| Abstract | Acute ischemic stroke is the most common cerebrovascular disease characterized by high morbidity in the elderly population and with high overall mortality. In addition, acute ischemic stroke is the leading cause of disability, which represents a significant socioeconomic burden for society. The cerebrovascular pathological process leaves a characteristic biochemical imprint that comprehends a prognostic significance. The aim of this study is to examine whether concentrations of resistin, copeptin, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glucose and urate correlate with the degree of the neurological deficit and the cerebral ischemic lesion volume; to determine whether these metabolic parameters consider a prognostic significance for the short-term functional outcome; to investigate whether there is a correlation of mortality observed within 90 days of the onset of the disease.
The study included 112 patients admitted to the Department of Neurology of the General Hospital of Zadar within 24 hours after stroke onset. For all patients, demographic data (age, gender) and information about vascular risk factors (diabetes mellitus, hypertension, and personal history of TIA or previous stroke) were collected. A control group of 63 participants who matched to the patients by age and gender was recruited. Diagnosis of stroke was confirmed by an experienced neurologist based on the degree of the neurological deficit which was evaluated using a modified NIHSS (National Institute of Health Stroke Scale). The volume of ischemic lesions was determined using CT (computerized tomography) imaging and measured as the volumetric estimation by a neuroradiologist. Barthel index was used to define the short-term stroke outcome. The biochemical parameters were determined on the automated biochemical analyzer and the neutrophil count was determined on the haematological analyzer. Resistin and copeptin concentrations were determined by the enzyme-immunochemical method.
For the study of differences between corresponding data, the Friedman test was used. Mann-Whitney and Kruskal-Wallis test were used to test the differences between the two or more groups. Kaplan-Meier analysis was employed to determine the probability of survival. Independent predictors were determined using logistic regression analysis, and the Spearman test was used for correlation analysis. Statistical analysis was conducted using MedCalc statistical software.
Resistin concentrations in the patient group were higher than in control group (P = 0,024), unlike it, was for copeptin (P = 0,863). Copeptin revealed prognostic significance for a poor short-term functional outcome (P = 0,033). The negative correlations of copeptin with glucose at admission (ρ = -0,27; P = 0,004), and resistin with survival (ρ = -0,30; P = 0,004) were determined. The size of the neurological deficit determined by the mNIHSS scale (P = 0,001) and the volume of ischemic injury (P = 0,042), were shown as independent predictors for a poor functional outcome. In the group of patients with severe stroke, lower values for the HDL-cholesterol at 48 hours (P = 0,050), Barthel index (P = 0,001) and survival (P < 0,001) were determined. In the identical group, the CRP at admission and 24 hours (P = 0,005; P = 0,042; respectively), neutrophil count (P = 0,001) and stroke volume (P = 0,001) showed higher values. Concentration of resistin, triglycerides, urates, CRPs, neutrophils, mNIHSS above a certain value, and total and HDL-cholesterol below a certain value were associated with more significant mortality within 90 days. Total cholesterol values measured at 24 hours (P = 0,023), LDL-cholesterol at admission, at 24 hours and at discharge (P = 0,043; P = 0,020; P = 0,049; respectively), neutrophil count (P = 0,009), Barthel index (P = 0,050), mNIHSS (P < 0,001) and survival (P = 0,001) differed significantly between the subgroups separated by the size of the ischemic lesion.
Statistically lower values of HDL-cholesterol, Barthel index and survival, and higher CRP values, neutrophil count and ischemic injury volume were determined in a group of patients with a severe neurological deficit. The certain parameters differed significantly between subgroups separated by the volume of ischemic injury. Higher values of the total and LDL-cholesterol, neutrophil count and mNIHSS scale, and lower levels of Barthel index and survival rates were found in a group of patients with higher stroke volume. Higher copeptin concentrations, more severe neurological deficits and ischemic injury volume are independent predictors for the short-term functional outcome. Increased resistin concentrations showed a discrimination ability between patients with acute ischemic stroke and control group. Higher resistin concentrations have indicated a significant association with shorter survival. Furthermore, more elevated levels of triglyceride, urates, CRP, neutrophil count and mNIHSS score, and lower total and HDL cholesterol levels, were associated with increased mortality within 90 days of disease. |
| Abstract (english) | Acute ischemic stroke is the most common cerebrovascular disease characterized by high morbidity in the elderly population and with high overall mortality. In addition, acute ischemic stroke is the leading cause of disability, which represents a significant socioeconomic burden for society. The cerebrovascular pathological process leaves a characteristic biochemical imprint that comprehends a prognostic significance. The aim of this study is to examine whether concentrations of resistin, copeptin, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glucose and urate correlate with the degree of the neurological deficit and the cerebral ischemic lesion volume; to determine whether these metabolic parameters consider a prognostic significance for the short-term functional outcome; to investigate whether there is a correlation of mortality observed within 90 days of the onset of the disease.
The study included 112 patients admitted to the Department of Neurology of the General Hospital of Zadar within 24 hours after stroke onset. For all patients, demographic data (age, gender) and information about vascular risk factors (diabetes mellitus, hypertension, and personal history of TIA or previous stroke) were collected. A control group of 63 participants who matched to the patients by age and gender was recruited. Diagnosis of stroke was confirmed by an experienced neurologist based on the degree of the neurological deficit which was evaluated using a modified NIHSS (National Institute of Health Stroke Scale). The volume of ischemic lesions was determined using CT (computerized tomography) imaging and measured as the volumetric estimation by a neuroradiologist. Barthel index was used to define the short-term stroke outcome. The biochemical parameters were determined on the automated biochemical analyzer and the neutrophil count was determined on the haematological analyzer. Resistin and copeptin concentrations were determined by the enzyme-immunochemical method.
For the study of differences between corresponding data, the Friedman test was used. Mann-Whitney and Kruskal-Wallis test were used to test the differences between the two or more groups. Kaplan-Meier analysis was employed to determine the probability of survival. Independent predictors were determined using logistic regression analysis, and the Spearman test was used for correlation analysis. Statistical analysis was conducted using MedCalc statistical software.
Resistin concentrations in the patient group were higher than in control group (P = 0,024), unlike it, was for copeptin (P = 0,863). Copeptin revealed prognostic significance for a poor short-term functional outcome (P = 0,033). The negative correlations of copeptin with glucose at admission (ρ = -0,27; P = 0,004), and resistin with survival (ρ = -0,30; P = 0,004) were determined. The size of the neurological deficit determined by the mNIHSS scale (P = 0,001) and the volume of ischemic injury (P = 0,042), were shown as independent predictors for a poor functional outcome. In the group of patients with severe stroke, lower values for the HDL-cholesterol at 48 hours (P = 0,050), Barthel index (P = 0,001) and survival (P < 0,001) were determined. In the identical group, the CRP at admission and 24 hours (P = 0,005; P = 0,042; respectively), neutrophil count (P = 0,001) and stroke volume (P = 0,001) showed higher values. Concentration of resistin, triglycerides, urates, CRPs, neutrophils, mNIHSS above a certain value, and total and HDL-cholesterol below a certain value were associated with more significant mortality within 90 days. Total cholesterol values measured at 24 hours (P = 0,023), LDL-cholesterol at admission, at 24 hours and at discharge (P = 0,043; P = 0,020; P = 0,049; respectively), neutrophil count (P = 0,009), Barthel index (P = 0,050), mNIHSS (P < 0,001) and survival (P = 0,001) differed significantly between the subgroups separated by the size of the ischemic lesion.
Statistically lower values of HDL-cholesterol, Barthel index and survival, and higher CRP values, neutrophil count and ischemic injury volume were determined in a group of patients with a severe neurological deficit. The certain parameters differed significantly between subgroups separated by the volume of ischemic injury. Higher values of the total and LDL-cholesterol, neutrophil count and mNIHSS scale, and lower levels of Barthel index and survival rates were found in a group of patients with higher stroke volume. Higher copeptin concentrations, more severe neurological deficits and ischemic injury volume are independent predictors for the short-term functional outcome. Increased resistin concentrations showed a discrimination ability between patients with acute ischemic stroke and control group. Higher resistin concentrations have indicated a significant association with shorter survival. Furthermore, more elevated levels of triglyceride, urates, CRP, neutrophil count and mNIHSS score, and lower total and HDL cholesterol levels, were associated with increased mortality within 90 days of disease. |
