Biomarkers of Hypercoagulability and Inflammation in Childhood-Onset Arterial Ischemic Stroke

Objective To test the hypothesis that acute elevations of biomarkers of hypercoagulability and inflammation are common in children with arterial ischemic stroke (AIS), particularly among etiologic subtypes that carry an increased risk of recurrent stroke. Study design In this prospective/retrospective institutional-based cohort study of acute childhood-onset AIS (n = 50) conducted between 2005 and 2009, D-dimer, factor VIII (FVIII) activity, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were serially evaluated at the time of clinical blood sampling. Patients were classified by stroke subtype as cardioembolic, moyamoya, non-moyamoya arteriopathy, or other. Results Both D-dimer and CRP were frequently elevated in acute childhood-onset AIS and exhibited a decreasing trend with time. Acute D-dimer levels were significantly higher in cardioembolic AIS compared with noncardioembolic AIS (median, 2.04 mu g/mL [range 0.54-4.54 mu g/mL] vs 0.32 mu g/mL [0.22-3.18 mu g/mL]; P =.002). At an optimal threshold of >= 0.50 mu g/mL, the sensitivity and specificity of D-dimer for cardioembolic subtype were 78% and 79%, respectively. Conclusions Our findings identify D-dimer and CRP as candidate biomarkers for etiology and prognosis in childhood-onset AIS. Further studies should investigate the role of these and other biomarkers of hypercoagulability and inflammation in childhood-onset AIS. (J Pediatr 2010; 156: 651-6).