Investigation of neutrophil lymphocyte ratio and thiol disulfide balance in patients who have diagnosis of ischemic stroke in the emergency department and comparisons of 28-days mortality.

Introduction and Objective: Stroke is the leading cause of increased mortality/morbidity in general and ischemic stroke is the most frequent among all the strokes. Rapid diagnosis and effective treatment in ischemic stroke patients is the most effective weapon in reducing mortality and morbidity. In emergency departments, where this is the first point of reference, it is always necessary to have prognostic markers for these patients. We aim to demonstrate the relationship between calculated neutrophil lymphocyte ratio and oxidative markers and the mortality / morbidity of the disease with this study. Materials and Methods: 143 patients with ischemic stroke who were admitted to Atatürk Training and Research Hospital Emergency Department of Ankara Yıldırım Beyazıt University between 18.03.2017 ve 30.11.2017 were included in the study as "patient group" and 85 healthy volunteer "control group" of similar age group with no complaints. The control group was selected from the individuals who came to the internal medicine policlinic for routine control, who had no additional disease and who agreed to participate in the study. Two groups recorded age, sex, neutrophil, lymphocyte, platelet, urea, creatinine, albumin, native thiol (NT), total thiol (TT), disulfide (D), ischemic modified albumin (IMA) and ferroxidase values. Rates of neutrophil / lymphocyte (NLO), platelet / lymphocyte (PLO), index 1 (disulfide / native thiol), index 2 (disulfide / total thiol), index 3 (native thiol / total thiol) was recorded. In addition to complate blood count and biochemical tests, no additional blood samples were taken for the oxidation parameters studied. Oxidative parameters were studied from blood samples already taken in the biochemical tube. Results: Of the 143 patients taken to study, 67 were female (49,6%) and 76 were male (53,1%). The mean age was 71.99 years ± 11.57 years. There was no difference between patient and control group for age parameter. The platelet count was lower in the patient group (median: 277x10³, min: 98x10³ max: 473x10³; median for the control group: 258x10³ min: 72x10³ max: 575x10³; p= 0.02 Mann Whitney U-test). The neutrophil count and NLO were higher in the patient group (median for neutrophil in the patient group respectively: 5600/μL min: 900/μL max: 19900/μL, median for NLO: 3.64 min: 0.90 max: 33.17, median in control group: 4580 min: 1820 max: 12740, p< 0.01, p= 0.01 Mann Whitney U-test, respectively). At the end of the 28th day, albumin was found to be lower in the exited group (median in living: 4,19 g/dL min: 2,96 g/dL max: 5,0 g/dL excitus group median: 4,02 g/dL min: 2,79 g/dL max: 4,53 g/dL; p= 0,021; Mann Whitney Utest). Within the continuous variables only the normal distribution of NT and TT parameters was observed. NT and TT values were lower in the patient group (p= 0,002, p= 0,007, independent samples t-test, respectively) while IMA values were higher in the patient group (p< 0.001, Mann Whitney U-test). Albumin was found to be lower in patients with mortality than in non-mortal patients (p<0,021; Mann Whitney U-test). However, albumin was not a strong marker for mortality. Conclusion: Neutrophil and NLO values were higher in patients with ischemic stroke and were not associated with mortality. NT and TT values were lower in the patient group but not related with mortality. This may be due to an increase in oxidant end products. IMA is higher in the patient group. Although the albumin was associated with mortality in the patient group but it was not predicted as a strong marker. In conclusion, our study demonstrated the importance of inflammatory markers and oxidative parameters in ischemic stroke patients.