C-reactive protein an D-dimer as a prognostic factors of ischemic stroke

Inflammatory processes have a fundamental role of atherosclerotic lesion and increased risk of vascular disease especially cerebral ischemia. The study was performed to assess the prognostic influence of inflammatory markers, C - reactive protein [CRP] and D-dimer on outcome of ischemic stroke. The study includes 100 patients with first-ever ischemic stroke. The study was performed at Al-Azhar University Hospitals from May 2005 to January 2006, followed by one-year follow up. All patients were suspected to complete history and clinical examinations, CT or MRI in the first day and one week latter. CRP and D-dimer were measured within the first 24 hours of ischemic stroke. In addition to routine investigations such as; fasting and post prandial blood sugar, lipid profile, CBC, ECG, echocardiography and body mass index [BMI]. The primary end-point was either, death of any causes [vascular or non-vascular] or any non-fatal vascular events [transient ischemic attack, recurrent stroke, unstable angina, acute myocardial infarction or peripheral ischemia]. Multiple logistic regression analysis was used to evaluate the association between end-point and risk factors of stroke. The incidence of diabetes, hypertension, hypercholesterolemia and obesity were significantly higher in patients than control [p < 0.01] and in patients with fatal and non-fatal vascular events than those survival free vascular events [p <0.01]. Serum levels of CRP and D-dimer were significantly higher in patients with first-ever stroke than control [p <0.001] and in patients with fatal and non-fatal vascular events than those survival free vascular events [p < 0.01]. Kaplan-Meier analysis showed an increased incidence of new vascular events during follow-up with increased levels of CRP especially in high tertiles [64%] compared to intermediate [29%] and low tertiles [18.5%], [OR 9.1, CI 3.9-18.4; p <0.001]. Also Kaplan-Meier analysis showed an increased incidence of new vascular events during follow-up with increased levels of D-dimer especially in high tertiles [44.4%] compared to intermediate [34%] and low tertiles [30%], [OR 1.95, CI 0.95-2.1; p <0.01]. However, logistic regression analysis between, risk factors and outcome during 1-year follow-up proved that CRP is the most risk factor predictive for recurrent vascular events independent to other risk factors for stroke [OR 2.57, CI 1.34-5.10; p <0.001]. We can conclude that increased serum levels of CRP are related with a worse outcome in patients with first-ever stroke more than D-dimer independent to other risk factors of ischemic stroke. Therefore, addition of CRP to standard initial screening will generate an improved method for identifying persons at high risk of future vascular events

Impaired glucose tolerance after acute stroke

The objective of this work is to determine the prevalence of disturbances in glucose metabolism in patients with acute stroke. Research design and methods-Consecutively admitted acute stroke patient [n=100] were screened for glucose tolerance according to the standardized World Health Organization protocol in the 1[st] and 2[nd] week after the stroke event. In addition, we repeatedly measured fasting capillary blood glucose during the first 10 days. Of the 100 subjects analyzed, 30 [30%] were classified as having newly diagnosed diabetes, 28 [28%] as having IGF or IGT, 29 [29%] as having transient hyperglycemia and only 16 [16%] were normoglycemia. Patients with newly diagnosed diabetes had more severe stroke National Institutes of Health Stroke Scale [NIHSS] on admission], hypertension and HbAIc than other studied groups [p<0.001], a higher rate of pneumonia and urinary tract infection during the admission [P0.001] and a worse outcome at discharge [mRS 0-1 at discharge]; [P<0.001] than nondiabetic patients. Patients with normal glucose regulation were more often men [more women among diabetic patients] and significantly younger than patients classified as having abnormal glucose regulation. In multivariate logistic regression model, National Institutes of Health Stroke Scale [NIHSS] on admission, female sex and urinary tract infection were independently associated with the classification of newly diagnosed diabetes. Age < 70 years and normotension were factors associated with normal glucose values in OGTT. It could be concluded that - The majority of acute stroke patients have disorders of glucose metabolism and in most cases this fact has been unrecognized. Diabetes worsens the outcome of acute stroke. Therefore, in the post-acute phase, an oral glucose tolerance test should be recommended in all stoke patients with no prior history of diabetes