Retrospective Evaluation of Patients Admitted to the Emergency Department with Acute Ischemic Stroke; Analysis of 50 Cases
Abstract
Aim: The aim of this study is to contribute to the literature by investigating the relationship of the data obtained from the patients presented to our emergency service with acute ischemic stroke with the prognosis of patients. Materials and methods: The study was conducted over the files of all patients applied to emergency service and obtained acute ischemic stroke (AIS) diagnosis between 01.01.2019-31.12.2019. All patients over 18 with accessible data and diagnosed with AIS were included in the study. Patients without of AIS type, and younger than 18, or without accessible data were excluded. Results: A total of 50 patients were included in the study. The average age of the patients was 69.74±11.72. Among the patients, 20 (40%) were female. The analysis of application complaints of the cases revealed that 30 (60%) patients had loss of power in extremities. The leading medical history of patients were smoking 35 (70%) and hypertension 34 (68%). The laboratory results of the cases revealed the CRP as 22.11±37.45 mg/L and neutrophil lymphocyte ratio (NLR) as 3.05±1.93. According to Modified Rankin Scale (MRS), 30 (60%) of the cases had a score equal and lower than 2, and 20 (40%) of them had a score of 3 or higher. NLR was statistical significance at differentiating between dependent and independent patients groups according to MRS. Conclusion: Although there are studies suggesting the use of NLR as a prognosis marker in AIS, for the generalization of these data they should be supported with many further randomized and controlled studies.
Keywords
acute ischemic stroke Emergency department modified rankin score neutrophil-lymphocyte ratio prognosis
References
- 1. h t t p s : / / d a t a . t u i k . g o v . t r / B u l t e n / I n d e x -?p=Olum-ve-Olum-Nedeni-Istatistikleri-2019-33710
- 2. National Institute of Neurological Disorders and Stroke, National Institute of Health. NINDS: Stroke Proceedings: Executive Summary. Proceedings of a National Symposium on Rapid Rapid İdentification and Treatment of Acute Stroke Bethesda, MD; 2011
- 3. Sacco PL. Vascular diseases. In: Merrit, Rowland LP, editors. Merrit’s neurology. 10th ed. Hagerstown: Williams&Wilkins; 2000. p. 177-85
- 4. Kıyan S, Özsaraç M, Ersel M, et al. Retrospective Analysis of 124 Acute Ischemic stroke patients who attended to the emergency department in one year period. Akademik Acil Tıp Dergisi 2009;8:15–20
- 5. Oğuzhan Ç. Definitions, classification, epidemiology and risk factors in brain vascular diseases. In: Ö g e AE, editör. Nöroloji. İstanbul: Nobel Tıp Kitapevleri; 2004. s. 193-4.
- 6. Reganon E, Vila V, Martínez-Sales V, Vaya A, Lago A, Alonso P, et al. Association between inflammation and hemostatic markers in atherothrombotic stroke. Thromb Res 2003;112:217-21.
- 7. Yoneda Y, Okuda S, Hamada R, Toyota A, Gotoh J, Watanabe M, et al. Hospital cost of ischemic stroke and intracerebral hemorrhage in Japanese stroke centers. Health Policy 2005;73:202-11.
- 8. Williams LS, Bruno A, Rouch D, Marriott DJ. Stroke patients’ knowledge of stroke. Influence on time to presentation. Stroke 1997;28:912-5.
- 9. Hakbilir O, Çete Y, Göksu E, Akyol C, Kılıçaslan İ. Characteristics of patients who present to the emergency department with sroke and the impact of delayed presentation on therapeutic management strategies. Turk J Emerg Med 2006;6(3):132-138
- 10. Gürger M, Bozdemir MN, Yıldız M, Gürger M, Özden,M, Bozgey Z, Dağlı MN. The value of cardiac markers in predicting the hospital mortality of ischemic stroke patients. Turk J Emerg Med 2008;8(2):59-66.
- 11. Keskin Ö, Kalemoğlu M, Deniz T. The Investigation of Factors Effecting the Management of Stroke Pations. Turk J Emerg Med 2004; 4(4):160-64.
- 12. Keskin Ö, Kalemoğlu M, Ulusoy E, Uzun H, Yıldırım İ. Clinical Investigations on the Causes of the Prehospital Delay in Acute Stroke Care. Nobel Medicus Online Dergi. http://www. nobelmedicus.com/contents/200511/14-17.htm
- 13. Ghandehari K, Izadi Z; Khorasan Stroke Registry. The Khorasan Stroke Registry: results of a five-year hospital-based study. Cerebrovasc Dis2007;23:132-9.
- 14. Rabkin SW, Mathewson AL, Tate RB. Predicting risk of ischemic heart disease and cerebrovascular disease from systolic and diastolic blood pressures. Ann Intern Med 1978;88:342-5
- 15. Lindsberg PJ, Roine RO. Hyperglycemia in acute stroke. Stroke 2004;35:363-4.
- 16. Dalal PM, Parab PV. Cerebrovascular disease in type 2 diabetes mellitus. Neurol India 2002;50:380-5.
- 17. Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, et al. A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. J Intern Med 2002;252:121-9.
- 18. Silvestrelli G, Paciaroni M, Caso V, Milia P, Palmerini F, Venti M, et al. Risk factors and stroke subtypes: results of five consecutive years of the Perugia Stroke Registry. Clin Exp Hypertens 2006;28:279-86.
- 19. Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA 1998;279:1288-92.
- 20. Du X, McNamee R, Cruickshank K. Stroke risk from multiple risk factors combined with hypertension: a primary care based case-control study in a defined population of northwest England. Ann Epidemiol 2000;10:380-8.
- 21. Chang CY, Chen JY, Ke D, Hu ML. Plasma levels of lipophilic antioxidant vitamins in acute ischemic stroke patients: correlation to inflammation markers and neurological deficits. Nutrition 2005; 21: 987-93
- 22. Palasik W, Fiszer U, Lechowicz W, Czartoryska B, Krzesiewicz M, Lugowska A. Assessment of relations between clinical outcome of ischemic stroke and activity of inflammatory processes in the acute phase based on examination of selected parameters. Eur Neurol 2005; 53: 188-93
- 23. Rost NS, Wolf PA, Kase CS, Kelly-Hayes M, Silbershatz H, Massaro JM, et al. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke. 2001; 32: 2575-9
- 24. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997; 336: 973-9
- 25. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731-3.
- 26. Aytaç E, Akpınar ÇK, Gürkaş E. Neutrophil to lymphocyte ratio: A simple and readily available independent marker of mortality in acute ischemic stroke. Firat Med J.2017;22:192-6.
- 27. Kocatürk O, Beşli F, Güngören F, Kocatürk M, Tanrıverdi Z. The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke. Neurol Sci. 2019;40:139-46.
- 28. Demir T, Akdağ D, Peköz M, Bıçakçı Ş. The effect of neutrophyl/ lymphocyte ratio and mean platelet volume on shortterm prognosis in middle cerebral artery infarctions Cukurova Med J 2020;45(4):1572-1579 DOI: 10.17826/cumj.741495
- 29. Zhang RL, Chopp M, Chen H, Garcia JH. Temporal profile of ischemic tissue damage, neutrophil response, and vascular plugging following permanent and transient (2H) middle cerebral artery occlusion in the rat. J Neurol Sci. 1994;125:3–10.
- 30. Davies CA, Loddick SA, Stroemer RP, Hunt J, Rothwell NJ. An integrated analysis of the progression of cell responses induced by permanent focal middle cerebral artery occlusion in the rat. Exp Neurol. 1998;154:199–212.
- 31. Huang J, Upadhyay UM, Tamargo RJ. Inflammation in stroke and focal cerebral ischemia. Surg Neurol. 2006;66:232–45.
Acil servise akut iskemik inme ile başvuran hastaların retrospektif değerlendirilmesi; 50 vakanın analizi
Abstract
Amaç
Bu çalışmanın amacı, acil servisimize akut iskemik inme(Aİİ) ile başvuran hastalardan elde edilen verilerin hastaların prognozu ile ilişkisini araştırarak literatüre katkıda bulunmaktır.
Gereçler ve yöntem
Çalışma 01.01.2019-31.12.2019 tarihleri arasında acil servise başvuran ve Aİİ tanısı alan tüm hastaların dosyaları üzerinden yapılmıştır. 18 yaş üzeri, verileri erişilebilir olan ve Aİİ tanısı alan tüm hastalar çalışmaya dâhil edildi. Akut iskemik tipte inmesi olmayan, 18 yaşından küçük veya verileri erişilebilir olmayan hastalar çalışma dışı bırakıldı.
Bulgular
Çalışmaya toplam 50 hasta dâhil edildi. Hastaların yaş ortalaması 69,74±11,72 idi. Hastaların 20'si (%40) kadındı. Olguların başvuru şikâyetleri incelendiğinde 30 (%60) hastada ekstremitelerde güç kaybı olduğu görüldü. Hastaların önde gelen tıbbi öyküsü sigara içme 35 (%70) ve hipertansiyon 34 (%68) idi. Olguların laboratuvar sonuçlarında CRP: 22,11±37,45 ve nötrofil/lenfosit oranı (NLR) 3,05±1,93 olarak saptandı. Modifiye Rankin Skalası'na (MRS) göre olguların 30'u (%60) 2 ve altında, 20'si (%40) 3 ve üzerinde puan aldı. NLR, MRS'ye göre bağımlı ve bağımsız hasta gruplarını ayırt etmede istatistiksel olarak anlamlıydı.
Sonuç
Aİİ'de prognoz belirteci olarak NLR kullanımını öneren çalışmalar olsa da, bu verilerin genellenmesi için daha birçok randomize ve kontrollü çalışma ile desteklenmesi gerekmektedir.
References
- 1. h t t p s : / / d a t a . t u i k . g o v . t r / B u l t e n / I n d e x -?p=Olum-ve-Olum-Nedeni-Istatistikleri-2019-33710
- 2. National Institute of Neurological Disorders and Stroke, National Institute of Health. NINDS: Stroke Proceedings: Executive Summary. Proceedings of a National Symposium on Rapid Rapid İdentification and Treatment of Acute Stroke Bethesda, MD; 2011
- 3. Sacco PL. Vascular diseases. In: Merrit, Rowland LP, editors. Merrit’s neurology. 10th ed. Hagerstown: Williams&Wilkins; 2000. p. 177-85
- 4. Kıyan S, Özsaraç M, Ersel M, et al. Retrospective Analysis of 124 Acute Ischemic stroke patients who attended to the emergency department in one year period. Akademik Acil Tıp Dergisi 2009;8:15–20
- 5. Oğuzhan Ç. Definitions, classification, epidemiology and risk factors in brain vascular diseases. In: Ö g e AE, editör. Nöroloji. İstanbul: Nobel Tıp Kitapevleri; 2004. s. 193-4.
- 6. Reganon E, Vila V, Martínez-Sales V, Vaya A, Lago A, Alonso P, et al. Association between inflammation and hemostatic markers in atherothrombotic stroke. Thromb Res 2003;112:217-21.
- 7. Yoneda Y, Okuda S, Hamada R, Toyota A, Gotoh J, Watanabe M, et al. Hospital cost of ischemic stroke and intracerebral hemorrhage in Japanese stroke centers. Health Policy 2005;73:202-11.
- 8. Williams LS, Bruno A, Rouch D, Marriott DJ. Stroke patients’ knowledge of stroke. Influence on time to presentation. Stroke 1997;28:912-5.
- 9. Hakbilir O, Çete Y, Göksu E, Akyol C, Kılıçaslan İ. Characteristics of patients who present to the emergency department with sroke and the impact of delayed presentation on therapeutic management strategies. Turk J Emerg Med 2006;6(3):132-138
- 10. Gürger M, Bozdemir MN, Yıldız M, Gürger M, Özden,M, Bozgey Z, Dağlı MN. The value of cardiac markers in predicting the hospital mortality of ischemic stroke patients. Turk J Emerg Med 2008;8(2):59-66.
- 11. Keskin Ö, Kalemoğlu M, Deniz T. The Investigation of Factors Effecting the Management of Stroke Pations. Turk J Emerg Med 2004; 4(4):160-64.
- 12. Keskin Ö, Kalemoğlu M, Ulusoy E, Uzun H, Yıldırım İ. Clinical Investigations on the Causes of the Prehospital Delay in Acute Stroke Care. Nobel Medicus Online Dergi. http://www. nobelmedicus.com/contents/200511/14-17.htm
- 13. Ghandehari K, Izadi Z; Khorasan Stroke Registry. The Khorasan Stroke Registry: results of a five-year hospital-based study. Cerebrovasc Dis2007;23:132-9.
- 14. Rabkin SW, Mathewson AL, Tate RB. Predicting risk of ischemic heart disease and cerebrovascular disease from systolic and diastolic blood pressures. Ann Intern Med 1978;88:342-5
- 15. Lindsberg PJ, Roine RO. Hyperglycemia in acute stroke. Stroke 2004;35:363-4.
- 16. Dalal PM, Parab PV. Cerebrovascular disease in type 2 diabetes mellitus. Neurol India 2002;50:380-5.
- 17. Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, et al. A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. J Intern Med 2002;252:121-9.
- 18. Silvestrelli G, Paciaroni M, Caso V, Milia P, Palmerini F, Venti M, et al. Risk factors and stroke subtypes: results of five consecutive years of the Perugia Stroke Registry. Clin Exp Hypertens 2006;28:279-86.
- 19. Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA 1998;279:1288-92.
- 20. Du X, McNamee R, Cruickshank K. Stroke risk from multiple risk factors combined with hypertension: a primary care based case-control study in a defined population of northwest England. Ann Epidemiol 2000;10:380-8.
- 21. Chang CY, Chen JY, Ke D, Hu ML. Plasma levels of lipophilic antioxidant vitamins in acute ischemic stroke patients: correlation to inflammation markers and neurological deficits. Nutrition 2005; 21: 987-93
- 22. Palasik W, Fiszer U, Lechowicz W, Czartoryska B, Krzesiewicz M, Lugowska A. Assessment of relations between clinical outcome of ischemic stroke and activity of inflammatory processes in the acute phase based on examination of selected parameters. Eur Neurol 2005; 53: 188-93
- 23. Rost NS, Wolf PA, Kase CS, Kelly-Hayes M, Silbershatz H, Massaro JM, et al. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke. 2001; 32: 2575-9
- 24. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997; 336: 973-9
- 25. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731-3.
- 26. Aytaç E, Akpınar ÇK, Gürkaş E. Neutrophil to lymphocyte ratio: A simple and readily available independent marker of mortality in acute ischemic stroke. Firat Med J.2017;22:192-6.
- 27. Kocatürk O, Beşli F, Güngören F, Kocatürk M, Tanrıverdi Z. The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke. Neurol Sci. 2019;40:139-46.
- 28. Demir T, Akdağ D, Peköz M, Bıçakçı Ş. The effect of neutrophyl/ lymphocyte ratio and mean platelet volume on shortterm prognosis in middle cerebral artery infarctions Cukurova Med J 2020;45(4):1572-1579 DOI: 10.17826/cumj.741495
- 29. Zhang RL, Chopp M, Chen H, Garcia JH. Temporal profile of ischemic tissue damage, neutrophil response, and vascular plugging following permanent and transient (2H) middle cerebral artery occlusion in the rat. J Neurol Sci. 1994;125:3–10.
- 30. Davies CA, Loddick SA, Stroemer RP, Hunt J, Rothwell NJ. An integrated analysis of the progression of cell responses induced by permanent focal middle cerebral artery occlusion in the rat. Exp Neurol. 1998;154:199–212.
- 31. Huang J, Upadhyay UM, Tamargo RJ. Inflammation in stroke and focal cerebral ischemia. Surg Neurol. 2006;66:232–45.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | August 31, 2021 |
| Submission Date | July 27, 2021 |
| Acceptance Date | September 14, 2021 |
| Published in Issue | Year 2021 Volume: 3 Issue: 2 |
Cite
Indexing and Abstracting