Determination of Risk Factors on Mortality in the Patients With Ischemic Stroke Who Admitted to Emergency Department
Abstract
Aim
In this study, we aimed to determine the risk factors affecting mortality in patients with Ischemic stroke and contribute to the data of Ischemic stroke in Turkey.
Material and Methods
In this study, the records of 445 patients diagnosed with Ischemic stroke who were admitted to the Emergency Department of S.B.Ü Gazi Yaşargil Education Research Hospital between January 2017 and December 2018 were retrospectively analysed. The demographic and clinical findings (including age, gender, complaints at admission, neurological examination findings, diffusion MRI findings, carotid Doppler USG, laboratory tests, and mortality-discharge rates) were examined.
Results
The mean age of surviving patients was 70.32±12.05 years, while the mean age of the patients who died was 79.64±9.95 yearsFrom the medical background, it was found that 48.2% (n=27) of the patients who died had hypertension and 33.9% (n=19) had diabetes. According to the diffusion MRI results of our patients, the anterior circulatory disorder was found in 76.8% (n=43) of the patients who died. In 92.9% (n=52) of the deaths, the plaque was detected on Carotid Color Doppler USG. While examining intima-media thickness (IMT) of patients who died on Carotid Color Doppler USG, the thickness of the right intima-media was 1.22±0.36 mm and the thickness of the left intima-media was 1.32±0.43 mm. An increase was detected. The ferritin levels of the patients were measured as 213.2±169.4 ng/mL in deceased patients and it was found to be higher (p:0.005). The free T3 level was measured as 2.30±0.81 pg/dL in deceased patients and it was found to be lower (p<0.001).
Conclusion
The findings such as admission with loss of consciousness, presence of hypertension, anterior circulatory disorder on diffusion MRI, low free T3 level, high ferritin level, presence of plaque on carotid Doppler USG, and increased IMT are the important risk factors for mortality. Therefore, when this group of patients is encountered; knowing the risk factors may provide a prediction in terms of death and survival in patients with ischemic stroke.
Keywords
References
- 1. Ropper AH, Brown RH. Serebrovasküler hastalıklar. Çoban O, Bebek N [Çeviri editörleri]. 8. baskı, Ankara: Güneş Kitapevi; 2006.
- 2. Cerebrovascular disorders. A clinical and research classification. WHO offset Publ 1978: No:43 Geneva
- 3. Lewandowski C, Barsan W. Treatment of acute ischemic stroke. Ann Emerg Med 2001;37:202-16.
- 4. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747–57.
- 5. Onat A., Keleş İ, Çetinkaya A, ve ark. On Yıllık TEKHARF Çalışması Verilerine Göre Türk Erişkinlerinde Koroner Kökenli Ölüm ve Olayların Prevalansı Yüksek. Türk Kardiyoloji Derneği Arş. 2001; 29:8-19
- 6. Oğul E. Beyin Damar Hastalıkları. İçinde: Oğul E, editör. Klinik Nöroloji. Nobel&Güneş Kitabevi; 2002. s.1–2.
- 7. Reganon E, Vila V, Martinez-Sales V, et al. Association between infl ammation and hemostatic markers in atherothrombotic stroke. Thromb Res 2003; 112:217–21.
- 8. Bogousslavsky J, Van Melle G, Regli F, fort he Lausssane Stroke Registry: Analysis of 1000 Consecutive Patients With First Stroke. Stroke 1988;19: 1083-92.
- 9. Kumral E, Ozkaya B, Sagduyu A, Sirin H, Vardarli E, Pehlivan M. The Ege Stroke Registry: A Hospital Based Study in The Aegean Region, Izmir, Turkey. Cerebrovasc Dis 1998;8: 278-88.
- 10. Hakbilir O, Çete Y, Göksu E, et al. İnme popülasyonun demografi k özellikleri ve acil servis başvurularının yeni tedavi yaklaşımları üzerine etkisi. Türkiye Acil Tıp Dergisi 2006; 6:132–8.
- 11. Kıyan S, Özsaraç M, Ersel M, et al. Acil servise başvuran akut iskemik inmeli 124 hastanın geriye yönelik bir yıllık incelenmesi. Akademik Acil Tıp Dergisi 2009;8:15–20.
- 12. Gülșen Çığșar, Neșe Nur User. Acil Servise Bașvuran Akut İnmeli Hastaların Analizi. Kafkas J Med Sci 2015; 5(1):6–12.
- 13. Navarrete-Navarro P, Rivera-Fernandez R, Lopez-Mutuberria MT, et al. Outcome prediction in terms of functional disability and mortality at 1 year among ICU-admitted severe stroke patients: a prospective epidemiological study in the south of the European Union (Evascan Project, Andalusia, Spain). Intensive Care Med 2003;29:1237–44.
- 14. Benjamin Maïer, Benjamin Gory, Guillaume Taylor, et all. Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy: A Collaborative Pooled Analysis. Journal of the American Heart Association. 2017;6(10): DOI: 10.1161/JAHA.117.006484
- 15. Ringleb PA, Bousser MG, Ford G, et al. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457507.
- 16. Kovalenko IB, Chefranova JY et al. The remote results of treatment of ischemic stroke conditioned by atherosclerotic affection of carotid arteries. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2019 Nov;27(6):1049-1052
- 17. Barrett KM, Brott TG, Brown RD, et al. For the Ischemic Stroke Genetics Study Group. Sex diff erences in stroke severity, symptoms, and defi cits aft er fi rst-ever ischemic stroke. J Stroke Cerebrovasc Diseas 2007;16, 34–9.
- 18. Tauboul PJ, Elbaz A, Koller C, Lucas C, Adrai V, Chedru F, Amerenco. The GENİC Investigators. Common carotid arter intima-media thickness and brain infarction. Circulation 2000;102: 313-318.
- 19. Şengül Y, Bilge S. ve ark. Akut İskemik İnmede C-Reaktif Protein Ve İnternal Karotis Arter İntima Media Kalınlığı. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2008;XIX(3):138-143
- 20. Lynne EW, Carl DL, et al. Race–spescific Relationships between Coronary and Carotid Artery Calcification and Carotid Intimal Medial Thickness. Stroke. 2004; 35: 97.
- 21. Alevizaki M, Synetou M, Xynos K et al. Low triiodothyronin: a strong predictor of outcome in acute stroke patients. Europan Journal of Clinical İnvestigation 2007; 37:61-7
- 22. Lervasi G, Pingitore A, Landi P, Raciti M, Ripoli A, Scarlattini M et al. Low-T3 syndrome:a strong prognostic predictor of death in patients with hearth disease. Circulation 2003;107:708- 13
- 23. Scoscia E, Baglioni S, Eslami A, Iervasi G, Monti S, Todisco T. Low triiodothyroinine (T3) state: a predictor of outcome in respiratory failure? Results of a clinical pilot study. Eur J Endocrinol 2004;151:557-60
- 24. Anna Song, Wankyu Eo, Sehyun Kim, Bumsang Shim, Sookyung Lee5. Significance of serum ferritin as a prognostic factor in advanced hepatobiliary cancer patients treated with Korean medicine: a retrospective cohort study. BMC Complementary and Alternative Medicine (2018) 18:176
- 25. Kamyar Kalantar-Zadeh,Deborah L. Regidor et al. Time-Dependent Associations between Iron and Mortality in Hemodialysis Patients. J Am Soc Nephrol 2005;16: 3070–3080
- 26. Koyama S, Fujisawa S, Watanabe R, Itabashi M, Ishibashi D, Ishii Y, et al. Serum ferritin level is a prognostic marker in patients with peripheral T-cell lymphoma. Int J Lab Hematol. 2017;39(1):112–117. doi: 10.1111/ijlh.12592
Acil Servise Başvuran İskemik İnmeli Hastalarda; Mortalite Üzerine Etkili Risk Faktörlerini Belirleme
Abstract
Amaç
Bu çalışmada; iskemik inmeli hastalarda mortalite üzerine etkili olan risk faktörlerini belirleme ve bu sayede ülkemiz iskemik inme verilerine katkıda bulunmayı amaçladık.
Gereç ve Yöntemler
Bu çalışmada S.B.Ü Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi Acil Servisine Ocak 2017 – Aralık 2018 tarihleri arasında başvuran ve iskemik inme tanısı konulan 445 hastanın kayıtları geriye dönük olarak incelendi. Hastaların yaş, cinsiyet, başvuru sırasındaki şikâyeti, nörolojik muayene bulguları, difüzyon MR bulguları, karotis dopler USG, laboratuvar testleri, ölüm ve taburculuk oranlarını da içeren demografik ve klinik bulgular incelendi.
Bulgular
Sağ kalan 389(%87,4) ve ölen 56(%12,6) hasta mevcuttu. Sağ kalan hastaların yaş ortalamaları 70,32±12,05, ölen hastaların yaş ortalamaları 79,64±9,95 idi. Ölen hastaların %37,5’inde (n=21) başvuru şikâyeti bilinç değişikliği-koma olarak tespit edildi (p<0,001). Ölen hastaların özgeçmişinde %48,2’sinde (n=27) hipertansiyon, %33,9’unde (n=19) diyabet saptandı. Hastalarımızın Difüzyon MR sonucuna göre; ölen hastaların %76,8’inde (n=43) ön dolaşım bozukluğu saptandı. Ölen hastaların %92,9’unde (n=52) Karotis Renkli Dopler USG’de plak tespit edildi. Hastaların Karotis Renkli Dopler USG’de Karotis intima media kalınlıklarını (İMK) incelediğimizde; ölen hastalarda sağ intima media kalınlığı 1,22±0,36mm, sol intima media kalınlığı 1,32±0,43mm olarak ölçülüp artmış olarak tespit edildi. Hastaların ferritin değeri ölen hastalarda daha yüksek tespit edildi (p:0.005), serbest T3 değeri ölen hastalarda daha düşük olarak ölçüldü (p<0.001).
Sonuç
Başvuru şikayetinin bilinç kaybı olması, özgeçmişte Hipertansiyon varlığı, difüzyon MR’da ön dolaşım bozukluğu olması, düşük serbest T3 düzeyi, yüksek ferritin düzeyi, karotis dopler USG’de plak varlığı ve İMK artışı mortalite üzerine etkili önemli risk faktörleridir. Bu nedenle bu grup hastalarla karşılaşıldığında; risk faktörlerinin bilinmesi iskemik inme hastalarında ölüm ve sağ kalım açısından bir öngörü sağlayabileceğini düşünmekteyiz.
Keywords
References
- 1. Ropper AH, Brown RH. Serebrovasküler hastalıklar. Çoban O, Bebek N [Çeviri editörleri]. 8. baskı, Ankara: Güneş Kitapevi; 2006.
- 2. Cerebrovascular disorders. A clinical and research classification. WHO offset Publ 1978: No:43 Geneva
- 3. Lewandowski C, Barsan W. Treatment of acute ischemic stroke. Ann Emerg Med 2001;37:202-16.
- 4. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747–57.
- 5. Onat A., Keleş İ, Çetinkaya A, ve ark. On Yıllık TEKHARF Çalışması Verilerine Göre Türk Erişkinlerinde Koroner Kökenli Ölüm ve Olayların Prevalansı Yüksek. Türk Kardiyoloji Derneği Arş. 2001; 29:8-19
- 6. Oğul E. Beyin Damar Hastalıkları. İçinde: Oğul E, editör. Klinik Nöroloji. Nobel&Güneş Kitabevi; 2002. s.1–2.
- 7. Reganon E, Vila V, Martinez-Sales V, et al. Association between infl ammation and hemostatic markers in atherothrombotic stroke. Thromb Res 2003; 112:217–21.
- 8. Bogousslavsky J, Van Melle G, Regli F, fort he Lausssane Stroke Registry: Analysis of 1000 Consecutive Patients With First Stroke. Stroke 1988;19: 1083-92.
- 9. Kumral E, Ozkaya B, Sagduyu A, Sirin H, Vardarli E, Pehlivan M. The Ege Stroke Registry: A Hospital Based Study in The Aegean Region, Izmir, Turkey. Cerebrovasc Dis 1998;8: 278-88.
- 10. Hakbilir O, Çete Y, Göksu E, et al. İnme popülasyonun demografi k özellikleri ve acil servis başvurularının yeni tedavi yaklaşımları üzerine etkisi. Türkiye Acil Tıp Dergisi 2006; 6:132–8.
- 11. Kıyan S, Özsaraç M, Ersel M, et al. Acil servise başvuran akut iskemik inmeli 124 hastanın geriye yönelik bir yıllık incelenmesi. Akademik Acil Tıp Dergisi 2009;8:15–20.
- 12. Gülșen Çığșar, Neșe Nur User. Acil Servise Bașvuran Akut İnmeli Hastaların Analizi. Kafkas J Med Sci 2015; 5(1):6–12.
- 13. Navarrete-Navarro P, Rivera-Fernandez R, Lopez-Mutuberria MT, et al. Outcome prediction in terms of functional disability and mortality at 1 year among ICU-admitted severe stroke patients: a prospective epidemiological study in the south of the European Union (Evascan Project, Andalusia, Spain). Intensive Care Med 2003;29:1237–44.
- 14. Benjamin Maïer, Benjamin Gory, Guillaume Taylor, et all. Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy: A Collaborative Pooled Analysis. Journal of the American Heart Association. 2017;6(10): DOI: 10.1161/JAHA.117.006484
- 15. Ringleb PA, Bousser MG, Ford G, et al. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457507.
- 16. Kovalenko IB, Chefranova JY et al. The remote results of treatment of ischemic stroke conditioned by atherosclerotic affection of carotid arteries. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2019 Nov;27(6):1049-1052
- 17. Barrett KM, Brott TG, Brown RD, et al. For the Ischemic Stroke Genetics Study Group. Sex diff erences in stroke severity, symptoms, and defi cits aft er fi rst-ever ischemic stroke. J Stroke Cerebrovasc Diseas 2007;16, 34–9.
- 18. Tauboul PJ, Elbaz A, Koller C, Lucas C, Adrai V, Chedru F, Amerenco. The GENİC Investigators. Common carotid arter intima-media thickness and brain infarction. Circulation 2000;102: 313-318.
- 19. Şengül Y, Bilge S. ve ark. Akut İskemik İnmede C-Reaktif Protein Ve İnternal Karotis Arter İntima Media Kalınlığı. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2008;XIX(3):138-143
- 20. Lynne EW, Carl DL, et al. Race–spescific Relationships between Coronary and Carotid Artery Calcification and Carotid Intimal Medial Thickness. Stroke. 2004; 35: 97.
- 21. Alevizaki M, Synetou M, Xynos K et al. Low triiodothyronin: a strong predictor of outcome in acute stroke patients. Europan Journal of Clinical İnvestigation 2007; 37:61-7
- 22. Lervasi G, Pingitore A, Landi P, Raciti M, Ripoli A, Scarlattini M et al. Low-T3 syndrome:a strong prognostic predictor of death in patients with hearth disease. Circulation 2003;107:708- 13
- 23. Scoscia E, Baglioni S, Eslami A, Iervasi G, Monti S, Todisco T. Low triiodothyroinine (T3) state: a predictor of outcome in respiratory failure? Results of a clinical pilot study. Eur J Endocrinol 2004;151:557-60
- 24. Anna Song, Wankyu Eo, Sehyun Kim, Bumsang Shim, Sookyung Lee5. Significance of serum ferritin as a prognostic factor in advanced hepatobiliary cancer patients treated with Korean medicine: a retrospective cohort study. BMC Complementary and Alternative Medicine (2018) 18:176
- 25. Kamyar Kalantar-Zadeh,Deborah L. Regidor et al. Time-Dependent Associations between Iron and Mortality in Hemodialysis Patients. J Am Soc Nephrol 2005;16: 3070–3080
- 26. Koyama S, Fujisawa S, Watanabe R, Itabashi M, Ishibashi D, Ishii Y, et al. Serum ferritin level is a prognostic marker in patients with peripheral T-cell lymphoma. Int J Lab Hematol. 2017;39(1):112–117. doi: 10.1111/ijlh.12592
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | March 30, 2020 |
| Published in Issue | Year 2020 Volume: 3 Issue: 1 |
