Incidence and Clinical Outcome of Patients with Hypertensive Acute Ischemic Stroke: An Update from Tertiary Care Center of Central India.

INTRODUCTION: We evaluated the incidence and clinical outcome of patients with hypertensive acute ischemic stroke (AIS) admitted to a tertiary care center in Central India. In addition, we examined the status of stroke biomarkers namely neuron-specific enolase (NSE), glial specific protein (S-100ßß), and inter-α-trypsin inhibitor heavy chain 4(ITIH4) in the serum of patients suffering from AIS with hypertension (HTN) and without HTN. METHODS: A total of 104 patients with AIS were enrolled for the study. Clinical outcome and stroke biomarker levels were evaluated in them at the time of hospital discharge and then followed at 12 months and 18 months after hospital discharge. RESULTS: HTN is a major risk factor associated with 67%(70.104) of patients with AIS. Multivariate analysis suggests higher odds of 4.088(95%Cl, 0.721-23.179) and 2.437(95%Cl, 0.721-23.179) for 12 and 18 months outcome in patients with AIS and HTN, respectively. Serum NSE and S-100ßß decreased at the time of discharge as compared to admission level in improved patients suffering from AIS with or without HTN, whereas levels of ITIH4 peptides 2 and 7 increased at the time of discharge (compared to its admission level) only in improved patients with AIS regardless of HTN or non-HTN condition. CONCLUSION: HTN is one of the major risk factors associated with higher risk of AIS as well as long-term unfavourable outcome after AIS in Central India region. NSE, S-100ßß, and ITIH4 were found to be independent predictors of outcome in patients with AIS irrespective of HTN and non-HTN condition.

Prediction of Outcome in Diabetic Acute Ischemic Stroke Patients: A Hospital-Based Pilot Study Report.

BACKGROUND: Demographic and clinical characteristics are known to influence the outcome in acute ischemic stroke (AIS) patients. PURPOSE: This study is aimed at evaluating short- and long-term outcomes in diabetic AIS patients. In addition, the study also evaluates the impact of diabetes on the performance of indigenously reported biomarker, inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and known biomarkers, neuron-specific enolase (NSE) and glial-derived S-100 beta beta protein (S-100ßß). METHODS: This study was performed on 29 diabetes and 75 non-diabetes AIS patients. Outcome of AIS patients was analyzed by using modified Rankin scale at discharge, then at 12 and 18 months after discharge. Based on the obtained scores, patients were classified as improved group (scales 1-3) and dependent/expired group (scales 3-6). Blood samples were collected during admission and at discharge/expired time. Levels of NSE, S100ßß, and ITIH4 were analyzed in all samples. RESULTS: On discharge, frequencies of dependent/expired outcome were 4/29 (14%) and 19/75 (17%) in diabetic and non-diabetic AIS patients. However, follow-up outcome at 12 and 18 months showed higher dependent/expired cases of 43 and 41% among diabetic AIS patients compared to 27 and 21% in non-diabetic patients. Multivariate analysis revealed that diabetes is an independent risk factor for dependent/expired outcome in AIS patients (OR 0.484 (at discharge); 1.307 (at 12 months) and 1.675 (at 18 months)). NSE, S100ßß, and ITIH4 showed a differential expression in both the outcome groups of AIS patients, irrespective of diabetes. CONCLUSION: Diabetes increases the risk of dependent/expired outcome in AIS patients. Also, serum NSE, S100ßß, and ITIH4 are independent biomarkers for prognosis of outcome in AIS patients, irrespective of diabetes.

Impact of Admission Time on Treatment and Outcome of Stroke in Patients Admitted to Tertiary Care Hospital: A Pilot Study from Central India.

INTRODUCTION: Admission of patients within window period has been linked with efficacy of treatment outcome and recovery. The present study examined the effects of early vs delayed admission on functional outcome of Acute Ischemic Stroke (AIS) as well as added value of stroke markers in such patients admitted to a tertiary care hospital in Central India. MATERIALS AND METHODS: Hundred and four patients admitted to Neurology department of Central India Institute of Medical Sciences were grouped as early referrals (within 24 hour admission) and late referrals (after 24 hour admission) based on onset of symptoms and time of admission. Baseline data, throm bolysis eligibility, hospital and long term outcomes were determined in early and later referrals. Stroke markers NSE, S-100 ßß and ITIH4 peptides were also screened in patients who were further categorized as improved and expired /dependent during hospital outcome. Outcome of death /dependency in both groups was analysed using multivariate regression analysis. Kaplan-Meier analysis was performed to determine the rate of stroke-mortality in hospital and over 12 and 15 month period. RESULTS: Hospital outcome indicated higher percentage (90%) of improved cases in early referrals as opposed to 79% observed in late referrals. Similarly, the ratio of dependency was slighter higher in late referrals (18%) as compared to early referral (6%) cases. The long term outcome at 12 and 18 months showed more or less similar ratio of death/dependency in early (23%, 9%) and late referrals (32%,24%) respectively. Multivariate analysis revealed no significant impact of risk confounders at long term and short term outcome in both groups. Analysis of stroke marker revealed better prognosis with significant association between ITIH4 peptides and NSE & S-100 ßß level with level of improvement in early referrals. CONCLUSION: Early admission of AIS patients is associated with better hospital outcome. However admission time has no major impact on long term outcome in AIS patients. Moreover, stroke markers such ITIH4, can be used as a predictor of stroke outcome and may have prognostic importance in AIS cases in future.

Comparative evaluation of risk factors, outcome and biomarker levels in young and old acute ischemic stroke patients.

BACKGROUND: Stroke is the third leading cause of death and disability worldwide accounting for 400-800 strokes per 100,000 individuals each year. PURPOSE: In the present study, we compared risk factors, clinical outcome, and prognostic biomarkers NSE, S-100 ßß and ITIH4 levels in young and old acute ischemic stroke (AIS) patients. METHODS: We compared the risk factors and clinical outcomes in young (n = 38) and old (n = 66) AIS patients admitted to tertiary health care centre in Central India. In addition, we also evaluated NSE, S100ßß & ITIH4 levels in admission and discharge samples of young and old AIS patients with different clinical outcome. RESULTS: Hypertension was a major risk factor in 45% of young and 80% of old AIS patients. Hospital outcome was less favorable in young AIS patients with higher dependent rates of 24% as compared to 12% in old AIS patients. Whereas long term outcome at 12 and 18 months after discharge was more favorable in young AIS patients with low dependency rates of 16% and 11% as compared to 41% and 24% in older AIS patients respectively. Similarly, serum NSE, S100ßß and ITIH4 levels showed a distinct pattern of expression at discharge time in AIS patients with improved and dependent outcome in both the age groups. CONCLUSION: Young males with hypertension and smoking habits are at a high risk of AIS while old AIS patients are at a greater risk of worse long term outcome. Serum levels of NSE and S100ßß are independent predictors of outcome in AIS patients. Similarly, it also suggests that serum ITIH4 levels could be used as a potential biomarker for predicting the outcome in AIS patients.