Evaluation of the Relationship Between Hematological Parameters and Stroke in Emergency Department

Yıl 2023, , 13 - 19, 08.03.2023

Elgin Bahçeli , Mehtap Bulut

https://doi.org/10.54996/anatolianjem.1103611

Öz

Aim: Our aim is to investigate the relationship between ischemic stroke, which is one of the leading causes of death in the world, and hematological parameters which are easily accessible, cheap and rapid tests.

Material and Methods: The study was a single-center, retrospective and patients aged 18 years and older with acute ischemic stroke and transient ischemic attack (TIA) who applied to Medipol Mega University Hospital Emergency Department were included in the study. Hematological parameters of patients were evaluated with stroke subgroups according to TOAST, clinical outcomes and duration of hospitalization. The predictive efficiency of the hematological parameters to the intensive care unit (ICU) admission status was compared using the ROC (Receiver Operating Characteristic).

Results: Of the 152, 97 (63.8%) were male and 55 (36.2%) were female. The median age of the patients was 64,38 ± 13,69. Leukocyte (WBC), neutrophil, monocyte and leukocyte to mean platelet volume ratio (WMR) values in ICU patients were statistically higher than the service patients. Mean platelet volume to platelet ratio (MPR) value was lower in the intensive care unit (ICU) than in the service patients. WBC, neutrophil, monocyte, MPR and WMR's predictive efficiencies to admission to ICU from emergency department were found statistically significant and the predictive power of WMR (AUC: 0.699 ± 0.056) was highest.

Conclusion: As a result, WBC, neutrophil, monocyte, WMR and MPR can be used to predict ICU admission in patients with transient ischemic attack and ischemic stroke.

Anahtar Kelimeler

Emergency department, hematological parameters, ischemic stroke, MPR, WMR

Acil Serviste İnme ve Hematolojik Parametreler Arasındaki İlişki İncelemesi

Öz

Amaç: Amacımız dünyada ölüm nedenleri arasında ön sıralarda yer alan iskemik inme ile kolay ulaşılabilir, ucuz ve hızlı bir test olan hematolojik parametrelerin ilişkisini araştırmaktır.

Gereç ve Yöntemler: Araştırma tek merkezli, retrospektif olup Medipol Mega Üniversitesi Hastanesi Acil Servisine başvuran 18 yaş ve üzeri akut iskemik inme ve geçici iskemik atak (GİA) tanısı alan hastalar dahil edildi. Hastaların hematolojik parametreleri ile TOAST sınıflamasına göre inme alt grupları, acil serviste klinik sonlanma durumları ve yatış süreleri değerlendirildi. Hematolojik parametrelerin yoğun bakım ünitesine (YBÜ) yatış durumunu öngörmedeki etkinlikleri ROC (Receiver Operating Characteristic) eğrisi kullanılarak karşılaştırıldı.

Bulgular: Toplam 152 hastanın 97’si (%63,8) erkek ve 55’i (%36,2) kadındı. Hastaların yaş ortalaması 64,38 ± 13,69 olarak saptandı. YBÜ’de takip edilen hastaların lökosit (WBC), nötrofil, monosit ve lökositin ortalama platelet hacmine oranı (WMR) servis hastalarına göre istatistiksel olarak yüksek bulundu. Ortalama eritrosit hacminin platelete oranı (MPR) YBÜ’de takip edilen hastalarda servis hastalarına göre daha düşük bulundu. WBC, nötrofil, monosit, ortalama eritrosit hacminin platelete oranı (MPR) ve WMR değerlerinin acil servisten yoğun bakıma yatışı öngörme başarısı istatistiksel olarak anlamlı bulunmuş olup WMR’nin öngörme gücü (AUC: 0,699 ± 0,056) en yüksek saptandı.

Sonuç: Sonuç olarak GİA ve iskemik inmeli hastalarda WBC, nötrofil, monosit, WMR ve MPR, YBÜ’ye yatışı öngörmede kullanılabilir.

Anahtar Kelimeler

Acil servis, hematolojik parametreler, iskemik inme, MPR, WMR

Kaynakça

• 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.
• Lewandowski C, Barsan W. Treatment of acute ischemic stroke. Ann Emerg Med. 2001;37(2):202-16.
• Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380: 2095-2128.
• Hankey G. The global and regional burden of stroke, Lancet 2013;1(5):e239-e240.
• Tatar M, Mollahaliloğlu S, Şahin B, et al. Turkey: Health system review. Health Systems in Transition, 2011; 13(6):1-186
• Ünal B,. Ergör G. Dinç-Horasan G, et al. Chronic diseases and risk factors survey in Turkey. Ankara, Anıl Matbaa Ltd. Şti, 2013, 69-89
• Elkind MS, Cheng J, Boden-Albala B, et al. Northern Manhattan Stroke Study. Elevated white blood cell count and carotid plaque thickness: the northern manhattan stroke study. Stroke 2001;32(4): 842-849.
• Wang Q, Tang XN, Yenari MA. The inflammatory response in stroke. J Neuroimmunol. 2007;184(1):53-68.
• Gong X, Zou X, Liu L, et al. Prognostic value of inflammatory mediators in 1-year outcome of acute ischemic stroke with middle cerebral artery stenosis. Mediat Inflamm. 2013;2013
• Santilli F, Vazzana N, Lianni R, et al. Platelet activation in obesity and metabolic syndrome. Obes Rev. 2012;13(1): 27-42.
• Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal. 2014;28(1): 27-31.
• Gokhan S, Ozhasenekler A, Mansur Durgun H, et al. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci. 2013;17(5), 653-7.
• Tokgoz S, Keskin S, Kayrak M, et al. Is neutrophil/lymphocyte ratio predict to short-term mortality in acute cerebral infarct independently from infarct volume? J Stroke Cerebrovasc. 2014;23(8), 2163-8.
• Altintas, O., Altintas, M. O., Tasal, A., et al. The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy. Neurological research, 2016;38(9), 759-765.
• Dehghani MR, Rezaei Y, Taghipour-Sani L. White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-STelevation acute coronary syndrome. Cardiol J, 2015; 22(4): 437–445.
• Çoban, O. Beyin damar hastalıklarında tanımlar, sınıflama, epidemiyoloji ve risk faktörleri. Öge AE. Nöroloji. Nobel Tıp Kitabevleri. İstanbul, 2004, 193-197.
• Dogan NO, Keles A, Aksel G, et al. Mean platelet volume as a risk stratification tool in the emergency department for evaluating patients with ischaemic stroke and TIA. J Pak Med Assoc. 2013;63(5), 581–584.
• Arikanoglu A, Yucel Y, Acar A, et al. The relationship of the mean platelet volume and C-reactive protein levels with mortality in ischemic stroke patients. Eur Rev Med Pharmacol Sci. 2013;17(13), 1774–77.
• Caso V, Paciaroni M, Agnelli G et al. Gender differences in patients with acute ischemic stroke. Womens Health (Lond Engl) 2010;6:51–7.
• Silvestrelli, G., Paciaroni, M., Caso, V., et al. Risk Factors and Stroke Subtypes: Results of Five Consecutive Years of the Perugia Stroke Registry. Clinical and Experimental Hypertension, 2006; 28(3-4), 279-286. 55
• Lim H-H, Jeong I-H, An G-D, et al. Early prediction of severity in acute ischemic stroke and transient ischemic attack using platelet parameters and neutrophil-to-lymphocyte ratio. J Clin Lab Anal. 2018;e22714.
• Elsayed AM, Mohamed GA. Mean platelet volume and mean platelet volume/platelet count ratio as a risk stratification tool in the assessment of severity of acute ischemic stroke. Alexandria Journal of Medicine, 2017; 53(1), 67–70.
• Farah R, Samra N. Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke. Journal of Clinical Laboratory Analysis, 2018;32(1), e22189.
• Akıl E, Akıl MA, Varol S, et al. Echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio are novel inflammatory predictors of cerebral ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23(9),2328‐2334.
• Osadnik T, Wasilewski J, Lekston A, et al. The platelet-to-lymphocyte ratio as a predictor of all-cause mortality in patients with coronary artery disease undergoing elective percutaneous coronary intervention and stent . implantation. J Saudi Heart Assoc. 2015;27(3),144–51.
• Temiz A, Gazi E, Güngör Ö, et al Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with STelevated myocardial infarction. Medical science monitor: international medical journal of experimental and clinical research, 2014: 20, 660-665.
• Çiçek G, Açıkgöz SK, Yayla Ç, et al. White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for STsegment elevation myocardial infarction. Cardiology journal, 2016;23(3), 225-235.
• Ren H, Liu X, Wang L, et al.. Lymphocyte-to-Monocyte Ratio: A Novel Predictor of the Prognosis of Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases, 2017;26(11), 2595–2602.
• Liberale L, Montecucco F, Bonaventura A, et al. Monocyte count at onset predicts poststroke outcomes during a 90- day follow-up. European Journal of Clinical Investigation, 2017; 47(10), 702–710.