Mortality in acute stroke: predictive value of lipid profile and routine investigations
Keywords:Acute stroke, Lipid profile, Mortality
Background: The prognostic value of routine blood investigations in acute stroke has not been adequately studied. Most studies do not use accumulative measurement of these parameters and numbers of subjects taken were less. In this study we assess the impact of these simple parameters on the mortality in acute stroke patients as well as their correlation with clinical findings.
Methods: Total 205 consecutive patients of acute stroke presented within 72 hours of symptom onset were studied. After clinical evaluation and neuroimaging, routine blood investigations along with lipid profile estimations were performed. The patients were followed up for a maximum period of 30 days from onset of stroke.
Results: After analysis it was demonstrated that out of all clinical parameters low Glasgow Coma Scale (GCS), higher systolic and diastolic blood pressure can strongly predict fatality significantly. Among blood investigations raised leukocyte counts(TLC) , erythrocyte sedimentation rate, blood urea, serum creatinine, serum bilirubin along with decreased level of total cholesterol (p=0.0001) and low density lipoprotein (LDL) (p=0.02) signifies their accumulative importance in predicting fatality in expired patients. But after logistic regression analysis only GCS, TLC, blood urea, serum creatinine and total cholesterol independently correlate with mortality.
Conclusions: Our study shows that it is useful to take necessary interventions, accordingly in early hours focusing on correctable parameters in acute stroke to prevent mortality in acute stroke.
Pandian JD, Srikanth V, Read SJ, Thrift AG. Poverty and stroke in India: a time to act. Stroke. 2007;38:3063–9.
Dalal PM, Shenoy A. Stroke Epidemic in India-Time to prioritize prevention strategies. JAPI. 2013.
Dalal P.M. Burden of stroke –Indian prospective. International J Stroke. 2006;1:164-6.
Ong TZ, Raymond AA. Risk Factors for Stroke and Predictors of One-Month Mortality Singapore Med J. 2002;43:517-21.
Weir CJ, Bradford APJ, Lees KR. The prognostic value of the components of the Glasgow Coma Scale following acute stroke. QJM. 2003; 96:67-74.
Zuliani G, Cherubini A, Ranzini M, Ruggiero C, Atti AR, Fellin R. Risk Factors for Short-Term Mortality in Older Subjects with Acute Ischemic Stroke Gerontology. 2006;52:231-6.
Miah MT, Aminul Hoque AKM, Khan RR, Nur Z, Mahbub MS, Rony RI, et al. GCS following Ac. Stroke and in hospital outcome. Journal of medicine. 2009;10:11-4.
Smajlović D, Salihović D, Ibrahimagić OC, Sinanović O, Vidović M. Analysis of risk factors, localization and 30-day prognosis of intracerebral hemorrhage. Bosnian journal of basic medical sciences. 2008;8:121-5.
Tetri S, Juvela S, Saloheimo P, Pyhtinen J, Hillbom M. Hypertension and diabetes as predictors of early death after spontaneous intracerebral haemorrhage. J Neurosurg. 2009;110:411-7.
MariaSessa. Intracerebral haemorrhage and hypertension. Neurol Sci. 2008;29:S258–9.
Wei JW, Huang Y, Wang JG, Liu M, Wong LKS, Huang Q, et al. Comparison of Recovery Patterns and Prognostic Indicators for Ischemic and Haemorrhagic Stroke in China: The China QUEST (Quality Evaluation of Stroke Care and Treatment) Registry Study. Stroke. 2010, 41:1877-83.
Członkowska A, Ryglewicz D, Lechowicz W. Basic analytical parameters as the predictive factors for 30-day case fatality rate in stroke. ActaNeurolScand. 1997;95:121-4.
Jason J Sico, Laura J Myers, Dede Ordin, Linda S Williams, Dawn M Bravata. The Association between Hematocrit and Mortality among Ischemic Stroke Patients Stroke. 2012;43:A147.
Kazmierski R, Guzik P, Ambrosius W, Ciesielska A, Moskal J, Kozubski W. Predictive value of white blood cell count on admission for in-hospital mortality in acute stroke patients. Clin Neurol Neurosurg. 2004;107:38–43.
Feng-zeng Li, Hui Chen, Yong-hong Wang, Ying-jun Yang, Cheng-hua Li, Zi-he Dong. A new prognostic model and score to predict short term outcome after intracerebral haemorrhage. Scientific Research and Essays.1992;6:2063–8.
D’Erasmo E, Aliberti G, Celi FS, Romagnoli E, Vecci E, Mazzuoli GF. Platelet count, mean platelet and their relation to prognosis in cerebral infarction. J Intern Med. 1990;227:11-4
Chamorro A, Vila N, Ascaso C, Saiz A, Montalvo J, Alonso P et al. Early prediction of stroke severity. Role of erythrocyte sedimentation rate. Stroke. 1995;26:573-6.
Rallidis LS, Vikelis M, Panagiotakos DB, Liakos GK, Krania E, Kremastinos DT. Usefulness of inflammatory and haemostatic markers to predict short term risk for death in ischemic stroke. ActaNeurol Scand. 2008;117:415–20.
El-Sheikh WM. Stroke mortality: predictive value of simple laboratory tests and APACHE III scoring system. Menoufiya Medical Journal 353 Stroke Mortality: Predictive. 2009;22.
Florian Schlenk, Peter Vajkoczy, Asita Sarrafzadeh. Inpatient Hyperglycaemia Following Aneurysmal Subarachnoid Haemorrhage: Relation to Cerebral Metabolism and Outcome. Neurocritical Care. 2009:56-63.
Jia Liu, Ben-Bo Gao, Allen C. Clermont, Price Blair, Tamie J. Chilcote, and Sukanto Sinha et al. Hyperglycaemia-induced cerebral hematoma expansion is mediated by plasma kallikrein. Nature. Medicine. 2011;17:206-10.
Sweileh WM. Predictors of in-hospital mortality after acute stroke: impact of renal dysfunctional int. J ClinPharmacolTher. 2008;46:637-43.
Woo J, Lau E, Kay R, et al. A case control study of some haematological and biochemical variables in acute stroke and their prognostic value. Neuroepidemiology. 1990;9:315-20.
Hyeon Chang Kim, Dae Ryong Kang, Chung Mo Nam, Nam Wook Hur, Jee Seon Shim, Sun Ha Jee et al. Elevated serum aminotransferase level as a predictor of intracerebral haemorrhage: Korea medical insurance corporation study. Stroke 2005; 36:1642-7.
Dyker AG, Weir CJ, Lees KR. Influence of cholesterol on survival after stroke: retrospective study. BMJ. 1997;314:1584-8.
Yih-tsen Lai, Ching-lin Hsieh, Hung-pin Lee, Shin-liang Pan. Are higher total serum cholesterol levels associated with better long-term motor function after ischemic stroke? Nutritional Neuroscience. 2012;15:239-43.
Pan S-L, Lien I-N, Chen TH. Is higher serum total cholesterol level associated with better long-term functional outcomes after noncardioembolic ischemic stroke? Arch Phys Med Rehabil. 2010;91:913-8.
Vauthey C, deFreitas GR, van Melle G, Devuyst G, Bogousslavsky J. Better outcome after stroke with higher serum cholesterol levels. Neurology. 2000;54:1944-9.