Non-kardiyak iskemik inmeli hastalarda prognoz ile troponin ilişkisi

Öz

Amaç: İnme prognozunun tahmin edilebilmesi için inme şiddet ölçekleri, iskemi hacmi ve bazı biyo-belirteçler kullanılmıştır.

Ulusal Sağlık İnme Skalasının (NIHSS) inme prognozu ile ilişkili olduğu bildirilmiştir. İskemi hacmi ve prognoz arasında farklı

yorumlar vardır. Uzun dönem prognoz ile ilişkisi olmadığı bildirilmiştir. Ayrıca miyokard infarktüsü tanısı için çok önemli bir

yeri olan troponinin iskemi prognozu ile ilişkili olabileceği bildirilmiştir. Çalışmamızda yaklaşık 5 yıllık takibi yapılan nonkardiyak

iskemik inmeli olgularda inme şiddeti ölçeği, iskemi hacmi ve troponin I seviyelerinin sağ kalım ile ilişkisini

incelemeyi amaçladık.

Materyal ve Metod: Ocak 2012-Mart 2013 tarihleri arasında nöroloji kliniğinde non-kardiyak iskemik inme tanısı alan 18

yaşından büyük hastaların dosyaları retrospektif olarak incelendi. TC. Sağlık Bakanlığı Halk Sağlığı Müdürlüğü Ölüm Bildirim

Sistemi (https://obs.gov.tr/) üzerinden sağ kalımı değerlendirildi. NIHS sklası, inme hacmi, troponin I seviyeleri ölen ve sağ

hasta grupları arasında incelendi ve 5 yıllık sağ kalım ile ilişkileri değerlendirildi.

Bulgular: İleri yaş, erkek cinsiyet, NIHS skalası değerleri 5 yıllık sağ kalım ile ilişkiliydi. İskemi hacmi ve Troponin I 5 yıllık

sağ kalım ile ilişkili değildi.

Tartışma: Literatürde iskemik inme prognozunu yansıtabileceği bildirilen troponin düzeylerinin, non-kardiyak inmeli

hastalarda uzun dönem prognoz tahmini için kullanılamayacağını tespit ettik. Ayrıca benzer sonuç iskemi hacmi içinde

geçerlidir. Bunun yanında ileri hasta yaşının ve geliş NIHS skorlarının uzun dönem prognozu belirlemede etkin olduğunu

tespit ettik.

Anahtar Kelimeler

• Serebral Infarkt,Prognoz,Troponin I

Prognosis and troponin relationship in non-cardiac ischemic stroke patients

Öz

Background: Various markers such as severity scales, infarct volume and biomarkers were used to predict the stroke

prognosis. National Institute of Health Stroke Scale (NIHSS) was reported to be associated with stroke prognosis whereas

conflicting statements were present regarding the association of infarct volume. Volume is thought to be unrelated with long

term prognosis. Furthermore, troponin which is an important biomarker for myocardial infarction is suggested to be related

with stroke prognosis. In this study, we aim to investigate the relationship between factors such as NIHS scale, infarct

volume, troponin I and 5 year survival of patients with non-cardiac stroke.

Material and Methods: Between January2012 and March 2013, files of patients over 18 years of age with non-cardiac

stroke were investigated retrospectively. Death reporting system as a web service given by National Health Ministry

(https://obs.gov.tr/) was used to determine the survival status. Data regarding the NIHS score, infarct volume and troponin I

levels were acquired. Relationship of those factors with 5-year survival was evaluated statistically.

Results: Old age, male gender and NIHS score were independently associated with 5-year survival whereas there was no

association between troponin I and infarct volume.

Conclusions: We found that troponin I which was reported as it might be associated with long term survival in patients with

non-cardiac stroke could not predict 5-year survival. Results were also same for infarct volume. Furthermore, we found that

old age and NIHS score can be used to predict the 5-year survival.

Anahtar Kelimeler

• Cerebral infarction,Prognosis,Troponin I

Kaynakça

1. 1- Bender M, Jusufovic E, Railic V, Kelava S, Tinjak S, Dzevdetbegovic D, et. al., High Burden of Stroke Risk Factors in Developing Country: the Case Study of Bosnia-Herzegovina. Mater Sociomed. 2017 Dec;29(4):277-279.
2. 2- Sajobi TT, Menon BK, Wang M, Lawal O, Shuaib A, Williams D, et al., Early Trajectory of Stroke Severity Predicts Long-Term Functional Outcomes in Ischemic Stroke Subjects: Results From the ESCAPE Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Stroke. 2017 Jan;48(1):105-110.
3. 3- Wang J, Yu XD, Li GQ. Comparative study on short-term and long-term prognostic determinants in patients with acute cerebral infarction. Int J Clin Exp Med. 2015 Jun 15;8(6):9855-61.4- Su YC, Huang KF, Yang FY, Lin SK. Elevation of troponin I in acute ischemic stroke. Peer J. 2016 Apr 11;4:1866.
4. 5- Cui YX, Ren H, Lee CY, Li SF, Song JX, Gao XG, et al., Characteristics of elevated cardiac troponin I in patients with acute ischemic stroke. J Geriatr Cardiol. 2017 Jun;14(6):401-406.
5. 6- Ahn SH, Lee JS, Kim YH, Kim BJ, Kim YJ, Kang DW, et al., Prognostic Significance of Troponin Elevation for Long-Term Mortality after Ischemic Stroke. J Stroke. 2017 Sep;19(3):312-322.
6. 7- Barber M, Morton JJ, Macfarlane PW, Barlow N, Roditi G, Stott DJ. Elevated troponin levels are associated with sympathoadrenal activation in acute ischaemic stroke. Cerebrovasc Dis. 2007;23(4):260-6.
7. 8- Van Houten J, Fricker G, Collins B, Bhatia R, Ellis C, Schrag M. Circulating Troponin I Level in Patients with Acute Ischemic Stroke. Curr Neurol Neurosci Rep. 2018 Apr 20;18(6):32.
8. 9- D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T.B. Ferguson, K. Flegal, et al., Heart disease and stroke statistics: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Circulation. 119(2009);480-486.

9. 10- T. Brott, J.R. Marler, C.P. Olinger, H.P. Adams Jr., T. Tomsick, W.G. Barsan, et al., Measurements of acute cerebral infarction: lesion size by computed tomography, Stroke. 20(1989);871-875.
10. 11- J.S. Leinonen, J.P. Ahonen, K. Lonnrot, M. Jehkonen, P. Dastidar, G. Molnar, et al., Low plasma antioxidant activity is associated with high lesion volume and neurological impairment in stroke, Stroke. 31(2000);33-39.
11. 12- Ceylan M, Yalcin A, Bayraktutan OF, Atis O, Acar E. Serum pentraxin-3 levels in acutestroke: No association with stroke prognosis. Atherosclerosis. 2015 Dec;243(2):616-20.
12. 13- Katz BS, McMullan JT, Sucharew H, Adeoye O, Broderick JP. Design and validation of a prehospital scale to predict stroke severity: Cincinnati Prehospital Stroke Severity Scale. Stroke. 2015 Jun; 46(6):1508-12.
13. 14- Mar J, Masjuan J, Oliva-Moreno J, Gonzalez-Rojas N, Becerra V, Casado MÁ, et al. Outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain. Health Qual Life Outcomes. 2015 Mar 17;13:36.
14. 15- Luvizutto GJ, Gabriel MG, Braga GP, Fernandes TD, Resende LA, Pontes Neto OM, et al., Aspects correlates with Scandinavian Stroke Scale for predicting early neurological impairment. Arq Neuropsiquiatr. 2015 May;73(5):450-3.
15. 16- Wei W, Li S, San F, Zhang S, Shen Q, Guo J, et al., Retrospective analysis of prognosis and risk factors of patients with stroke by TOAST. Medicine (Baltimore). 2018 Apr;97(15): 0412.
16. 17- Palm F, Urbanek C, Wolf J, Buggle F, Kleemann T, Hennerici MG, et al., Etiology, risk factors and sex differences in ischemic stroke in the Ludwigshafen Stroke Study, a population-based stroke registry. Cerebrovasc Dis. 2012;33(1):69-75.
17. 18- D. Schlegel, S.J. Kolb, J.M. Luciano, J.M. Tovar, B.L. Cucchiara, D.S. Liebeskind, et al.,Utility of the NIH StrokeScale as a predictor of hospital disposition, Stroke. 34 (2003);134-137.
18. 19- T. Rundek, H. Mast, A. Hartmann, B. Boden-Albala, L. Lennihan, I.F. Lin, et al., Predictors of resource use after acute hospitalization: the Northern Manhattan stroke study. Neurology. 55(2000); 1180-1187.
19. 20- Hsu CY, Hu GC, Chen YM, Chen CH, Hu YN. Predictors of short- and long-term mortality in first-ever ischaemic older stroke patients. Australas J Ageing. 2013 Dec;32(4):229-32.
20. 21- Nam KW, Kwon HM, Park SW, Lim JS, Han MK, Lee YS. Distal hyperintense vessel sign is associated with neurological deterioration in acute ischaemic stroke. Eur J Neurol. 2017 Apr;24(4):617-623.
21. 22- K.B. Slot, E. Berge, P. Dorman, S. Lewis, M. Dennis, P. Sandercock, et al.,Impact of functional status at six months on long term survival in patients with ischaemic stroke: prospective cohort studies. BMJ. 336(2008);376-379.
22. 23- Cheng YY, Shu JH, Hsu HC, Liang Y, Chang ST, Kao CL, et al., TheImpact of Rehabilitation Frequencies in the First Year after Stroke on the Risk of Recurrent Stroke and Mortality. J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2755-2762.
23. 24- Thålin C, Rudberg AS, Johansson F, Jonsson F, Laska AC, Nygren AT, et al., Elevated Troponin Levels in Acute Stroke Patients Predict Long-term Mortality. J Stroke Cerebrovasc Dis. 2015 Oct;24(10):2390-6.
24. 25- Peddada K., Cruz-flores S., Goldstein L.B. Ischemic stroke with troponin elevation: patient characteristics, resource utilization, and in hospital outcomes. Cerebrovasc Dis. 2016;42(3–4):213–223.