Serum inflammatory markers as predictors of neurological status in patients with stroke in the course of hypertension: a two-center study
Abstract
Introduction. Every year, 60.000 people have stroke incidents in Poland. Despite the fact that it can be prevented, stroke remains the leading cause of morbidity and mortality worldwide. Hypertension is one of the leading risk factors for the stroke incident. The aim was to assess the relationship between inflammatory markers and clinical status of hypertensive patients with the stroke.
Material and methods. 713 patients with stroke in the course of hypertension from the Departments of Neurology in Bytom and Zabrze were enrolled in the retrospective study. They were divided into groups: N1, R1 (with improvement in NIHSS and Rankin results, respectively) and N2, R2 (with deterioration or no changes in NIHSS and Rankin between the day of admission and discharge).
Results. The majority of patients were females [%] (51.5 vs 48.5). Women were significantly older than man [years] (78.0 vs 69.0, P = 0.001, respectively) and had higher NIHSS results at admission [points] (6.0 vs 5.0, P = 0.001, respectively). There were significant differences in the serum CRP [mg/l] (4.75 vs 9.40, P = 0.001) and WBC [103/μL] (8.58 vs 9.02, P = 0.006) between N1 and N2, respectively and between R1 and R2: WBC (8.50 vs 9.00, P = 0.006) and CRP (4.20 vs 8.70, P = 0.001), respectively. A significant correlation between CRP and NIHSS on admission was observed (R = 0.191, P < 0.05). NIHSS and Rankin score on admission were correlated with age (R = 0.212, and R = 0.231, P < 0.05, respectively). CRP was related with the volume [cm3] of lesions in CT (R = 0.170, P < 0.05).
Conclusions. Inflammation seems to be associated with the worse neurological status of patients with stroke and hypertension. Age and sex affect the clinical course of stroke. CRP may indicate the size of changes in CT.
Keywords: strokehypertensionNIHSSRankininflammationCRPWBC
References
- Sacco RL, Kasner SE, Broderick JP, et al. American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, Council on Nutrition, Physical Activity and Metabolism. 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.
- Sahathevan R, Brodtmann A, Donnan GA. Dementia, stroke, and vascular risk factors; a review. Int J Stroke. 2012; 7(1): 61–73.
- Yang Q, Tong X, Schieb L, et al. Vital Signs: Recent Trends in Stroke Death Rates - United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017; 66(35): 933–939.
- Marshall IJ, Wang Y, McKevitt C, et al. Trends in risk factor prevalence and management before first stroke: data from the South London Stroke Register 1995-2011. Stroke. 2013; 44(7): 1809–1816.
- O'Collins VE, Donnan GA, Macleod MR, et al. Hypertension and experimental stroke therapies. J Cereb Blood Flow Metab. 2013; 33(8): 1141–1147.
- Ghandehari K. Challenging comparison of stroke scales. J Res Med Sci. 2013; 18(10): 906–910.
- Mancia G, Fagard R, Narkiewicz K, et al. Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31(7): 1281–1357.
- Tykarski A, Narkiewicz K, Gaciong Z, et al. Guidelines for the Management of Hypertension. Arterial Hypertension. 2015; 19(2): 53–83.
- Centers for Disease Control and Prevention (CDC). Vital signs: awareness and treatment of uncontrolled hypertension among adults--United States, 2003-2010. MMWR Morb Mortal Wkly Rep. 2012; 61: 703–709.
- Yu JG, Zhou RR, Cai GJ. From hypertension to stroke: mechanisms and potential prevention strategies. CNS Neurosci Ther. 2011; 17(5): 577–584.
- Faraco G, Iadecola C. Hypertension: a harbinger of stroke and dementia. Hypertension. 2013; 62(5): 810–817.
- Hippisley-Cox J, Coupland C, Brindle P. Derivation and validation of QStroke score for predicting risk of ischaemic stroke in primary care and comparison with other risk scores: a prospective open cohort study. BMJ. 2013; 346: f2573.
- Holroyd-Leduc JM, Kapral MK, Austin PC, et al. Sex differences and similarities in the management and outcome of stroke patients. Stroke. 2000; 31(8): 1833–1837.
- Jerath NU, Reddy C, Freeman WD, et al. Gender differences in presenting signs and symptoms of acute ischemic stroke: a population-based study. Gend Med. 2011; 8(5): 312–319.
- Niewada M, Kobayashi A, Sandercock PAG, et al. International Stroke Trial Collaborative Group. Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the international stroke trial. Neuroepidemiology. 2005; 24(3): 123–128.
- Santalucia P, Pezzella FR, Sessa M, et al. Women Stroke Association (WSA). Sex differences in clinical presentation, severity and outcome of stroke: results from a hospital-based registry. Eur J Intern Med. 2013; 24(2): 167–171.
- Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008; 7(10): 915–926.
- Shrestha S, Poudel RS, Khatiwada D, et al. Stroke subtype, age, and baseline NIHSS score predict ischemic stroke outcomes at 3 months: a preliminary study from Central Nepal. J Multidiscip Healthc. 2015; 8: 443–448.
- den Hertog HM, van Rossum JA, van der Worp HB, et al. PAIS investigators. C-reactive protein in the very early phase of acute ischemic stroke: association with poor outcome and death. J Neurol. 2009; 256(12): 2003–2008.
- Christensen H, Boysen G. C-reactive protein and white blood cell count increases in the first 24 hours after acute stroke. Cerebrovasc Dis. 2004; 18(3): 214–219.
- VanGilder RL, Davidov DM, Stinehart KR, et al. C-reactive protein and long-term ischemic stroke prognosis. J Clin Neurosci. 2014; 21(4): 547–553.
- Yaghi S, Herber C, Boehme AK, et al. The Association between Diffusion MRI-Defined Infarct Volume and NIHSS Score in Patients with Minor Acute Stroke. J Neuroimaging. 2017; 27(4): 388–391.
- Chaudhuri JR, Mridula KR, Umamahesh M, et al. High sensitivity C-reactive protein levels in Acute Ischemic Stroke and subtypes: A study from a tertiary care center. Iran J Neurol. 2013; 12(3): 92–97.
- Ormstad H, Aass HC, Lund-Sørensen N, et al. Serum levels of cytokines and C-reactive protein in acute ischemic stroke patients, and their relationship to stroke lateralization, type, and infarct volume. J Neurol. 2011; 258(4): 677–685.