İskemik Serebrovasküler Olay Geçirmiş Hastalarda Hemoglobin A1c, Laktat, Prokalsitonin Seviyelerinin Fonksiyonel Sonuç ile İlişkisi
Öz
Amaç:Amaç: İnme yönetiminde prognostik parametrelerin ortaya konması, acil servis hekimleri için mortalite ve morbiditeyi azaltmada önemlidir. Akut inmede prognoz için belirlenebilmiş herhangi bir parametre bulunamamıştır. Bu çalışmada, serum prokalsitonin(PCT), laktat ve HgA1c düzeylerinin başvuru sırasındaki ve PCT ve laktat düzeylerinin 2 saat içindeki değişikliklerinin akut iskemik inmeden sonra kısa dönem fonksiyonel sonuçla (3. gün) ilişkili olup olmadığını belirlemeyi amaçladık.
Hastalar ve Yöntem:Bu prospektif gözlemsel prognostik test çalışmasıydı. Ardışık tüm hastalar çalışmaya dahil edildi. Giriş ve 2. saatte tüm deneklerden PCT ve laktat seviyeleri ve giriş HgA1c düzeyleri toplandı. Bu değerleri 3. günde Modifiye Rankin Skalası (mRs) ve mortalite ile ilişkilendirmeyi ve prediktif değerlerini belirlemeyi amaçladık.
Bulgular:İyi (mRS <2) ve kötü sonlanımlı gruplar arasında PCT ve laktat değerlerinin kendileri ile PCT ve laktat değer değişimleri açısından istatistiksel olarak anlamlı bir fark bulunamadı. İki grup arasında geliş HgA1c değeri açısından istatistiksel olarak anlamlı bir fark vardı. Olumsuz sonucu belirlemek için eşik değer analizi yapıldığında, eşik değer 5.7 olarak belirlendi.
Sonuç:Çalışma sonuçları, ilk başvuru sırasında daha yüksek HgA1c düzeyi olan iskemik inme hastalarının 3. günde kötü fonksiyonel nörolojik sonuç risk artışı olduğunu göstermiştir.
Anahtar Kelimeler
Kaynakça
- 1. Wang C, Gao L, Zhang ZG, Li YQ, Yang YL et al. Procalcitonin Is a StrongerPredictor of Long-TermFunctionalOutcomeandMortalitythan High-Sensitivity C-Reactive Protein in PatientswithIschemicStroke. MolNeurobiol. 2016;53(3):1509-1517. doi: 10.1007/s12035-015-9112-7.
- 2. Tu WJ, DongX, Zhao SJ, YangDG, Chen H. Prognosticvalue of plasmaneuroendocrinebiomarkers in patientswithacuteischaemicstroke. J Neuroendocrinol 2013; 25:771–778. doi: 10.1111/jne.12052.
- 3. Katan M, Moon YP, Paik MC, Mueller B, Huber A et al. ProcalcitoninandMidregionalProatrialNatriureticPeptide as Markers of IschemicStroke: TheNorthern Manhattan Study. Stroke. 2016;47(7):1714-9. doi: 10.1161/STROKEAHA.115.011392
- 4. Zhang Y, Chen Z, Tang Y, Shan W, Wang L et al. Associationbetweenprocalcitoninlevelsandcarotidatherosclerosis in acuteischemicstrokepatients. Int J Neurosci. 2018 Mar;128(3):237-242. doi: 10.1080/00207454.2017.1387114.
- 5. Yang DY, Tsai TH, Cheng CH, Lee CW, Chen SH et al. Simultaneousmonitoring ofextracellularglucose, pyruvate, lactateandglutamate in gerbilcortexduringfocal cerebralischemiabydualprobemicrodialysis. J Chromatogr A 2001;913:349–54.
- 6. Jo S, Jeong T, Lee JB, Jin YH, Yoon J et al. Initialhyperlactatemia in the ED is associatedwithpooroutcome in patientswithischemicstroke. Am J EmergMed. 2012 Mar;30(3):449-55. doi: 10.1016/j.ajem.2011.12.019.
- 7. Sunaga K, Miura K, Naruse Y, Sakurai M, Morikawa Y et al. Glycated hemoglobin and risk of stroke, ischemicandhemorrhagic, in Japanese men andwomen. CerebrovascDis. 2008;26(3):310-6. doi: 10.1159/000149579.
- 8. Cloonan L, Fitzpatrick KM, Kanakis AS, Furie KL, Rosand J et al. Metabolicdeterminants of whitematterhyperintensityburden in patientswithischemicstroke. Atherosclerosis. 2015 May;240(1):149-53. doi: 10.1016/j.atherosclerosis.2015.02.052.
- 9. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ et al. Guidelinesfortheearlymanagement of patientswithacuteischemicstroke: a guidelineforhealthcareprofessionalsfromtheAmericanHeartAssociation/AmericanStrokeAssociation. Stroke. 2013 Mar;44(3):870-947. doi: 10.1161/STR.0b013e318284056a.
- 10. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PPet al. STARD 2015: An UpdatedList of EssentialItemsforReportingDiagnosticAccuracyStudies. BMJ. 2015;351:h5527.doi: 10.1136/bmj.h5527.
- 11. Tian D, Zhang S, He X, Liu H. Serum procalcitonin as a diagnostic marker in acuteischemicstroke. Neuroreport. 2015 Jan 7;26(1):33-7. doi: 10.1097/WNR.0000000000000298.
- 12. Li YM, Liu XY. Serum levels of procalcitoninandhighsensitivity C-reactive protein areassociatedwithlong-termmortality in acuteischemicstroke. J NeurolSci. 2015;352(1-2):68-73. doi: 10.1016/j.jns.2015.03.032.
- 13. Miyakis S, Georgakopoulos P, Kiagia M, Papadopoulou O, Pefanis A et al. Serial serum procalcitoninchanges in theprognosis of acutestroke. ClinChimActa. 2004;350(1-2):237-9. doi: 10.1016/j.cccn.2004.08.002
- 14. Walz W, Mukerji S. Lactateproductionandrelease in culturedastrocytes. NeurosciLett1988;86:296-300.
- 15. Schurr A, Rigor BM. Brain anaerobiclactateproduction: a suicidenoteor a survival kit? Dev Neurosci1998;20:348-57.
- 16. LaManna JC, Harrington JF, Vendel LM, bi-Saleh K, Lust WD et al. Regionalblood-brainlactateinflux. Brain Res 1993;614:164–70.
- 17. Brouns R, Sheorajpanday R, Wauters A, De Surgeloose D, Mariën P et al. Evaluation of lactate as a marker of metabolicstressandcause of secondarydamage in acuteischemicstrokeor TIA. ClinChimActa. 2008 Nov;397(1-2):27-31. doi: 10.1016/j.cca.2008.07.016.
- 18. Lei C, Wu B, Liu M, Chen Y. Associationbetween hemoglobin A₁C levelsandclinicaloutcome in ischemicstrokepatientswithorwithoutdiabetes. J ClinNeurosci. 2015 Mar;22(3):498-503. doi: 10.1016/j.jocn.2014.08.030.
- 19. Masrur S, Cox M, Bhatt DL, Smith EE, Ellrodt G et al. Association of AcuteandChronicHyperglycemiaWithAcuteIschemicStrokeOutcomes Post-Thrombolysis: FindingsFromGetWithTheGuidelines-Stroke. J AmHeartAssoc. 2015 Sep 25;4(10):e002193. doi: 10.1161/JAHA.115.002193.
- 20. Kocaman G, Dürüyen H, Koçer A, Asil T. RecurrentIschemicStrokeCharacteristicsandAssessment of Sufficiency of SecondaryStrokePrevention. Noro Psikiyatr Ars. 2015 Jun;52(2):139-144. doi: 10.5152/npa.2015.7499.
Relationship Between the Serum Levels of Procalcitonin, Lactate, HgA1c and Functional Outcome in Acute Ischemic Stroke Patients
Öz
Purpose:Prognostic parameters in stroke management are important for emergency department physicians to reduce mortality and morbidity. No parameters could be determined for prognosis in acute stroke. In this study, we aimed to determine whether serum procalcitonin(PCT), lactate and HgA1c levels at admission and changes of PCT and lactate levels in 2 hours were associated with short-term functional outcome (3rd day) after acute ischemic stroke.
Patients and Methods:This was a prospective observational prognostic test study. All consecutive patients admitted to the emergency department and diagnosed as the first episode of acute ischemic stroke were included in the study. On admission and 2nd hour, PCT and lactate levels and admission HgA1c levels were collected from all subjects. We aimed to correlate these values with Modified Rankin Scale (mRs) and mortality on the 3rd day and to determine their predictive value.
Results:There was no statistically significant difference in PCT and lactate values and in terms of PCT and lactate clearances between the favorable (mRS <2) and nonfavorable groups. There was a statistically significant difference between two groups in terms of HgA1c value. When the threshold value analysis was performed to determine the non-favorable outcome, the threshold value was determined as 5.7.
Conclusion:Our results demonstrate that ischemic stroke patients with higher levels of HgA1c at the time of initial presentation have an increased risk for poor functional neurological outcome at the 3rd day.
Anahtar Kelimeler
Kaynakça
- 1. Wang C, Gao L, Zhang ZG, Li YQ, Yang YL et al. Procalcitonin Is a StrongerPredictor of Long-TermFunctionalOutcomeandMortalitythan High-Sensitivity C-Reactive Protein in PatientswithIschemicStroke. MolNeurobiol. 2016;53(3):1509-1517. doi: 10.1007/s12035-015-9112-7.
- 2. Tu WJ, DongX, Zhao SJ, YangDG, Chen H. Prognosticvalue of plasmaneuroendocrinebiomarkers in patientswithacuteischaemicstroke. J Neuroendocrinol 2013; 25:771–778. doi: 10.1111/jne.12052.
- 3. Katan M, Moon YP, Paik MC, Mueller B, Huber A et al. ProcalcitoninandMidregionalProatrialNatriureticPeptide as Markers of IschemicStroke: TheNorthern Manhattan Study. Stroke. 2016;47(7):1714-9. doi: 10.1161/STROKEAHA.115.011392
- 4. Zhang Y, Chen Z, Tang Y, Shan W, Wang L et al. Associationbetweenprocalcitoninlevelsandcarotidatherosclerosis in acuteischemicstrokepatients. Int J Neurosci. 2018 Mar;128(3):237-242. doi: 10.1080/00207454.2017.1387114.
- 5. Yang DY, Tsai TH, Cheng CH, Lee CW, Chen SH et al. Simultaneousmonitoring ofextracellularglucose, pyruvate, lactateandglutamate in gerbilcortexduringfocal cerebralischemiabydualprobemicrodialysis. J Chromatogr A 2001;913:349–54.
- 6. Jo S, Jeong T, Lee JB, Jin YH, Yoon J et al. Initialhyperlactatemia in the ED is associatedwithpooroutcome in patientswithischemicstroke. Am J EmergMed. 2012 Mar;30(3):449-55. doi: 10.1016/j.ajem.2011.12.019.
- 7. Sunaga K, Miura K, Naruse Y, Sakurai M, Morikawa Y et al. Glycated hemoglobin and risk of stroke, ischemicandhemorrhagic, in Japanese men andwomen. CerebrovascDis. 2008;26(3):310-6. doi: 10.1159/000149579.
- 8. Cloonan L, Fitzpatrick KM, Kanakis AS, Furie KL, Rosand J et al. Metabolicdeterminants of whitematterhyperintensityburden in patientswithischemicstroke. Atherosclerosis. 2015 May;240(1):149-53. doi: 10.1016/j.atherosclerosis.2015.02.052.
- 9. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ et al. Guidelinesfortheearlymanagement of patientswithacuteischemicstroke: a guidelineforhealthcareprofessionalsfromtheAmericanHeartAssociation/AmericanStrokeAssociation. Stroke. 2013 Mar;44(3):870-947. doi: 10.1161/STR.0b013e318284056a.
- 10. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PPet al. STARD 2015: An UpdatedList of EssentialItemsforReportingDiagnosticAccuracyStudies. BMJ. 2015;351:h5527.doi: 10.1136/bmj.h5527.
- 11. Tian D, Zhang S, He X, Liu H. Serum procalcitonin as a diagnostic marker in acuteischemicstroke. Neuroreport. 2015 Jan 7;26(1):33-7. doi: 10.1097/WNR.0000000000000298.
- 12. Li YM, Liu XY. Serum levels of procalcitoninandhighsensitivity C-reactive protein areassociatedwithlong-termmortality in acuteischemicstroke. J NeurolSci. 2015;352(1-2):68-73. doi: 10.1016/j.jns.2015.03.032.
- 13. Miyakis S, Georgakopoulos P, Kiagia M, Papadopoulou O, Pefanis A et al. Serial serum procalcitoninchanges in theprognosis of acutestroke. ClinChimActa. 2004;350(1-2):237-9. doi: 10.1016/j.cccn.2004.08.002
- 14. Walz W, Mukerji S. Lactateproductionandrelease in culturedastrocytes. NeurosciLett1988;86:296-300.
- 15. Schurr A, Rigor BM. Brain anaerobiclactateproduction: a suicidenoteor a survival kit? Dev Neurosci1998;20:348-57.
- 16. LaManna JC, Harrington JF, Vendel LM, bi-Saleh K, Lust WD et al. Regionalblood-brainlactateinflux. Brain Res 1993;614:164–70.
- 17. Brouns R, Sheorajpanday R, Wauters A, De Surgeloose D, Mariën P et al. Evaluation of lactate as a marker of metabolicstressandcause of secondarydamage in acuteischemicstrokeor TIA. ClinChimActa. 2008 Nov;397(1-2):27-31. doi: 10.1016/j.cca.2008.07.016.
- 18. Lei C, Wu B, Liu M, Chen Y. Associationbetween hemoglobin A₁C levelsandclinicaloutcome in ischemicstrokepatientswithorwithoutdiabetes. J ClinNeurosci. 2015 Mar;22(3):498-503. doi: 10.1016/j.jocn.2014.08.030.
- 19. Masrur S, Cox M, Bhatt DL, Smith EE, Ellrodt G et al. Association of AcuteandChronicHyperglycemiaWithAcuteIschemicStrokeOutcomes Post-Thrombolysis: FindingsFromGetWithTheGuidelines-Stroke. J AmHeartAssoc. 2015 Sep 25;4(10):e002193. doi: 10.1161/JAHA.115.002193.
- 20. Kocaman G, Dürüyen H, Koçer A, Asil T. RecurrentIschemicStrokeCharacteristicsandAssessment of Sufficiency of SecondaryStrokePrevention. Noro Psikiyatr Ars. 2015 Jun;52(2):139-144. doi: 10.5152/npa.2015.7499.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Temmuz 2021 |
| Gönderilme Tarihi | 25 Ekim 2019 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 12 Sayı: 3 |
