ROLE OF HAEMATOLOGICAL PARAMETERS AND C-REACTIVE PROTEIN IN DISCRIMINATION OF ISCHEMIC AND HEMORRHAGIC STROKE

Öz

Objective: Stroke is the third most common cause of death after cardiovascular diseases and cancers. We investigated whether CRP and complete blood count parameters had a role for early differentiation of ischemic and hemorrhagic stroke. Material and Method: We performed a retrospective study by using archive records. Patients diagnosed with ischemic or hemorrhagic stroke between November 5, 2015 and November 5, 2017 were included in the study. Demographic data, main symptoms and signs, computerized tomography and magnetic resonance imaging results of included patients were obtained. Platelet count, mean platelet volume, hemoglobin concentration, mean corpuscular volume, white blood cell count and C - reactive protein results of the patients were noted. Results: Of 100 patients entering the study, 68 (%68) had ischemic stroke. The remaining 32 (%32) patients were diagnosed with hemorrhagic stroke. The mean age was 75.35 ± 1.7 for women and 71.06 ± 1.9 for men. Mean platelet volume (p= 0.009) and white blood cell count (p= 0.006) were higher and statistically significant in the patients with hemorrhagic stroke compared to those with ischemic stroke. Conclusion: Even though mean platelet volume and white blood cell count seemed to be higher in hemorrhagic stroke, further studies are needed for more informative results.

Anahtar Kelimeler

• STROKE
• MPV
• WBC

HEMORAJİK İNME - İSKEMİK İNME AYIRICI TANISINDA HEMATOLOJİK PARAMETRELERİN VE CRP’NİN YERİ

Öz

Amaç: İnme, kardiyovasküler hastalıklar ve kanserlerden sonra üçüncü en yaygın ölüm nedenidir. CRP ve tam kan sayımı parametrelerinin iskemik ve hemorajik inmenin erken ayrımında rolü olup olmadığını araştırdık. Materyal ve Metod: Arşiv kayıtlarını kullanarak retrospektif bir çalışma yaptık. 5 Kasım 2015 ile 5 Kasım 2017 tarihleri arasında iskemik veya hemorajik inme tanısı alan hastalar çalışmaya dahil edilmiştir. Dahil edilen hastaların demografik verileri, temel semptom ve bulguları, bilgisayarlı tomografi ve manyetik rezonans görüntüleme sonuçları elde edildi. Hastaların trombosit sayısı, ortalama trombosit hacmi, hemoglobin konsantrasyonu, ortalama korpüsküler hacmi, beyaz küre sayısı ve C - reaktif protein sonuçları kayıt altına alınmıştır. Bulgular: Çalışmaya dahil edilen 100 hastanın 68'inde (% 68) iskemik inme vardı. Kalan 32 (% 32) hastaya hemorajik inme tanısı kondu. Kadınlarda ortalama yaş 75.35 ± 1.7, erkeklerde 71.06 ± 1.9 idi. Hemorajik inmeli hastalarda iskemik inmeli hastalara göre ortalama trombosit hacmi (p = 0,009) ve beyaz küre sayısı (p = 0,006) daha yüksekti ve istatistiksel olarak anlamlı çıkmıştır. Sonuç: Ortalama trombosit hacmi ve beyaz kan hücresi sayısı hemorajik inmede daha yüksek görünse de, daha bilgilendirici sonuçlar için daha ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• iNME
• MPV
• WBC

Kaynakça

1. 1. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013;44(7):2064‐2089.
2. 2. Yew KS, Cheng EM. Diagnosis of acute stroke. Am Fam Physician, 2015 Apr 15;91(8):528-36.
3. 3. Nelson AM, Mase CA, Ma OJ. Spontaneous Subarachnoid and Intracerebral Hemorrhage. In:Tintinalli JE (eds). Tintinalli’s Emergency Medicine. A Comprehensive Study Guide. McGrawHill. NY:2020:9thed.p.114-6.
4. 4. Owolabi M, Olowoyo P, Popoola F, et al. The epidemiology of stroke in Africa: A systematic review of existing methods and new approaches. J Clin Hypertens (Greenwich). 2018;20(1):47‐55.
5. 5. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2011;42(2):517-84.
6. 6. Kutluk K. İskemik İnme. İstanbul: Nobel Tıp Kitapevi; 2004;1-4.
7. 7. Jauch EC et al. Guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2013; 44(3): p. 870-947.
8. 8. Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin Proc. 2005;80(7):923‐936.

9. 9. Mazaheri S, Reisi E, Poorolajal J, Ghiasian M. C-Reactive Protein Levels and Clinical Outcomes in Stroke Patients: A Prospective Cohort Study. Arch Iran Med. 2018;21(1):8‐12.
10. 10. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: alink between thrombosis and inflammation? Curr Pharm Des 2011;17(1):47-58.
11. 11. Ha SI, Choi DH, Ki YJ, Yang JS, Park G, Chung JW, Koh YY, Chang KS, Hong SP. Stroke prediction using mean platelet volume in patients with atrial fibrillation. Platelets, 2011;22(6):408-14.
12. 12. Farah R, Samra N. Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke. J Clin Lab Anal. 2018;32(1):e22189
13. 13. Morotti A, Phuah CL, Anderson CD, Jessel MJ, Schwab K, Ayres AM, Pezzini A,Padovani A, Gurol ME, Viswanathan A, Greenberg SM, Goldstein JN, Rosand J. Leukocyte Count and Intracerebral Hemorrhage Expansion. Stroke, 2016 Jun;47(6):1473-8.
14. 14. Elkind MS, Cheng J, Rundek T, Boden-Albala B, Sacco RL. Leukocyte count predicts outcome after ischemic stroke: the Northern Manhattan Stroke Study. J Stroke Cerebrovasc Dis. 2004;13(5):220‐227.
15. 15. Barlas RS, Honney K, Loke YK, et al. Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta-Analysis. J Am Heart Assoc. 2016;5(8):e003019.
16. 16. Tanne D, Molshatzki N, Merzeliak O, Tsabari R, Toashi M, Schwammenthal Y. Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study. BMC Neurol. 2010;10:22.
17. 17. Fateh-Moghadam S, Htun P, Tomandl B, Sander D, Stellos K, Geisler T, Langer H,Walton K, Handschu R, Garlichs C, Daniel WG, Gawaz M. Hyperresponsiveness of platelets in ischemic stroke. Thromb Haemost 2007;97(6):974-8.
18. 18. Ziai WC, Torbey MT, Kickler TS, Oh S, Bhardwaj A, Wityk RJ. Platelet count and function in spontaneous intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2003;12(4):201‐206.
19. 19. Mayda-Domaç F, Misirli H, Yilmaz M. Prognostic role of mean platelet volume and platelet count in ischemic and hemorrhagic stroke. J Stroke Cerebrovasc Dis. 2010;19(1):66‐72
20. 20. Hatamian H, Saberi A, Pourghasem M. The relationship between stroke mortality and red blood cell parameters. Iran J Neurol. 2014;13(4):237‐240
21. 21. Söderholm M, Borné Y, Hedblad B, Persson M, Engström G. Red cell distribution width in relation to incidence of stroke and carotid atherosclerosis: a population-based cohort study. PLoS One. 2015;10(5):e0124957.
22. 22. Huang Y, Jing J, Zhao XQ, et al. High-sensitivity C-reactive protein is a strong risk factor for death after acute ischemic stroke among Chinese. CNS Neurosci Ther. 2012;18(3):261‐266.
23. 23. Di Napoli M, Godoy DA, Campi V, et al. C-reactive protein level measurement improves mortality prediction when added to the spontaneous intracerebral hemorrhage score. Stroke 2011;42(5):1230‐1236.
24. 24. Emerging Risk Factors Collaboration, Kaptoge S, Di Angelantonio E, et al. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet 2010;375(9709):132‐140.