A Study on Prognostic significance of Serum Ferritin in patients with Acute Ischemic Stroke

BACKGROUND : Iron is an essential element for the human body. Iron-dependent free radicals formation has been related to greater damage in cerebral ischemia. This study analysed whether increased body iron stores measured as serum ferritin, were associated with early neurologic worsening on the outcome in patients with acute ischemic stroke. AIM & OBJECTIVE : 1. To analyze the prognostic significance of serum ferritin with severity of Stroke in correlation with stroke scales (NIHSS and MRS). 2. To study the relationship between serum ferritin and various risk factors for Stroke. MATERIALS AND METHODS : This was a cross sectional study (prospective) in which 60 patients who had acute ischemic stroke was included for study. Those patients who got admitted within 24 hours of stroke onset only were taken for study .The data of each patient will be collected on a proforma specially designed for this study and which includes demographic details, clinical features, past medical history, clinical and Lab values which will be analysed for statistical significance and correlation. Clinical status was determined by the NIHSS scale at admission and by MRS scale 4 weeks later. Serum ferritin levels were assayed on admission. RESULTS : Among 60 patients 35 patients had high serum ferritin [ ≥ 300 mg/l (male) , ≥200 mg/ml (female ) ] and 25 patients had normal ferritin value. Out of these 35 cases that have high serum ferritin, 37.14% of cases come under moderate category and 62.86% cases come under severe category. On the other hand, among the remaining 25 cases who had normal serum ferritin, all the 22 cases come under moderate group and none in severe group. Pearson’s r correlation also reveals positive correlation between serum ferritin and NIHSS scores. Pearson’s r value is 0.613. A positive correlation exists between these 2 variables with a statistically significant ‘p’ value. Out of 35 cases with high serum ferritin, 5 cases were in good outcome category and 30 cases in poor outcome category of MRS scores. In contrast among 25 cases with normal serum ferritin, 17 cases were in good outcome (MRS) and 8 cases were in poor outcome (MRS). Pearson’s r correlation analysis reveals positive correlation between serum ferritin and MRS. Pearson’s r value is 0.560 and is positive variable. Any increase or decrease in serum ferritin score analogous linearly with increase/decrease severity score of NIHSS. Increase in serum ferritin will favors the poor outcome of patients in terms of death and severe disability. CONCLUSIONS : High ferritin concentration within the first 24 hours from the onset of ischemic stroke are associated with early neurologic deterioration. Increased body iron stores may contribute to stroke progression by enhancing the cytotoxic mechanisms in cerebral ischemia. More research is needed to determine the origin of increased serum ferritin levels and the therapeutic implications. Antioxidants can be added as a part of treatment protocol in patients with Acute Ischemic stroke. Drugs like Desferroxamine can be used to reduce serum ferritin levels