The releationship between serum levels of gamma glutamyl transferase, mean thrombocyte volume, red blood cell distribution width, neutrophil to lymphocyte ratio with prognose and mortality in patients admitted emergency department with acute ischemic stroke

Öz

Objective: In our study, we aimed at determining the levels of Gamma Glutamyl Transferase (GGT), Mean Platelet
Volume (MPV), Red Cell Distribution Width (RDW), Neutrophile/Lymphocyte Ratio (NLR), as well as severity of
ischemic stroke and prognosis comparison, including the instructive parameters in ischemic stroke treatment, for the
patients with ischemic stroke diagnosis.
Methods: This retrospective study was carried put with 473 patients diagnosed with ischemic stroke.40 healthy
individuals that meet the requirements with respect to gender and age criteria were included in the study as the
control group. The NLR, RDW, MPV, GGT values checked when the cases applied were analyzed with regards to their
relation with mortality.
Results: The mean GGT, MPV, RDW, NLR values within the patient group were identified to be significantly high with
regards to statistical aspect, compared to the control group. GGT, MPV, RDW, NLR values in all the groups were found
to be higher than the control group in line with TOAST and OCSP classifications. Along with the increasing NIHSS and
decreasing GKS values, an increase was detected in GGT, MPV, RDW, NLR values. GGT, MPV, RDW and NLR values
were significantly higher in the patients who lost their lives compared to the surviving patients, with regards to
statistical aspect.
Conclusion: We are of opinion that the prognosis and mortality prediction can be performed in patients with ischemic
stroke, thanks to GGT, MPV, RDW, NLR values that are easy to Access and inexpensive blood parameters.

Anahtar Kelimeler

• Blood parameters
• Mortality
• Stroke

Acil Servise Başvuran İskemik İnme Hastalarında Gama Glutamil Transferaz, Ortalama Trombosit Hacmi, Nötrofil Lenfosit Oranı ve Eritrosit Dağılım Genişliği Değerlerinin Prognoz ve Mortalite ile İlişkileri

Öz

Amaç: Çalışmamızda Acil servise iskemik inme tanısı ile başvuran hastalarda, Gama Glutamil Transferaz (GGT),
Ortalama Trombosit Hacminin (MPV), Eritrosit Dağılım Genişliği (RDW), Nötrofil/Lenfosit Oranı (NLR) düzeyleri ile
iskemik inmenin klinik seyir ve prognozu karşılaştırmayı, bunun sonucunda iskemik inmenin tanı ve tedavisinde yol
gösterici olabilecek parametrelerin tespitini amaçladık.
Yöntemler: Bu retrospektif çalışma acil servise gelen ve çalışmaya alınma kriterlerine uyan, klinik ve radyolojik olarak
iskemik inme tanısı kesinleşen 473 hasta ile yapıldı. Çalışmaya cinsiyet ve yaşça uyumlu 40 sağlıklı birey kontrol
grubu olarak dahil edildi. Olguların başvuru anında bakılan NLR, RDW, MPV, GGT değerlerinin mortalite ile ilişkisi
incelendi.
Bulgular: Hasta grubunda ortalama GGT, MPV, RDW, NLR değerleri kontrol grubuna göre istatistiksel olarak anlamlı
yüksek saptandı. TOAST ve OCSP sınıflamasına göre tüm gruplarda GGT, MPV, RDW, NLR değerleri kontrol grubundan
yüksek bulundu. Artan NIHSS ve azalan GKS değerleri ile GGT, MPV, RDW, NLR değerlerinde yükselme tespit edildi.
GGT, MPV, RDW ve NLR değerleri ölen hastalarımızda sağ kalan hastalarımıza göre istatistiksel olarak anlamlı
derecede yüksekti.
Sonuç: Ulaşılması kolay ve ucuz kan parametleri olan GGT, MPV, RDW, NLR değerleri ile iskemik inme hastalarında
prognoz ve mortalite öngörüsü yapılabileceği kanaatindeyiz.

Anahtar Kelimeler

• Kan parametreleri
• Mortalite
• İnme

Kaynakça

1. 1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet.2006; 367: 1747-57.
2. 2. Onat A, Hergenc G, Can G. Prospective validation in identical Turkish cohort of two metabolic syndrome definitions for predicting cardiometabolic risk and selection of most appropriate definition. Anatol J Kardiol.2007; 7: 29-34.
3. 3. Malmgren R, Warlow C, Bamford J, Sandercock P. Geographical and secular trends in stroke incidence. Lancet, 1987; 2: 1196–201.
4. 4. Warlow CP. Epidemiology of stroke. Lancet, 1998; 352: 1–4.
5. 5. Gürbüzer N, Gözke E. Gamma Glutamyl Transferaz Levels in Patients with Acute ischemic Stroke Hindavi Publishing Corparation Volume 2014 article ID: 170626.
6. 6. Akıncı E, Doğan N.Ö. Can we use serum gamma glutamiyl transferase levels to predict early mortality in stroke? Pak J Med Sci. 2014 May-Jun; 30: 606–10. doi: 10.12669/pjms.303.4456
7. 7. Rutmann E, Brant L, Concin H, Gamma Glutamyl Transferase as a risc factor for cardiyovascüler disease Mortality Circulation 2005; 112: 2130-7.
8. 8. J. B. Whitfield, “Gamma glutamyl transferase,” Critical Reviewsin Clinical Laboratory Sciences, vol. 38, no. 4, pp. 263–355, 2001.

9. 9. Durdu T, Yılmaz F, Aslan ED, The value of mean platelet volüme in ischemic stroke patient (JPMA 63: 1468; 2013).
10. 10. Arikanoglu A, Yucel Y, Acar A, et all. 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: 1774-7.
11. 11. Tamer D, Fevzi Y, Deniz AE, et all. The value of serum mean platelet volume in ischaemic stroke patient. JPMA. 2013; 63 : 1509- 10.
12. 12. Ford HC, Toomath RJ, Carter JM, Delahunt JW, Fagerstrom JN. Mean platelet volume is increased in hyperthyroidism. Am J Hematol. 1988; 27: 190- 3.
13. 13. Arevalo-Lorido JC, Carretero-Gomez J, Alvarez-Oliva A, et all. Mean platelet volume in acute phase of ischemic stroke, as predictor of mortality andfunctional outcome after 1 year. J Stroke Cerebrovasc Dis.2013; 22: 297-303.
14. 14. Martin JF, Bath PM, Burr ML. Influence of platelet size on outcome after myocardial infarction. Lancet.1991; 338: 1409-11.
15. 15. Kara H, Degirmenci S, Bayir A, et all. Red cell distribution width and neurological scoring systems in acute stroke patients. Neuropsychiatr Dis Treat. 2015; 11: 733-9.
16. 16. Ramirez-Moreno JM, Gonzalez-Gomez M, Ollero-Ortiz A, et all. Relation between red blood cell distribution width and ischemic stroke: a case-control study. Int J Stroke. 2013; 8: E36.
17. 17. Martinez-Velilla N, Ibanez B, Cambra K, Alonso-Renedo J. Red blood cell distribution width, multimorbidity, and the risk of death in hospitalized older patients. Age.2012; 34: 717-23.
18. 18. Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci.2009; 277: 103-8.
19. 19. Tokgoz S, Keskin S, Kayrak M, Seyithanoglu A, Ogmegul A. Is neutrophil/lymphocyte ratio predict to short-term mortality in acute cerebral infarct independently from infarct volume? J Stroke Cerebrovasc. 2014; 23: 2163-8.
20. 20. Buck BH, Liebeskind DS, Saver JL, et all. Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke. 2008; 39: 355-60.
21. 21. Gibson PH, Cuthbertson BH, Croal BL, et all. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 2010; 105: 186-91.
22. 22. Gokhan S, Ozhasenekler A, Mansur Durgun H, et all. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci. 2013; 17: 653-7.