Akut iskemik inme hastalarında hematolojik parametrelerin uzun dönem mortalite üzerine etkisi

Abstract

ÖZET Amaç: Akut iskemik inmede (Aİİ) erken ya da geç dönemde mortalite görülebilmektedir. Geç dönem mortalitesinde mean platelet volüm (MPV), nötrofil lenfosit oranı (NLR), platelet lenfosit oranı (PLR) ve enfarkt hacminin rolünü araştırdık. Yöntem: Bu retrospektif kesitsel çalışmaya ardışık 12 aylık bir sürede bir üniversite hastanesinin acil servisine başvuran 132 Aİİ hasta alındı. Dışlama kriterlerine göre bazı hastalar çalışmadan çıkarıldı. Hastalar hayatta kalan ve ölen olarak gruplara ayrıldı. Her grupta MPV, NLR, PLR seviyeleri, National Institutes of Health Stroke Scale (NIHSS) skorlarına göre değerlendirildi. Difüzyon ağırlıklı MR görüntüleri (DWI MRs) değerlendirilerek hastaların enfarkt hacimleri hesaplandı. Bulgular: Dışlama sonucu geride kalan toplam 83 Aİİ’li hastanın verileri analiz edildi. Ölenlerin ortalama yaşı, NIHSS skoru ve enfarkt hacmi hayatta kalanlardan istatistiksel olarak anlamlı derecede daha yüksekti (sırası ile p˂0,01, p=0,026, p=0,021). Sperman’s analizine göre, NLR, MPV ve PLR başvuru anındaki GCS ile negatif olarak korelasyon gösterir iken NIHSS ve enfarkt hacmi ile pozitif olarak korelasyon gösterdiği saptandı. ROC eğrisi analizinde uzun dönem mortalite belirleyicisi olarak, NLR, MPV ve PLR’nin optimal cut-off değerleri sırasıyla 4,68, 7,20 ve 167,66 olarak belirlendi. Bu seviyede sensitiviteleri sırasıyla 54,84, 48,39, 61,29, spesifiteleri sırasıyla 75, 73,08, 73,8, pozitif prediktivite değerleri sırasıyla 56,7, 51,7, 57,6 ve negatif prediktivite değerleri sırasıyla 73,6, 70,4, 76 idi. (AUC: 0,64[0,52-0,74 %95 CI], 0,64[0,52-0,74 %95 CI], 0,66[0,55-0,76 %95 CI]). Sonuç: Sonuçlar MPV, PLR, enfarkt hacmi ve ortalama yaşın, Aİİ hastalarında 3 yıllık tüm nedenlere bağlı mortalitede bağımsız prediktör olduğunu gösterdi.

Keywords

• İskemik inme
• platelet lenfosit oranı
• mortalite.
• mean platelet volüm
• nötrofil lenfosit oranı

Effects of hematological parameters on long term mortality in acute ischemic stroke patients

Abstract

Aims: Mortality can be seen in acute ischemic stroke (AIS) in the early or late period. We investigated the role of mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and stroke volume in late-term mortality. Methods: This retrospective cross-sectional study included 132 AIS patients who applied to the emergency department of a university hospital over a consecutive 12-month period. Some patients were excluded from the study according to the exclusion criteria. Patients were divided into groups as survivors and deceased. MPV, NLR, PLR levels in each group were evaluated according to the National Institutes of Health Stroke Scale (NIHSS) scores. Diffusion-weighted MR images (DWI MRs) were evaluated and the infarct volumes of the patients were calculated. Results: The data of a total of 83 AIS patients who remained after exclusion were analyzed. The mean age, NIHSS score and infarct volume of the deceased were statistically significantly higher than the survivors (p<0.01, p=0.026, p=0.021, respectively). According to Spearman’s analysis, NLR, MPV and PLR were negatively correlated with Glasgow Coma Scale (GCS) at presentation, while they were positively correlated with NIHSS and infarct volume. In ROC curve analysis, the optimal cut-off values of NLR, MPV and PLR as predictors of long-term mortality were determined as 4.68, 7.20 and 167.66, respectively. At this level, their sensitivities were 54.84, 48.39, 61.29, respectively, their specificities were 75, 73.08, 73.8, respectively, their positive predictive values were 56.7, 51.7, 57.6, respectively, and their negative predictive values were 73.6, 70.4, 76, respectively, (AUC: 0.64[0.52-0.74 95% CI], 0.64[0.52-0.74 95% CI], 0.66[0.55-0.76 95% CI]). Conclusion: The results showed that MPV, PLR, infarct volume and mean age were independentpredictors of 3-year all-cause mortality in AIS patients.

Keywords

• Ischemic stroke
• mean platelet volume
• neutrophil/ lymphocyte ratio
• platelet lymphocyte ratio
• mortality

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