بررسي نقش لكوسيتوزيس و سرعت سديمانتاسيون بالا بعنوان عوامل پروگنوستيك در سكته هاي مغزي ايسكميك حاد

Determination of the role of leukocytosis and increased erythrocytes sedimentation rate as effective factors in ischemic stroke prognosis

Background and Aim: In a near future, stroke will be the second leading cause of death and disability in many regions of the world. To reduce the overall burden of the disease on society, the development and the establishment of an organized approach for acute stroke care is postulated. The identification of predictors for death and poor outcome might contribute to reduce mortality and morbidity rates after stroke by enhancing the application of specific therapeutic and management strategies to patients at high risk. However, only limited information is available in this regard. Leukocytosis and increased erythrocyte sedimentation rate (ESR) during the early phases of acute ischemic stroke has been proposed to be related with poor prognosis. This study aimed at evaluating these two parameters in patients with ischemic stroke. Material and Methods: In an analytic study. 150 patients with confinned ischemic stroke hospitalized at Tabriz Imam Hospital were reviewed during a 13-month period. The white blood cell (WBC) count and ESR were determined on admitting and 3 days after. Any history of diabetes mellitus (OM), hypertension (HTN), heart disease (HO), hyperlipidemia (HLP), smoking, CT findings, Level of consciousness, and the condition of patient on admission and discharge (according to Rankinʹs scale) was assessed. The patients categorized into three groups: expired during hospital stay, discharged in good situation (Rankinʹs scale of 0-2), discharged in poor situation (Rankinʹs scale of3-5). Results: One hundred fifty patients, 75 males and 75 females, with the mean age of 67.3±8.2 (48-88) years enrolled in this study. There were 32 (21.3%) expired cases, 26 (17.3%) cases discharged in good condition and 92 (61.3%) cases discharged in poor condition. Leukocytosis on day one was significantly more prevalent in patients passed away during hospitalization or discharged in not-so-well condition. High WBC and ESR levels, altered consciousness, diffused lesions in CT scan, and imperfect neurological condition on day one, as well as positive history of OM and HTN were significantly related with higher in-hospital death rate and/or poor condition at discharge. In a multivariate study, all the mentioned parameters except a positive history of OM were independent predictors of short mortality and morbidity in the patients (p<0.05). Conclusion: This study showed that the raised WBC count and ESR just after an ischemic stroke attack might be related with a poor prognosis and necessitate immediate and meticulous monitoring and therapies.