Prognostic Significance of Serum Ferritin Concentration in Patients with Acute Ischemic Stroke

INTRODUCTION: With the advent of promising therapies for Acute Ischemic stroke, comes a higher expectation for rapid recovery and good outcome. Despite these new therapies, poor outcome may still occur because ischemic stroke is a heterogenous disease in which outcome is influenced by many factors. The extent of brain Injury and the resultant outcome from inchemia is largely dictated at a physiological level by the severity and duration of the insult. Outcome is further influenced by genetic predisposition, temperature, glucose and other unknown factors. For a Longtime serum ferritin was measured only to know the stored Iron status. Now it has been suggested that it influences the prognosis of Ischemic stroke and also acts as a risk factor for Ischemic episodes by enhancing atherogenesis. AIM: To study the prognostic significance of serum ferritin concentration in patients with Acute Ischemic stroke. MATERIALS AND METHODS: Setting: Medical wards, Government Stanley Hospital. Study Design: Single center observational prospective hospital based study. Period of Study: February 2005 to February 2006. Government Stanley Hospital is a tertiary care institute and referral center for patients from all over south India. All stroke patients admitted within the above period and who satisfied the set criteria were included. Inclusion Criteria: Patients with stroke as defined by WHO criteria. Rapidly developing clinical signs of focal or global (coma) neurological deficit lasting more than 24 hrs or leading to death with no apparent cause other than Vascular origin. All patients who presented within 48 hrs of onset of stroke and who gave informed consent to participate in the study were included. Exclusion Criteria: Patients with sub arachnoid haemorrhage, extra dural haemorrhage, sub dural haemorrhage and intra cerebral haemorrhage were excluded by CT scan brain. As ferritin is an Acute phase reactant samples are taken with in 48 hrs of onset38 and patients with high ESR / CRP were excluded. Diagnostic procedures, treatment and all stages of rehabilitation took place according to prevailing norms and protocols. The treating physicians advice was exercised if and when found necessary. Serum Ferrtin was measured when the patient was admitted and was correlated with functional recovery of the patients after 4 weeks. Patients were reviewed 4 weeks after onset of stroke and were stratified using glasgow outcome scale(GOS). GOS was used to assess the functional outcome and residual neurological deficits. CONCLUSION: In patients with Acute Ischemic stroke, • Serum ferritin levels can be used as a prognostic indicator. • Antioxidants can be added as a part of treatment protocol in patients with Acute Ischemic stroke. • Iron restriction should be done in persons with high risk for Ischemic Stroke. • Serum ferritin measurement should be routinely done in high risk patients like serum glucose and cholesterol measurement. Drugs like Deferroxamine can be used to reduce serum ferritin levels