An observational study to predict the clinical outcome of patients with acute ischemic stroke using parameters like stress hyperglycaemia neutrophil to lumphocyte ratio mean platelet volume and platelet distribution width

Abstract

INTRODUCTION: newlineRole of stress induced hyperglycemia, Neutrophils and lymphocytes ratio, newlinePC, MPV and PDW indices in AIS were assessed in several studies. However, there were newlinedifferences of findings noted in each study. Hence this study was performed to determine newlineSH, NLR, MPV and PDW among cases with AIS and to assess their association with newlineseverity of AIS, in order to assess the exact prevailing relationship between these newlineparameters and AIS. newlineMETHODS: newlineA cross sectional study was conducted in the department of General newlineMedicine, Chettinad Medical College Hospital and Research Institute among subjects newlineadmitted with AIS during April 2021 to April 2022. A total of hundred AIS cases were newlineincluded in this study. newlineDATA COLLECTION: newlineThe principal investigator used a pre-structured proforma to evaluate all the newlinecases for the demographics and clinical presentation after obtaining written informed newlineconsent. Following this the lead investigator assessed the full history of the individuals and newlineclinical examinations were done. NLR, MPV, PDW, FBS, and HbA1c were evaluated in newlinethe subjects. The primary investigator submitted the clinical presentation into the same newlineproforma that all reports were entered newlineDATA EVALUATION: SPSS 19 was used to examine data that was entered into an excel newlinespreadsheet. Chi Square and independent sample t tests were properly conducted to test the newlinehypothesis. Statistics were considered significant at p values less than 0.05. newlineRESULTS: Severity of stroke was assessed using NIHSS; mild, moderate, moderate to newlinesevere and severe stroke were reported in 4%, 28%, 39% and 29% of subjects, respectively. newlineBased on MRS, there were no subjects with extreme scores (score 1 and 6) in this study. newlineScore 2 was noted in 12% of subjects, score 3 was noted in 40% of subjects, score 4 was newlinenoted in 34% of subjects, and score 5 was noted in 14% of subjects. Notably, 11% of cases newlinereported with elevated FBS levels, which could be due to stress induced hyperglycemia. newlineMPV was elevated in 44% of cases and PDW was increased in 41% of stroke subjects. newlineNLR was elevated in 45% of stroke subjects. newlineFBS and NLR were found to have been associated with the severity of newlinestroke, however MPV and PDW were not associated with the severity of stroke. On newlineassessing the FBS with other risk factors, obesity was associated with FBS however newlinesmoking; alcohol consumption and family history of stroke were not present. NLR, MPV newlineand PDW were not associated with other risk factors. newlineCONCLUSION: We infer that SH and elevated NLR can result in severe stages of stroke. newlineHence assessment of FBS and NLR should be done as a routine in order to assess the newlineseverity of stroke. newlineKeywords: AIS- Acute ischemic stroke, PI- platelet indices, predictors, SS- stroke newlineseverity, SH- stress hyperglycemia, NLR Neutrophil lymphocyte ratio, FBS Fasting newlineblood sugar. newline