Gopal, S (2023) Serum Ferritin, CRP, RDW in Correlation with Severity of Acute Ischaemic Stroke. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Stroke is an abrupt onset of a neurological deficit attributable to a focal vascular cause. Globally, it is one of the leading causes of death and disability-adjusted life-years (DALYs) as per the estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study. They are broadly classified as ischemic and haemorrhagic strokes. About 85% of all strokes are ischemic, and 15% are haemorrhagic. Ischemic strokes result from interruption of the blood supply to the brain, while haemorrhagic strokes result from the rupture of blood vessels. NIHSS, on the other hand, evaluates patients on 11 different parameters and has been found to be an excellent predictor of patient outcomes. Red cell distribution width (RDW) is a measure of the variation in red blood cell (RBC) sizes, based on the width of the mean corpuscular volume (MCV) and is easily and inexpensively determined by automated flow cytometer, as part of a complete blood counts. High RDW levels may be associated with elevated levels of inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin (IL) levels (6). High RDW levels have been found to be associated with a poor prognosis in acute myocardial infarction and peripheral artery disease. RDW has also been evaluated as a predictor of mortality in patients with cardiovascular disease, cancer, chronic lung disease, symptomatic chronic congestive cardiac insufficiency and acute cardiac insufficiency. Utility of RDW in predicting stroke severity, is still being evaluated. In this study, we tried to correlate RDW with the severity of acute ischemic stroke and also tried to find out whether RDW can be used as a predictor of mortality in acute ischemic stroke. AIMS AND OBJECTIVES: To study the severity of acute ischemic stroke in correlation with serum ferritin, CRP and RDW concentration. MATERIALS AND METHODS: All patients who presented within 48 hrs of onset of stroke and who gave informed consent to participate in the study were included As ferritin, CRP, RDW is an Acute phase reactant samples are taken with in 48 hrs of onset. RESULTS: The present study included 183 participants who presented with acute ischemic stroke and were evaluated with several markers. A high prevalence of acute ischemic stroke was reported in patients aged 61-70 (33.33%), followed by the age group of 41-50 (26.8%). In addition, a male predominance was reported in the current study, with a high incidence of hypertension (56.8%), diabetes mellitus (54.1%), the social habit of smoking (26.2%), and alcohol intake (17.5%). The NIHSS stroke severity assessment revealed that a majority of the patients were in the mild scoring criteria (42.6%), followed by moderate (21.9%), moderate to severe (16.4%), and severe criteria (19.1%). The clinical outcome of the study reports a loss of life due to mortality among 36 participants, with acute ischemic stroke accounting for 19.7% of the total participants. The RDW elevated levels, compared with the NIHSS score, revealed a significant difference (p-value <0.0001). Our study also reported that patients with a high RDW level had an increased mortality risk compared with the NIHSS score. The study revealed that patients with high CRP levels were associated with stroke mortality in AIS. In addition, higher CRP levels were also associated with larger infarct volumes in patients with acute ischemic stroke. [73] The findings revealed that patients with elevated CRP levels are more prone to developing complications in acute ischemic stroke, and the levels of CRP can be used to reflect the severity of AIS among patients. The comparison of mortality (loss of life) and recovery also reported a statistical difference concerning elevated serum CRP levels and mortality.During admission, elevated ferritin levels were reported based on the severity of the NIHSS score, which was in an upward trend with increasing severity (p-value <0.0001), which signifies that with increased severity of a stroke, high levels of serum ferritin can be reported. Literature has suggested that elevated serum ferritin levels can be a prognostic marker in ischemic stroke and act as a risk factor for ischemic episodes by causing atherogenesis. CONCLUSION: The study concludes with a linear relationship between the RDW, serum CRP, and serum ferritin levels in predicting the severity of stroke and mortality outcomes in patients with acute ischemic stroke.The study also reports a significant difference in clinical outcome and mortality (loss of life) when compared with all three markers (p-value <0.0001) respectively, which conclude that RDW, serum CRP levels, and serum ferritin levels can be used as a prognostic marker for assessing the severity of the stroke and formulating a therapeutic plan based on the severity.
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg.No.200120102009 |
| Uncontrolled Keywords: | Acute ischaemic strike, RAW, CRP, FERRITIN, NHISS SEVERITY SCORE. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 04 May 2021 09:04 |
| Last Modified: | 22 Mar 2024 16:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/15780 |
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