Influence of Acute Phase Biomarkers on Mortality and Functional Outcome in Adults with Acute Ischemic Stroke in North-western Nigeria

Abstract

Background: Stroke play a leading role in emergency admissions in developing countries and has contributed immensely to the huge financial burden to both the patient and the society especially in sub-Saharan Africa. Assessment of some routine acute phase biomarkers may aid in predicting mortality and functional outcomes in acute ischemic stroke. Objectives: To assess the role of routinely estimated C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), and platelet count in predicting mortality and short-term functional outcomes among patients with AIS in Kano, North western Nigeria. Methods: A case-control study where one hundred and twenty acute ischemic stroke patients and sixty age and sex matched healthy controls, were enrolled over a period of 10 months. Data on socio-demographic information and clinical characteristics were collected. Blood samples for acute phase biomarkers; C-reactive protein (C-RP), Erythrocyte sedimentation rate (ESR), and platelet count were collected and analyzed. The patients were followed up for 30-days and data on mortality and functional outcome using Modified Rankin Scale (MRS) was collected and analyzed using SPSS version 20.0 (IBM Armonk, NY). Results: The mean age of patients and their controls were 61.9±11.8 years and 61.8±12.4years and were predominantly of female gender (cases, 70/120 vs controls, 35/60). The mean of CRP, ESR, and platelets count for the cases and controls were 77.6±23.7 mg/L vs. 6.3± 2.8 mg/L, 53.4±30.2mm/hr vs. 12.2± 8.1mm/hr and 182.5±19.1/μL vs 251.4± 53.8/μL respectively. NIHSS was shown to independently predict 30-day mortality (Adjusted HR 1.10; 95% CI:1.02-1.18), p=0.011) after AIS. Additionally, elevated SBP, DBP, NIHSS and C-RP were shown to be associated with a poor 30-day functional outcome. Conclusion: The study showed that elevated levels of serum C-RP and ESR and a reduced platelet count predict higher mortality and poor functional outcomes in acute ischemic stroke. Assessment of some inexpensive routinely estimated acute phase biomarkers will guide therapy and help reduce overall mortality and improve short term functional outcomes in our resource-challenged environment.