SERUM FERRITIN LEVELS AS A PROGNOSTIC INDICATOR IN ACUTE ISCHEMIC STROKE: A COMPREHENSIVE CLINICAL STUDY
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i10.49206Keywords:
Serum ferritin, Acute ischemic stroke, Prognostic indicator, Stroke severity, Consciousness status, Disability outcomesAbstract
Objective: This clinical study investigates the potential of serum ferritin levels as a prognostic indicator in acute ischemic stroke.
Methods: This cross-section study included 75 patients enrolled in our outpatient clinic, General Medicine Department, and SMS Medical College. The study enrolled all patients who had a new onset focal neurological deficit due to a stroke. A total of 75 patients (25 in each group (mild/moderate/ severe) as per the National Institute of Health Stroke Scale scoring) of >14 years old, presenting in the general medicine wards were enrolled for the study. The study assesses the correlation between serum ferritin levels and various clinical parameters, including stroke severity, consciousness status, and disability outcomes.
Results: Severe group had the highest average blood ferritin level (408.48 with a standard deviation (SD) of 68.63). A significant relationship was observed between ferritin levels and loss of consciousness. In addition, the mean ferritin residue ratio (MRS) also correlated with ferritin levels, with MRS correlating to ferritin levels. A significant association between elevated serum ferritin levels and severe stroke, as well as unfavorable outcomes.
Conclusion: The findings suggest that serum ferritin could serve as a promising prognostic index in acute ischemic stroke, aiding in patient risk stratification and clinical decision-making.
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References
The World Health Organization. The World Health Organization Monica project (monitoring trends and determinants in cardiovascular disease): A major international collaboration. WHO Monica project principal investigators. J Clin Epidemiol 1988;41:105-14. doi: 10.1016/0895- 4356(88)90084-4, PMID 3335877.
Indian Council of Medical Research. Stroke. Assessment of the Burden of Noncommunicable Diseases. New Delhi: Indian Council of Medical Research; 2012. p. 6-7.
Khaku AS, Tadi P. Cerebrovascular Diseases. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2021. Available from: https://www. ncbi.nlm.nih.gov/books/NBK430927 [Last accessed on 2021 Sep 29].
Boehme AK, Esenwa C and Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res 2017;120:472-95. doi: 10.1161/ CIRCRESAHA.116.308398, PMID 28154098
Elkind MS. Why now? Moving from stroke risk factors to stroke triggers. Curr Opin Neurol 2007;20:51-7. doi: 10.1097/ WCO.0b013e328012da75, PMID 17215689
Alrabghi L, Alnemari R, Aloteebi R, Alshammari H, Ayyad M, Al Ibrahim M, et al. Stroke types and management. Int J Community Med Public Health 2018;5:1-5. doi: 10.18203/2394-6040.ijcmph20183439
Abernethy TJ, Avery OT. The occurrence during acute infections of a protein not normally present in the blood: I. Distribution of the reactive protein in patients’ sera and the effect of calcium on the flocculation reaction with C polysaccharide of Pneumococcus. J Exp Med 1941;73:173-82. doi: 10.1084/jem.73.2.173, PMID 19871070
Bishop GM, Robinson SR. Quantitative analysis of cell death and ferritin expression in response to cortical iron: Implications for hypoxia-ischemia and stroke. Brain Res 2001;907:175-87. doi: 10.1016/s0006- 8993(01)02303-4, PMID 11430901
Lesnefsky EJ. Tissue iron overload and mechanisms of iron catalyzed oxidative injury. In: Armstrong D, editor. Free Radicals in Diagnostic Medicine. New York: Plneum Press; 1994. p. 129-46. doi: 10.1007/978- 1-4615-1833-4_10, PMID 7771248
Eisenstein RS. Iron regulatory proteins and the molecular control of mammalian iron metabolism. Annu Rev Nutr 2000;20:627-62. doi: 10.1146/annurev.nutr.20.1.627, PMID 10940348
Wang W, Knovich MA, Coffman LG, Torti FM, Torti SV. Serum ferritin: Past, present and future. Biochim Biophys Acta 2010;1800:760-9. doi: 10.1016/j.bbagen.2010.03.011, PMID 20304033
Jacops A, Worwood A. Iron in Biochemistry and Medicine, II. London: Academic Press; 1980. p. 204-44.
Jacobs A, Worwood M. Ferritin in serum. Clinical and biochemical implications. N Engl J Med 1975;292:951-6. doi: 10.1056/ NEJM197505012921805, PMID 1090831
Garg R, Aravind S, Kaur S, Chawla SP, Aggarwal S, Goyal G. Role of serum ferritin as a prognostic marker in acute ischemic stroke: A preliminary observation. Ann Afr Med 2020;19:95-102. doi: 10.4103/ aam.aam_35_19, PMID 32499465
Narayan M, Singh SK. Study of association between serum ferritin and prognosis of patients in acute ischemic and haemorrhagic stroke. J Dent Med Sci 2018;17:46-56.
Egovindarajulu K, Maaran AT, Prathiba P, Saiprashanth PR. A study on prognostic significance of serum ferritin in patients with acute ischemic stroke. J Dent Med Sci 2016;15:31-9.
Thanikachalam R, Elangovan S, Srivijayan A. Evaluation of serum ferritin as a prognostic marker in acute ischemic stroke: A prospective observational study. Int J Res Med Sci 2020;8:4282-7. doi: 10.18203/2320-6012.ijrms20204974
Hornig CR, Dorndorf W, Agnoli AL. Hemorrhagic cerebral infarction--a prospective study. Stroke 1986;17:179-85. doi: 10.1161/01.str.17.2.179, PMID 3515635
Mahur H, Ralot TK, Singh DP, Ken P, Patel J. To establish the role of serum ferritin as a prognostic marker in patients of stroke. Indian J Neurosci 2018;4:64-8.
Koul RK, Yaseen Y, Amreen S, Shah PA. Role of serum ferritin in determining the severity and prognosis of stroke: A hospital based study. Int J Sci Study 2017;6:142-5.
Herbert V, Jayatilleke E, Shaw S, Rosman AS, Giardina P, Grady RW, et al. Serum ferritin iron, a new test, measures human body iron stores unconfounded by inflammation. Stem Cells 1997;15:291-6. doi: 10.1002/stem.150291, PMID 9253113
Roudbary SA, Saadat F, Forghanparast K, Sohrabnejad R. Serum C-reactive protein level as a biomarker for differentiation of ischemic from hemorrhagic stroke. Acta Med Iran 2011;49:149-52. PMID 21681701
ElHabr AK, Katz JM, Wang J, Bastani M, Martinez G, Gribko M, et al. Predicting 90-day modified Rankin scale score with discharge information in acute ischaemic stroke patients following treatment. BMJ Neurol Open 2021;3:e000177. doi: 10.1136/bmjno-2021-000177, PMID 34250487
Reif DW. Ferritin as a source of iron for oxidative damage. Free Radic Biol Med 1992;12:417-27. doi: 10.1016/0891-5849(92)90091-t, PMID 1317328. Castellanos M, Puig N, Carbonell T, Castillo J, Martínez JM, Rama R, et al. Iron intake increases infarct volume after permanent middle cerebral artery occlusion in rats. Brain Res 2002;952:1-6. doi: 10.1016/s0006-8993(02)03179-7, PMID 12363398
Côté R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian neurological scale: A preliminary study in acute stroke. Stroke 1986;17:731-7. doi: 10.1161/01.str.17.4.731, PMID 3738958
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Copyright (c) 2023 Dr. Nasiba Khan, Dr. Dharam Singh Meena, Dr. Suraj Rajputohit, Dr. Sudhir Bhandari
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