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ISRN Stroke  2013 

Prognostic Value of Complete Blood Count and Electrolyte Panel during Emergency Department Evaluation for Acute Ischemic Stroke

DOI: 10.1155/2013/974236

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Abstract:

Objective. To determine whether routine laboratory parameters are predictors of early mortality after acute ischemic stroke (AIS). Methods. The cohort consisted of 522 consecutive patients with AIS presenting to the emergency department (ED) at a tertiary referral center during a 27-month period, residing within the surrounding ten counties. Serum laboratory values were obtained for all patients and categorized according to whether the levels were low, normal, or high. These laboratory results were evaluated as potential predictors of 90-day mortality using Cox proportional hazards models. The associations were summarized by calculating risk ratios (RRs) and 95% confidence intervals (CI). Results. The presence of elevated white blood cell count (RR 2.2, 95% CI 1.5–3.4), low bicarbonate (RR 4.2, 95% CI 2.6–6.7), low calcium (RR 2.9, 95% CI 1.4–5.9), and high glucose (RR 1.3, 95% 1.1–1.6) were each univariately associated with significantly higher mortality within the first 90 days. Based on fitting a multivariate Cox regression model, elevated white blood cell count, low bicarbonate, and high glucose were each identified as being jointly associated with early mortality ( ). Conclusion. Early leukocytosis, acidosis, and hyperglycemia and hypocalcemia in AIS appear to be associated with early mortality. Whether addressing these factors will impact survival remains to be investigated. 1. Introduction For patients who present with chief complaint of acute ischemic stroke, the American Stroke Association recommends a set of diagnostic studies [1] to be done at presentation, with the intent of optimizing and expediting the care of these patients. From the Emergency Physicians’ perspective many tests are simply part of a routine battery, often without direct impact on emergency department (ED) management, diagnostic or prognostic value. In this study, we sought to determine whether the routine complete blood count (CBC) and electrolyte panel include any components that are markers of early mortality in acute ischemic stroke. Specifically, the parameters of interest were those obtained as part of routine clinical investigation. 2. Methods 2.1. Study Design This study was an observational study using a consecutive sample of local residents presenting to the ED with acute ischemic stroke (AIS). The primary outcome measure was death at 90 days. This study was approved by the Mayo Clinic Institutional Review Board. 2.2. Study Population and Setting This study was conducted at the Saint Marys Hospital, a tertiary referral academic medical center with an annual ED

References

[1]  H. P. Adams, R. J. Adams, T. Brott et al., “Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association,” Stroke, vol. 34, no. 4, pp. 1056–1083, 2003.
[2]  C. D. Lee, A. R. Folsom, F. J. Nieto, L. E. Chambless, E. Shahar, and D. A. Wolfe, “White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African-American and White men and women: atherosclerosis risk in communities study,” American Journal of Epidemiology, vol. 154, no. 8, pp. 758–764, 2001.
[3]  L. Nadav, A. Y. Gur, A. D. Korczyn, and N. M. Bornstein, “Stroke in hospitalized patients: are there special risk factors?” Cerebrovascular Diseases, vol. 13, no. 2, pp. 127–131, 2002.
[4]  A. J. Grau, A. W. Boddy, D. A. Dukovic et al., “Leukocyte count as an independent predictor of recurrent ischemic events,” Stroke, vol. 35, no. 5, pp. 1147–1152, 2004.
[5]  C. S. Gray, R. Taylor, J. M. French et al., “The prognostic value of stress hyperglycemia and previously unrecognized diabetes mellitus in acute stroke,” Diabetic Medicine, vol. 4, no. 3, pp. 237–240, 1987.
[6]  C. J. Weir, G. D. Murray, K. R. Lees, and A. G. Dyker, “Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study,” British Medical Journal, vol. 314, no. 7090, pp. 1303–1306, 1997.
[7]  G. de Courten-Myers, R. E. Myers, and L. Schoolfield, “Hyperglycemia enlarges infarct size in cerebrovascular occlusion in cats,” Stroke, vol. 19, no. 5, pp. 623–630, 1988.
[8]  C. L. Voll, I. Q. Whishaw, and R. N. Auer, “Postischemic insulin reduces spatial learning deficit following transient forebrain ischemia in rats,” Stroke, vol. 20, no. 5, pp. 646–651, 1989.
[9]  L. S. Williams, J. Rotich, R. Qi et al., “Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke,” Neurology, vol. 59, no. 1, pp. 67–71, 2002.
[10]  A. Bruno, S. R. Levine, M. R. Frankel et al., “Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial,” Neurology, vol. 59, no. 5, pp. 669–674, 2002.
[11]  J. F. Scott, G. M. Robinson, J. M. French, J. E. O'Connell, K. G. M. M. Alberti, and C. S. Gray, “Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia. The glucose insulin in stroke trial (GIST),” Stroke, vol. 30, no. 4, pp. 793–799, 1999.
[12]  C. S. Gray, A. J. Hildreth, J. E. O'Connell, and G. K. Alberti, “The management of post stroke hyperglycaemia (the United Kingdom glucose insulin in stroke trial—GISTUK),” Stroke, vol. 34, no. 1, p. 249, 2003.
[13]  T. A. Baird, M. W. Parsons, P. A. Barber et al., “The impact of diabetes and hyperglycaemia on stroke outcome—the GRACE Study,” in Proceedings of the Stroke Society of Australasia, p. 18, Auckland, New Zealand, September 2001.
[14]  A. M. Demchuk, L. B. Morgenstern, D. W. Krieger et al., “Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke,” Stroke, vol. 30, no. 1, pp. 34–39, 1999.
[15]  D. E. Saunders, F. A. Howe, A. van den Boogaart, M. A. McLean, J. R. Griffiths, and M. M. Brown, “Continuing ischemic damage after acute middle cerebral artery infarction in humans demonstrated by short-echo proton spectroscopy,” Stroke, vol. 26, no. 6, pp. 1007–1013, 1995.
[16]  C. S. Robertson, R. G. Grossman, J. C. Goodman, and R. K. Narayan, “The predictive value of cerebral anaerobic metabolism with cerebral infarction after head injury,” Journal of Neurosurgery, vol. 67, no. 3, pp. 361–368, 1987.
[17]  H. Kuyama, T. Kitaoka, K. Fujita, and S. Nagao, “The effect of alkalizing agents on experimental focal cerebral ischemia,” Acta Neurochirurgica, vol. 60, pp. 325–328, 1994.
[18]  R. E. Anderson and F. B. Meyer, “Protection of focal cerebral ischemia by alkalinization of systemic pH,” Neurosurgery, vol. 51, no. 5, pp. 1256–1266, 2002.
[19]  Y. Sato, H. Kuno, M. Kaji, K. Etoh, and K. Oizumi, “Influence of immobilization upon calcium metabolism in the week following hemiplegic stroke,” Journal of the Neurological Sciences, vol. 175, no. 2, pp. 135–139, 2000.
[20]  R. Jayasinghe and P. Kovoor, “Drugs and the QTc interval,” Australian Prescriber, vol. 25, no. 3, pp. 63–65, 2002.

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