The role of serum ferritin, pro-brain natriuretic peptide and homocysteine levels in determining ischaemic stroke subtype, severity and mortality

Abstract

Background: In ischaemic stroke, there are many biochemical and immunological reactions secondary to a reduced cerebral blood flow. The purpose of this Study is to investigate the correlation between stroke subtype, stroke severity, mortality, and serum ferritin, pro-brain natriuretic peptide (pro-BNP), homocysteine values before a specific treatment is given to stroke patients in the emergency department. Methods: Consecutive acute ischaemic stroke patients admitted between December 2007 and April 2008 were enrolled into the study. Serum ferritin, pro-BNP and homocysteine levels were Studied before specific treatment was carried Out. Stroke subtypes were determined according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and Oxfordshire Community Stroke Project (OCSP) criteria. The severity of stroke was determined by the National Institutes of Health Stroke Scale (NIHSS). Fifteen healthy individuals who matched the Study group in terms of sex and age were chosen as control. Results: Ninety-two patients were included in the study. There was a significant difference in the serum ferritin, pro-BNP and homocysteine levels between patients who died and those who survived (p=0.013, p<0.001 and p=0.003 respectively). Serum ferritin, pro-BNP and homocysteine levels were higher in all stroke subtypes than in the control group. Comparing among stroke subtypes, only serum pro-BNP levels were higher in the cardioembolic stroke group than in the atherothrombotic stroke and lacunar stroke groups (p=0.003 and p<0.001 respectively); and only serum pro-BNP levels were higher in the total anterior circulation infarct group than in the posterior circulation infarct and lacunar infarct groups (p=0.010 and p=0.017 respectively). Pro-BNP levels were significantly higher in patients with NIHSS score >15 than NIHSS=8-15 and NIHSS=1-7 (p=0.016 and p<0.001 respectively). Conclusion: Ferritin, pro-BNP and homocysteine levels were raised in acute ischaemic stroke patients. However, only serum pro-BNP level is clinically useful in predicting stroke subtype, severity and mortality that could provide an insight to the choice of treatment. (Hong Xong j.emerg.med. 2010;17:13-21)