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Morbidity predictors in ischemic stroke
J N Panicker1, M Thomas, K Pavithran
1Department of Hematology, Medical College, Thiruvananthapuram, Kerala, India. tatsat@vsnl.com
Insights
Predicting long-term outcomes in ischemic stroke patients is crucial. Early assessment of upper limb power, aphasia, and C-reactive protein (CRP) levels can stratify patients for tailored rehabilitation.
Area of Science:
- Neurology
- Clinical Medicine
- Biomarkers
Background:
- Ischemic cerebrovascular accident (CVA) is a major cause of death and disability.
- Predictive parameters for long-term outcomes in ischemic stroke patients, particularly in India, require further clarification.
Purpose of the Study:
- To identify clinical and biochemical parameters for predicting long-term functional outcomes in Indian patients with ischemic stroke.
- To stratify patients based on predicted prognosis for optimized treatment and rehabilitation planning.
Main Methods:
- A prospective study involving 105 ischemic stroke patients.
- Assessment of focal neurological deficits, functional status (Barthel Index), and C-reactive protein (CRP) levels at admission.
- Follow-up at 6 months to evaluate functional status and categorize disability levels.
Main Results:
- Reduced upper limb power (MRC grade < 4), presence of aphasia, or positive CRP assay at admission were associated with severe disability at 6 months.
- Good upper/lower limb power (MRC grade > 3), absence of aphasia, and negative CRP assay predicted mild disability at 6 months.
- A follow-up rate of 86% was achieved.
Conclusions:
- Clinical and CRP parameters at admission can effectively stratify ischemic stroke patients by predicted long-term prognosis.
- This stratification enables personalized planning of treatment and rehabilitation strategies for improved patient management.
Background:
Although ischemic CVA is one of the leading causes for death and disability, parameters for predicting long-term outcome in such patients have not been clearly delineated, especially in the Indian context.
Methods:
A prospective hospital-based study of 105 patients of ischemic stroke, focal neurological deficits and functional score was assessed and the C-reactive protein level (CRP) was measured. A follow-up was done at 5 days and at 6 months and outcome variable was the functional status at 6 months using Barthel Index of Activities of Daily Living. Accordingly, patients were grouped into 3 - Barthel Index < 41: Severely disabled, Barthel Index 41-60: Moderately disabled and Barthel Index > 60: Mildly disabled.
Results:
At admission, if upper limb power was less than Medical Research Council (MRC) grade 4, or aphasia was present or CRP assay was positive, then at 6 months, these patients most likely belonged to the severely disabled group. If upper limb or lower limb power was greater than MRC grade 3 or there was no aphasia or conjugate gaze deviation or CRP assay was negative, these patients most likely belonged to the mildly disabled group at 6 months. Follow-up rate was 86%.
Conclusion:
Patients can be stratified according to the predicted prognosis. The treatment and rehabilitation can be properly planned and strictly adhered to in patients predicted to have worse prognosis.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
01:15Ischemic Stroke ll: Pathophysiology