Background: Ischemic stroke comprises 85% of all stroke cases. Stroke is the third major cause of mortality worldwide and an important cause of long term disability contributing to major economic burden in most of the countries. Since inflammatory response is a key factor for ischemic damage of neurons, the markers of inflammation are supposed to have some predictive value in outcome of the ischemic stroke patients.
Objective: The purpose of this study was to estimate the biochemical markers of inflammation and atherosclerosis (CRP and TNFα) in acute ischemic stroke patients and compare them with controls. Also to correlate these parameters with stroke severity, short term outcome after 7 days and long term outcome at 6 months using modified Rankin scale and Barthel Index.
Method and Material: The present study was conducted on 45 acute ischemic stroke patients and 80 age and sex matched. The biochemical markers of inflammation and atherosclerosis (CRP and TNFα) in acute ischemic stroke patients were estimated and compared with controls. These parameters were analyzed for correlation with stroke severity (NIHSS), short term outcome after 7 days and long term outcome at 6 months using modified Rankin scale, Barthel Index and DWI MRI volume of infarct. The first blood sample was taken within 72 hours of onset of stroke and second sample was taken 7 days following the first sampling
Results: Broadly the results showed that CRP and TNF α levels on the day of admission were higher in the experimental group as compared to controls. Difference was statistically significant. After 7 days, the levels of serum CRP and TNF α were high when compared to controls, however, the difference between day 1 and day 7 were not found to be statistically significant. When the biochemical parameters were correlated with the severity of stroke in NIHSS score, it was found that CRP on the day of admission and around 7th day correlated significantly with the severity of stroke assessed on both occasions. Correlating with the DWI MRI, volume of infarct, it was found that CRP on the day of admission as well as after 7 days correlated with the volume of infarct, therefore CRP levels correlate with the extent of tissue damage following ischemia. TNFα level did not correlate with the volume of infarct. CRP levels around 7th day also correlated with short term and long term outcome of patients assessed by modified Rankin scale and Barthel Index.
Conclusion: Measuring CRP around one week following the stroke has the greatest prognostic value.
Key words: TNF alpha, C-reactive protein, acute ischemic stroke, serum, Barthel index, Rankin scale