Research Article
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The Relationship of Hematologic Parameters and Lipid Profile with Acute Ischemic Stroke

Year 2024, Volume: 14 Issue: 4, 334 - 343
https://doi.org/10.31832/smj.1529153

Abstract

Objective: This study aims to investigate the effect of routine laboratory parameters on clinical outcomes in patients with acute ischemic stroke (AIS).
Materials and Methods: Our study was designed as retrospective and cross-sectional. 94 patients with AIS who received inpatient treatment in our clinic with a diagnosis of acute ischemic stroke were included in the study. Laboratory data, demographic, and clinical characteristics were recorded at the time of admission. Neurological disabilities of the patients 3 months after treatment were evaluated with the modified Rankin Scale (mRS). mRS 0-2 was considered a good prognosis and mRS 3-6 was considered a poor prognosis.
Results: Of the 94 patients included in the study, 47 were men and 47 were women. The mean age was 71.18±11.92 years. Laboratory parameters hemoglobin, eosinophil, totalcholesterol, ldl-cholesterol, and triglyceride values were significantly lower in the group with mRS≥3. As a result of ROC analysis, the area under the curve of hemoglobin, eosinophil, total-cholesterol, ldl-cholesterol, and triglyceride was significantly higher[(AUC: 0.710 95%CI: 0.60-0.81); Sensitivity=67.6%, Specificity=67.9%, p=0.001]. In the multivariable logistic regression model, only the NIHSS score (National Institutes Of Health Stroke Scale Scores) was independently associated with the degree of disability (p=0.001). NIHSS is an independent factor in predicting stroke outcomes. Conclusion: It was determined that there was a significant inverse relationship between the routine laboratory parameters hemoglobin level, eosinophil level, LDL and total cholesterol levels, and infarct volume with the NIHSS scores of hemoglobin and LDLcholesterol.

Ethical Statement

Ethical approval was obtained.

Supporting Institution

No financial support was used for the study included in this article.

Thanks

We would like to thank our patients who participated in the study.

References

  • Katan M, Luft A. Global Burden of Stroke. Semin Neurol. Apr 2018;38(2):208-211. doi:10.1055/s-0038-1649503
  • Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. Jan 26 2016;133(4):e38-360. doi:10.1161/cir.0000000000000350
  • Shams Vahdati S, Ala A, Vahed N, Mohammadi S, Ameli H. Complete Blood Count Parameters as Prognostic Factor of Stroke: A Systematic Review. Basic Clin Neurosci. Nov-Dec 2022;13(6):745-754. doi:10.32598/bcn.2021.2168.2
  • Fan L, Gui L, Chai EQ, Wei CJ. Routine hematological parameters are associated with short- and long-term prognosis of patients with ischemic stroke. J Clin Lab Anal. Feb 2018;32(2)doi:10.1002/jcla.22244
  • Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. May 17 2005;45(10):1638-43. doi:10.1016/j.jacc.2005.02.054
  • Haybar H, Pezeshki SMS, Saki N. Evaluation of complete blood count parameters in cardiovascular diseases: An early indicator of prognosis? Exp Mol Pathol. Oct 2019;110:104267. doi:10.1016/j.yexmp.2019.104267
  • Madai VI, Galinovic I, Grittner U, et al. DWI intensity values predict FLAIR lesions in acute ischemic stroke. PLoS One. 2014;9(3):e92295. doi:10.1371/journal.pone.0092295
  • Branco JP, Costa JS, Sargento-Freitas J, et al. [Neuroimaging and Blood Biomarkers in Functional Prognosis after Stroke]. Acta Med Port. Nov 2016;29(11):749-754. Neuroimagem e Biomarcadores no Prognóstico Funcional de Doentes com Acidente Vascular Cerebral. doi:10.20344/amp.7411
  • Whiteley W, Chong WL, Sengupta A, Sandercock P. Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke. May 2009;40(5):e380-9. doi:10.1161/strokeaha.108.528752
  • Adiguzel A, Arsava EM, Topcuoglu MA. Temporal course of peripheral inflammation markers and indexes following acute ischemic stroke: prediction of mortality, functional outcome, and stroke-associated pneumonia. Neurol Res. Mar 2022;44(3):224-231. doi:10.1080/01616412.2021.1975222
  • Wang J, Ma L, Lin T, Li SJ, Chen LL, Wang DZ. The significance of eosinophils in predicting the severity of acute ischemic stroke. Oncotarget. Nov 28 2017;8(61):104238-104246. doi:10.18632/oncotarget.22199
  • Bellwald S, Balasubramaniam R, Nagler M, et al. Association of anemia and hemoglobin decrease during acute stroke treatment with infarct growth and clinical outcome. PLoS One. 2018;13(9):e0203535. doi:10.1371/journal.pone.0203535
  • Nybo M, Kristensen SR, Mickley H, Jensen JK. The influence of anaemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide. European journal of neurology. May 2007;14(5):477-82. doi:10.1111/j.1468-1331.2006.01591.x
  • Zhang R, Xu Q, Wang A, et al. Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack. J Am Heart Assoc. Dec 7 2021;10(23):e022547. doi:10.1161/jaha.121.022547
  • Koca AN, Acehan S, Satar S, et al. Which one predicts mortality better in acute ischemic stroke: negative vs positive acute-phase reactants. Neurological Research. 2024:1-9.
  • Icme F, Doğan Nö, Yüzbaşioğlu Y, Sarikaya P, Ay Mo, Gülen M. Prognostic Relationship Between Complete Blood Count Parameters and Transient Ischemic Attack, Ischemic Stroke and Hemorrhagic Stroke. Turkish Journal of Geriatrics/Türk Geriatri Dergisi. 2014;17(1)
  • Guldiken B, Ozkan H, Kabayel L. Mean platelet volume and peripheral blood count response in acute ischemic stroke. Trakya Universitesi Tip Fakultesi Dergisi. 2008;25(2):130-135.
  • Wang D, Zhang FH, Zhao YT, et al. Association of polymorphism in ICAM-1 (K469E) and cytology parameters in patients' initial blood test with acute ischemic stroke. Genet Mol Res. Dec 2 2015;14(4):15520-9. doi:10.4238/2015.December.1.2
  • Hatamian H, Saberi A, Pourghasem M. The relationship between stroke mortality and red blood cell parameters. Iran J Neurol. Oct 6 2014;13(4):237-40.
  • Bang OY, Saver JL, Liebeskind DS, et al. Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis. Neurology. Mar 6 2007;68(10):737-42. doi:10.1212/01.wnl.0000252799.64165.d5
  • Olsen TS, Christensen RH, Kammersgaard LP, Andersen KK. Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study. Stroke. Oct 2007;38(10):2646-51. doi:10.1161/strokeaha.107.490292
  • Koton S, Molshatzki N, Bornstein NM, Tanne D. Low cholesterol, statins and outcomes in patients with first-ever acute ischemic stroke. Cerebrovasc Dis. 2012;34(3):213-20. doi:10.1159/000342302
  • Vauthey C, de Freitas GR, van Melle G, Devuyst G, Bogousslavsky J. Better outcome after stroke with higher serum cholesterol levels. Neurology. May 23 2000;54(10):1944-9. doi:10.1212/wnl.54.10.1944
  • Yücel K, Eren F. İskemik ve Hemorajik İnme Hastalarında Kan Lipid Parametrelerinin Karşılaştırılması ve Mortalite ile İlişkisi. Comparison of Blood Lipid Parameters in Patients with Ischemic and Hemorrhagic Stroke and Its Relationship with Mortality. Sakarya Tıp Dergisi. June 2021;11(2):400-408. doi:10.31832/smj.849225
  • Hindy G, Engström G, Larsson SC, et al. Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes: A Mendelian Randomization Study. Stroke. Apr 2018;49(4):820-827. doi:10.1161/strokeaha.117.019653
  • Glasser SP, Mosher A, Howard G, Banach M. What is the association of lipid levels and incident stroke? Int J Cardiol. Oct 1 2016;220:890-4. doi:10.1016/j.ijcard.2016.06.091
  • Han Y, Huang Z, Zhou J, et al. Association between triglyceride-to-high density lipoprotein cholesterol ratio and three-month outcome in patients with acute ischemic stroke: a second analysis based on a prospective cohort study. BMC Neurol. Jul 16 2022;22(1):263. doi:10.1186/s12883-022-02791-2

Akut İskemik İnme ile Hematolojik Parametreler ve Lipid Profilinin İlişkisi

Year 2024, Volume: 14 Issue: 4, 334 - 343
https://doi.org/10.31832/smj.1529153

Abstract

Bu çalışmanın amacı akut iskemik inmeli (Aİİ) hastalarda rutin laboratuvar parametrelerinin klinik sonuçlar üzerine etkisini araştırmaktır. Çalışmamız, retrospektif ve kesitsel olarak tasarlanmıştır. Çalışmaya akut iskemik inme tanısı ile kliniğimizde yatarak tedavi gören 94 Aİİ’li hasta çalışmaya dahil edildi. Başvuru sırasındaki laboratuvar verileri, demografik ve klinik özellikler kaydedildi. Hastaların tedaviden 3 ay sonraki nörolojik özürlülükleri modifiye Rankin Skalası (mRS) ile değerlendiridi. Hastalar mRS’na göre hastalar iki gruba ayrıldı. mRS 0-2 arası iyi prognoz ve mRS 3-6 arası kötü prognoz olarak kabul edildi. Çalışmaya alınan 94 hastanın 47’si erkek, 47’si kadındı. Yaş ortalamaları 71,18± 11,92 yıl idi. Hipertansiyon, kalp yetmezliği ve atrial fibrilasyon görülme oranının kötü prognozlu grupta daha yüksek olduğu belirlendi (sırasıyla; %84,2 & %46.4; p<0,001, %21,1 & %5.4; p=0,04, %50 & %26,8; p=0,03). Laboratuvar parametrelerinden hemoglobin, eozinofil, total-kolesterol, ldl-kolesterol ve trigliserit değerleri mRS ≥3 olan grupta anlamlı olarak düşük idi. ROC analizi sonucu hemoglobin, eozinofil, total-kolesterol, ldl-kolesterol ve trigliseridin eğri altındaki alanı anlamlı olarak fazlaydı [(AUC: 0,710 %95 GA: 0,60-0,81); Duyarlılık = %67,6, Özgüllük = %67,9, p=0,001]. Çok değişkenli lojistik regresyon modelinde yalnızca NIHSS skoru (National Institues Of Health Stroke Scale Scores) bağımsız olarak sakatlık derecesi ile ilişkilendirildi (p=0,001). İnme sonucunu öngörmede NIHSS bağımsız bir faktördür. Bu çalışmada rutin laboratuvar parametrelerinden hemoglobin düzeyi, eozinofil seviyesi, LDL ve total kolestrol düzeyleri ile infarkt hacmi arasında hemoglobin ve LDL-kolesterolün NIHSS skorları ile ters yönlü anlamlı bir ilişki olduğu belirlendi.

Ethical Statement

Etik kurul onayı alınmıştır.

Supporting Institution

Destekleyici yoktur.

Thanks

Çalışmaya katılan tüm hastalarımıza teşekkür ederiz.

References

  • Katan M, Luft A. Global Burden of Stroke. Semin Neurol. Apr 2018;38(2):208-211. doi:10.1055/s-0038-1649503
  • Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. Jan 26 2016;133(4):e38-360. doi:10.1161/cir.0000000000000350
  • Shams Vahdati S, Ala A, Vahed N, Mohammadi S, Ameli H. Complete Blood Count Parameters as Prognostic Factor of Stroke: A Systematic Review. Basic Clin Neurosci. Nov-Dec 2022;13(6):745-754. doi:10.32598/bcn.2021.2168.2
  • Fan L, Gui L, Chai EQ, Wei CJ. Routine hematological parameters are associated with short- and long-term prognosis of patients with ischemic stroke. J Clin Lab Anal. Feb 2018;32(2)doi:10.1002/jcla.22244
  • Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. May 17 2005;45(10):1638-43. doi:10.1016/j.jacc.2005.02.054
  • Haybar H, Pezeshki SMS, Saki N. Evaluation of complete blood count parameters in cardiovascular diseases: An early indicator of prognosis? Exp Mol Pathol. Oct 2019;110:104267. doi:10.1016/j.yexmp.2019.104267
  • Madai VI, Galinovic I, Grittner U, et al. DWI intensity values predict FLAIR lesions in acute ischemic stroke. PLoS One. 2014;9(3):e92295. doi:10.1371/journal.pone.0092295
  • Branco JP, Costa JS, Sargento-Freitas J, et al. [Neuroimaging and Blood Biomarkers in Functional Prognosis after Stroke]. Acta Med Port. Nov 2016;29(11):749-754. Neuroimagem e Biomarcadores no Prognóstico Funcional de Doentes com Acidente Vascular Cerebral. doi:10.20344/amp.7411
  • Whiteley W, Chong WL, Sengupta A, Sandercock P. Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke. May 2009;40(5):e380-9. doi:10.1161/strokeaha.108.528752
  • Adiguzel A, Arsava EM, Topcuoglu MA. Temporal course of peripheral inflammation markers and indexes following acute ischemic stroke: prediction of mortality, functional outcome, and stroke-associated pneumonia. Neurol Res. Mar 2022;44(3):224-231. doi:10.1080/01616412.2021.1975222
  • Wang J, Ma L, Lin T, Li SJ, Chen LL, Wang DZ. The significance of eosinophils in predicting the severity of acute ischemic stroke. Oncotarget. Nov 28 2017;8(61):104238-104246. doi:10.18632/oncotarget.22199
  • Bellwald S, Balasubramaniam R, Nagler M, et al. Association of anemia and hemoglobin decrease during acute stroke treatment with infarct growth and clinical outcome. PLoS One. 2018;13(9):e0203535. doi:10.1371/journal.pone.0203535
  • Nybo M, Kristensen SR, Mickley H, Jensen JK. The influence of anaemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide. European journal of neurology. May 2007;14(5):477-82. doi:10.1111/j.1468-1331.2006.01591.x
  • Zhang R, Xu Q, Wang A, et al. Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack. J Am Heart Assoc. Dec 7 2021;10(23):e022547. doi:10.1161/jaha.121.022547
  • Koca AN, Acehan S, Satar S, et al. Which one predicts mortality better in acute ischemic stroke: negative vs positive acute-phase reactants. Neurological Research. 2024:1-9.
  • Icme F, Doğan Nö, Yüzbaşioğlu Y, Sarikaya P, Ay Mo, Gülen M. Prognostic Relationship Between Complete Blood Count Parameters and Transient Ischemic Attack, Ischemic Stroke and Hemorrhagic Stroke. Turkish Journal of Geriatrics/Türk Geriatri Dergisi. 2014;17(1)
  • Guldiken B, Ozkan H, Kabayel L. Mean platelet volume and peripheral blood count response in acute ischemic stroke. Trakya Universitesi Tip Fakultesi Dergisi. 2008;25(2):130-135.
  • Wang D, Zhang FH, Zhao YT, et al. Association of polymorphism in ICAM-1 (K469E) and cytology parameters in patients' initial blood test with acute ischemic stroke. Genet Mol Res. Dec 2 2015;14(4):15520-9. doi:10.4238/2015.December.1.2
  • Hatamian H, Saberi A, Pourghasem M. The relationship between stroke mortality and red blood cell parameters. Iran J Neurol. Oct 6 2014;13(4):237-40.
  • Bang OY, Saver JL, Liebeskind DS, et al. Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis. Neurology. Mar 6 2007;68(10):737-42. doi:10.1212/01.wnl.0000252799.64165.d5
  • Olsen TS, Christensen RH, Kammersgaard LP, Andersen KK. Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study. Stroke. Oct 2007;38(10):2646-51. doi:10.1161/strokeaha.107.490292
  • Koton S, Molshatzki N, Bornstein NM, Tanne D. Low cholesterol, statins and outcomes in patients with first-ever acute ischemic stroke. Cerebrovasc Dis. 2012;34(3):213-20. doi:10.1159/000342302
  • Vauthey C, de Freitas GR, van Melle G, Devuyst G, Bogousslavsky J. Better outcome after stroke with higher serum cholesterol levels. Neurology. May 23 2000;54(10):1944-9. doi:10.1212/wnl.54.10.1944
  • Yücel K, Eren F. İskemik ve Hemorajik İnme Hastalarında Kan Lipid Parametrelerinin Karşılaştırılması ve Mortalite ile İlişkisi. Comparison of Blood Lipid Parameters in Patients with Ischemic and Hemorrhagic Stroke and Its Relationship with Mortality. Sakarya Tıp Dergisi. June 2021;11(2):400-408. doi:10.31832/smj.849225
  • Hindy G, Engström G, Larsson SC, et al. Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes: A Mendelian Randomization Study. Stroke. Apr 2018;49(4):820-827. doi:10.1161/strokeaha.117.019653
  • Glasser SP, Mosher A, Howard G, Banach M. What is the association of lipid levels and incident stroke? Int J Cardiol. Oct 1 2016;220:890-4. doi:10.1016/j.ijcard.2016.06.091
  • Han Y, Huang Z, Zhou J, et al. Association between triglyceride-to-high density lipoprotein cholesterol ratio and three-month outcome in patients with acute ischemic stroke: a second analysis based on a prospective cohort study. BMC Neurol. Jul 16 2022;22(1):263. doi:10.1186/s12883-022-02791-2
There are 27 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Article
Authors

Gönül Akdağ 0000-0002-0486-6026

Emine Saygın Uysal 0009-0009-9979-355X

Mustafa Çetiner 0000-0002-4420-6452

Muhammed Alperen Bardakçı 0000-0001-9169-7429

Niyazi Uysal 0000-0003-0094-6480

Merve Yatmazoğlu Çetin 0009-0002-3329-6082

Dursun Ceylan 0000-0001-5110-1248

Fatma Akkoyun Arıkan 0000-0002-3543-6213

Sibel Canbaz Kabay 0000-0003-4808-2191

Early Pub Date December 18, 2024
Publication Date
Submission Date August 7, 2024
Acceptance Date October 7, 2024
Published in Issue Year 2024 Volume: 14 Issue: 4

Cite

AMA Akdağ G, Saygın Uysal E, Çetiner M, Bardakçı MA, Uysal N, Yatmazoğlu Çetin M, Ceylan D, Akkoyun Arıkan F, Canbaz Kabay S. The Relationship of Hematologic Parameters and Lipid Profile with Acute Ischemic Stroke. Sakarya Tıp Dergisi. December 2024;14(4):334-343. doi:10.31832/smj.1529153

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