Blood biomarkers for post-stroke cognitive impairment: a systematic review and meta-analysis

Abstract

Background and purpose

Post-stroke cognitive impairment (PSCI) is a frequent consequence of stroke, which affects the quality of life and prognosis of stroke survivors. Numerous studies have indicated that blood biomarkers may be the key determinants for predicting and diagnosing cognitive impairment, but the results remain varied. Therefore, this meta-analysis aims to summarize potential biomarkers associated with PSCI.

Methods

PubMed, Web of Science, Embase, and Cochrane Library were comprehensively searched for studies exploring blood biomarkers associated with PSCI from inception to 15 April 2022.

Results

63 studies were selected from 4,047 references, which involves 95 blood biomarkers associated with the PSCI. We meta-analyzed 20 potential blood biomarker candidates, the results shown that the homocysteine (Hcy) (SMD=0.35; 95%CI: 0.20-0.49; P<0.00001), c-reactive protein (CRP) (SMD=0.49; 95%CI: 0.20-0.78; P=0.0008), uric acid (UA) (SMD=0.41; 95%CI: 0.06-0.76; P=0.02), interleukin 6 (IL-6) (SMD=0.92; 95% CI: 0.27-1.57; P=0.005), cystatin C (Cys-C) (SMD=0.58; 95%CI: 0.28-0.87; P=0.0001), creatinine (SMD=0.39; 95%CI: 0.23-0.55; P<0.00001) and tumor necrosis factor alpha (TNF-α) (SMD=0.45; 95%CI: 0.08-0.82; P=0.02) levels were significantly higher in patients with PSCI than in the non-PSCI group.

Conclusion

Based on our findings, we recommend that paramedics focus on the blood biomarkers levels of Hcy, CRP, UA, IL-6, Cys-C, creatinine and TNF-α in conjunction with neuroimaging and neuropsychological assessment to assess the risk of PSCI, which may help with early detection and timely preventive measures. At the same time, other potential blood biomarkers should be further validated in future studies.