropriate therapy. Methods and Results: We systematically search databases and studies reporting prognostic biomarkers of ischemic stroke. The clinical outcome was functional independence and it was assessed using the modified Rankin Scale (mRS). A total of 39 articles were obtained, 13 studies were considered eligible for inclusion, reporting 14 distinct biomarkers. Discussion: Some biomarkers show promising results even though the studies available until now have low to moderate quality and present many methodological issues. The superiority of this biomarkers compared to the clinical and neuroimaging scales is yet to be proven. Thus, no biomarker currently appears to be effective in predicting the functional prognosis after ischemic stroke. Conclusion: We need more studies with better methodological design to validate, generalize and recommend the application of this biomarkers in medical practice.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
AVC isquémico Biomarcador Prognóstico Metodologia Revisão sistemática Neurologia