TY  - JOUR
T1  - Evaluation of the MAPH score in predicting acute ischemic stroke severity and major vessel occlusion in the emergency department
TT  - Acil serviste akut iskemik inme şiddeti ve majör damar oklüzyonunu öngörmede MAPH skorunun değerlendirilmesi
AU  - Sarcan, Emine
AU  - Yazla, Merve
PY  - 2025
DA  - October
Y2  - 2025
DO  - 10.32322/jhsm.1774461
JF  - Journal of Health Sciences and Medicine
JO  - J Health Sci Med /JHSM /jhsm
PB  - MediHealth Academy Yayıncılık
WT  - DergiPark
SN  - 2636-8579
SP  - 1041
EP  - 1048
VL  - 8
IS  - 6
LA  - en
AB  - Aims: This study aimed to evaluate the utility of the MAPH score, a biomarker combining blood viscosity indicators such as mean platelet volume (MPV), total protein, and hematocrit, in differentiating acute ischemic stroke (AIS) from transient ischemic attack (TIA) and predicting major vessel occlusion in patients presenting to the emergency department with suspected stroke.Methods: A retrospective analysis was conducted on 226 patients presenting to the emergency department with focal neurological symptoms. Patients were categorized into AIS and TIA groups based on diffusion-weighted magnetic resonance imaging findings. Data collected included demographic characteristics, vital signs, laboratory parameters, and imaging results. MPV, age, hematocrit, and total protein levels were recorded. High-shear rate and low-shear rate were calculated from total protein and hematocrit values. ROC curve analysis was performed to evaluate diagnostic performanceResults: The ROC analysis demonstrated the diagnostic accuracy of the MAPH score in differentiating AIS from TIA and predicting major vessel occlusion. Additionally, the score showed a significant correlation with NIHSS ≥20, indicating its association with stroke severity.Conclusion: The MAPH score is a simple and practical tool that aids in distinguishing AIS from TIA and predicting major vessel occlusion, thus improving stroke management in emergency settings.
KW  - MAPH score
KW  - acute ischemic stroke
KW  - transient ischemic attack
KW  - major vessel occlusion
KW  - emergency medicine
N2  - Amaç: Bu çalışma, ortalama trombosit hacmi (MPV), total protein ve hematokrit gibi kan viskozite göstergelerini birleştiren bir biyobelirteç olan MAPH skorunun, akut iskemik inme (Aİİ) ile geçici iskemik atak (GİA) ayrımında ve acil servise inme şüphesi ile başvuran hastalarda majör damar oklüzyonunu öngörmedeki değerini değerlendirmeyi amaçladı.Yöntem: Acil servise fokal nörolojik semptomlarla başvuran 226 hasta üzerinde retrospektif bir analiz yapıldı. Difüzyon ağırlıklı manyetik rezonans görüntüleme bulgularına göre hastalar Aİİ ve GİA gruplarına ayrıldı. Demografik özellikler, vital bulgular, laboratuvar parametreleri ve görüntüleme sonuçları kaydedildi. MPV, yaş, hematokrit ve total protein düzeyleri belirlendi. Total protein ve hematokrit değerlerinden yüksek kayma hızı ve düşük kayma hızı hesaplandı. Tanısal performansı değerlendirmek için ROC eğrisi analizi yapıldı.Bulgular: ROC analizi, MAPH skorunun Aİİ ile GİA ayrımındaki ve majör damar oklüzyonunu öngörmedeki tanısal doğruluğunu gösterdi. Ayrıca skorun NIHSS ≥ 20 ile anlamlı bir korelasyon gösterdiği, bu nedenle inme şiddeti ile ilişkili olduğu saptandı.Sonuç: MAPH skoru, Aİİ ile GİA’nın ayırt edilmesine ve majör damar oklüzyonunun öngörülmesine yardımcı olan, basit ve pratik bir araç olup acil servis koşullarında inme yönetimini geliştirmektedir.
CR  - Walter K. What is acute ischemic stroke? JAMA. 2022;327(9):885. doi:10. 1001/jama.2022.1420
CR  - Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: a report of us and global data from the american heart association. Circulation. 2024;149(8):e347-e913. doi:10.1161/CIR.00000 00000001209
CR  - Erdem AB, Çavuş UY, Ceylan A, Kaya U, Büyükcam F, Kavalcı C. The prognostic value of leukocyte in cerebrovascular diseases. Sci Healthcare. 2020;22(2):61-65. doi:10.34689/SH.2020.22.2.006
CR  - Kang J, Oh JS, Kim BJ, et al. High blood viscosity in acute ischemic stroke. Front Neurol. 2023;14:1320773. doi:10.3389/fneur.2023.1320773
CR  - Amin HP, Madsen TE, Bravata DM, et al. Diagnosis, workup, risk reduction of transient ischemic attack in the emergency department setting: a scientific statement from the American Heart Association. Stroke. 2023;54(3):e109-e121. doi:10.1161/STR.0000000000000418
CR  - Abacioglu OO, Yildirim A, Karadeniz M, et al. A new score for determining thrombus burden in STEMI patients: the MAPH score. Clin Appl Thromb Hemost. 2022;28:10760296211073767. doi:10.1177/ 10760296211073767
CR  - Akhan O, Boz M, Guzel T, Kis M. Discrimination of the acute pulmonary embolism subtypes based on the novel MAPH score. J Thromb Thrombolysis. 2024;57(4):683-690. doi:10.1007/s11239-024-029 52-9
CR  - Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864-870. doi:10.1161/01.str.20.7.864
CR  - de Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation. 1990;81(1):107-117. doi:10.1161/01.cir.81.1.107
CR  - Zheng YY, Wang L, Shi Q. Mean platelet volume (MPV) and platelet distribution width (PDW) predict clinical outcome of acute ischemic stroke: a systematic review and meta-analysis. J Clin Neurosci. 2022;101: 221-227. doi:10.1016/j.jocn.2022.05.019
CR  - Farah R, Samra N. Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke. J Clin Lab Anal. 2018;32(1):e22189. doi:10. 1002/jcla.22189
CR  - Bath P, Algert C, Chapman N, Neal B; PROGRESS Collaborative Group. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004;35(3): 622-626. doi:10.1161/01.STR.0000116105.26237.EC
CR  - Sadeghi F, Kovács S, Zsóri KS, Csiki Z, Bereczky Z, Shemirani AH. Platelet count and mean volume in acute stroke: a systematic review and meta-analysis. Platelets. 2020;31(6):731-739. doi:10.1080/09537104.2019. 1680826
CR  - Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh artery study. Br J Haematol. 1997;96(1):168-173. doi:10.1046/j.1365-2141.1997.8532481.x
CR  - Pries AR, Neuhaus D, Gaehtgens P. Blood viscosity in tube flow: dependence on diameter and hematocrit. Am J Physiol. 1992;263(6 Pt 2): H1770-H1778. doi:10.1152/ajpheart.1992.263.6.H1770
CR  - Çakmak Karaaslan Ö, Çöteli C, Özilhan MO, et al. The predictive value of MAPH score for determining thrombus burden in patients with non-ST segment elevation myocardial infarction. Egypt Heart J. 2022;74(1): 60. doi:10.1186/s43044-022-00299-1
CR  - Kwaan HC. Role of plasma proteins in whole blood viscosity: a brief clinical review. Clin Hemorheol Microcirc. 2010;44(3):167-176. doi:10.  3233/CH-2010-1271
CR  - Briley DP, Giraud GD, Beamer NB, et al. Spontaneous echo contrast and hemorheologic abnormalities in cerebrovascular disease. Stroke. 1994; 25(8):1564-1569. doi:10.1161/01.str.25.8.1564
CR  - Schouten HJ, Geersing GJ, Koek HL, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ. 2013;346:f2492. doi:10.1136/bmj.f2492
CR  - Bilgiç AB, Akpınar ÇK. Association of whole blood viscosity and severe extracranial carotid artery stenosis. Glob Emerg Crit Care. 2023;2(2):67-70. doi:10.4274/globecc.galenos.2023.44154
CR  - Ekizler FA, Cay S, Tak BT, et al. Usefulness of the whole blood viscosity to predict stent thrombosis in ST-elevation myocardial infarction. Biomark Med. 2019;13(15):1307-1320. doi:10.2217/bmm-2019-0246
CR  - Çınar T, Şaylık F, Akbulut T, et al. The association between whole blood viscosity and high thrombus burden in patients with non-ST elevation myocardial infarction. Kardiol Pol. 2022;80(4):429-435. doi:10.33963/KP.a2022.0043
CR  - Koton S, Pike JR, Johansen M, et al. Association of Ischemic Stroke Incidence, Severity, and Recurrence With Dementia in the Atherosclerosis Risk in Communities Cohort Study. JAMA Neurol. 2022;79(3):271-280. doi:10.1001/jamaneurol.2021.5080
CR  - Lyden P. Using the National Institutes of Health Stroke Scale: a cautionary tale. Stroke. 2017;48(2):513-519. doi:10.1161/STROKEAHA.116.015434
UR  - https://doi.org/10.32322/jhsm.1774461
L1  - https://dergipark.org.tr/en/download/article-file/5197195
ER  -