The releationship between ggt, mpv, nlr, rdw with prognose and mortality in patients admitted emergency department with acute ischemic stroke

Stroke is the third most common cause of death after cardiac diseases and cancers and is also one of the most common causes of morbidity and mortality both in Turkey and around the world. In addition, it is the major cause of morbidity and long-term disability in Europe. In elderly people, it is known to be the second most common cause of dementia and one of the most common causes of depression. In Turkey, stroke represents the third most common cause of death (1). In USA, almost 800,000 cases of stroke are reported every year and around 20% of these patients die within the same year. Stroke-related mortality and morbidity rates are remarkably high; therefore, early prediction of mortality is of prime importance for these patients. In the present study, we aimed to evaluate serum levels of gamma glutamyl transferase (GGT), mean thrombocyte volume (MPV), red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) as well as lateralization, localization, and size of ischemic stroke, subtypes of stroke, and clinical progress and prognosis of stroke in patients that presented to our emergency service with a diagnosis of ischemic stroke and also to investigate the relationship between Glasgow coma scale (GCS), National Institution Health Stroke Scale (NIHSS) and mortality and ultimately to identify guiding parameters for the diagnosis and treatment of stroke. After obtaining the ethical approval from the Local Ethics Committee, a total of 473 patients who presented to our emergency service between January 1, 2013 and April 30, 2015 and had a diagnosis of stroke in accordance with the inclusion criteria of the study were enrolled in the study. In addition, a control group was formed with 40 age- and gender-matched healthy individuals. During data collection, age, gender, time from onset of stroke to hospital admission, systolic and diastolic blood pressure at presentation, presence of atrial fibrillation (AF) on electrocardiography (ECG), medical history, ECG findings, GCS, NIHSS, brain tomography or magnetic resonance findings, TOAST and OCSP classifications, relevant laboratory parameters, and clinical outcome were recorded for each patient. All data were analyzed using SPSS 22.0 (SPSS Inc., Chicago IL, USA). The 473 patients included 236 (49.9%) men and 237 (50.1%) women. Total mortality occurred in 58 (12.3%) patients, including 31 (53.4%) women and 27 (46.6%) men. Mean age was 74.47+11.21 years in the mortality group and 61.00+15.70 in the surviving group. Of the 473 patients, 206 (43.6%) were literate and 267 (56.4%) were illiterate. A significant correlation was found between the presence of AF on ECG, multiple attacks, hypertension, diabetes mellitus, and intracranial hemorrhage and mortality. Similarly, a significant correlation was found between the presence of atherosclerotic infarct according to the TOAST classification, the presence of TACI according to the OCSP classification and mortality, and a positive correlation was found between decreased GCS, increased NIHSS and mortality. In the patient group, mean GGT, MPV, RDW, and NLR values were higher compared to the control group. No significant difference was found between the genders in terms of GGT, MPV, RDW, and NLR values. According to the TOAST and OCSP classifications, GGT, MPV, RDW, and NLR values were higher in the patient group compared to the control group. However, increased NIHSS and decreased GCS were found to be associated with increased GGT, MPV, RDW, and NLR. Moreover, GGT, MPV, RDW, and NLR were significantly higher in the mortality group than in the surviving group. We concluded that serum parameters including GGT, MPV, RDW, and NLR are simple, inexpensive and easily reachable tools that can be used in the prediction of prognosis and mortality in patients with ischemic stroke.