Serum ferritin and high sensitive c-reactive protein (hs-crp) value of levels in determination of functional prognosis in acute ischemic stroke patients

ABSTRACT In the acute phase of ischemic stroke, inflammation adversely affects the brain damage initiated by ischemia. The severity of this inflammatory response is related to early and late clinical outcomes of stroke. It would be very helpful to the clinician to identify new biochemical markers which may predict the early and late functional prognosis in terms of planning adequate rehabilitation programme of ischemic stroke patients. In regard to ischemic stroke, the predictive values of high sensitivity C-Reactive Protein (hs-CRP) and ferritin for functional disability after acute cerebral ischemic stroke is poorly defined. The aim of our study was to investigate the relationship between the levels of hs-CRP and ferritin with functional prognosis in acute ischemic stroke. A total of 62 patients with a diagnosis of ischemic stroke were included in this study. All the patients were examined initially within 48 hrs of after symptom onset. Ferritin and hs-CRP measurements were obtained on admission and at the 3 months control examination. Functional disability was evaluated using the Functional Independence Measure (FIM) and Functional Ambulatory Scale (FAS). Stroke severity was assessed by using American "National Institute of Health Stroke Scale (NIHSS)". These assessment scales were applied at initial and three months control evaluations. Patient population was grouped to hs-CRP levels as low hs-CRP levels (≤0,5mg/dl) and as high hs-CRP levels (>0,5 mg/dl). According to Oxfordshire Community Stroke Project Classification (OCPS), patients were subdivided into four clinical subgroups; total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI), lacuner infarcts (LACI) and posterior circulation infarcts (POCI). For statistical purposes, patients as grouped to the cortical involvement LACI and non-LACI and also TACI and non-TACI were compared in terms of hs-CRP, ferritin, stroke severity and functional prognosis. Results of this study pointed out that hs-CRP levels on admission were correlated with only the FIM scores on admission but not the 3 months controls. Neither the hs-CRP nor the ferritin levels were correlated to any of FAS and NIHHS scores. We could not find out any significant correlations between ferritin levels and FIM scores. Seven patients have died in the 3 months follow-up period. When the patients who died and who survived were compared, no significant differences were found by means of hs-CRP and ferritin levels . Patients in the TACI group had the most deleterious functional outcome while patients in the LACI group had the most favourable. There were no significant differences between high hs-CRP and low hs-CRP groups in regard to their functional outcome. Consequently; only the correlation between acute phase levels of hs-CRP and FIM scores was confirmed. Other correlations between the levels of hs-CRP and ferritin and other functional scales either studied initially or at 3 months time could not be revealed. Furthermore, FIM, FAS and NIHSS scores were more useful either to predict the functional outcome at 3 months after or to reveal the functional differences between the ischemic subgroups than the laboratory measures used in this study were. Keywords: Stroke, hs-CRP, ferritin, OCSP, FIM, FAS, NIHSS