Correlation between Serum Vitamin A and D Levels in Acute Phase Ischemic Stroke and Clinical Outcome

Abstract

<jats:sec> <jats:title>Background:</jats:title> <jats:p>In the last decade, a number of studies have examined the relationship between serum vitamin D concentration and the risk of cerebrovascular events. Besides vitamin D, the latest evidence shows that vitamin A is also a risk factor for cerebrovascular disease. Vitamin A and its derivatives act biologically <jats:italic>via</jats:italic> specific nuclear receptors that regulate gene transcription. Vitamin A receptors can also interact with other nuclear receptors that have neuroprotective effects such as vitamin D, against stroke. Although many studies suggested the synergism of vitamin A and D, there is still no study that evaluates their levels simultaneously in acute phase ischemic stroke, and the relationship to outcome.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective:</jats:title> <jats:p>The objective of this study was to analyze the correlation between serum vitamin A and D levels on admission in Acute Ischemic Stroke patients and clinical outcome by using the National Institutes of Health Stroke Scale (NIHSS).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A prospective cohort study was conducted, and samples were followed since the diagnosis of acute-phase Ischemic Stroke was established until the clinical outcome of day 14 after stroke onset. A total of 50 subjects enrolled for this study would be examined for serum levels of vitamins A and D on admission, and on the 14<jats:sup>th</jats:sup> day were assessed for NIHSS as a clinical outcome.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>From 50 research subjects, the mean of vitamin A and D level in the acute phase of Ischemic Stroke was 463.35 ± 116.97 µg/L and 21.65 ± 6.51 ng/mL, respectively. By using the Spearman’s correlation test, it was found that the acute phase vitamin A level and NIHSS on day 14 had a significant and strong correlation with p = 0.045 (r = -0.672). Along with it, vitamin D serum levels and NIHSS also had a significant and strong correlation with p = 0.026 (r = -0.754). Both of these results showed that vitamin A and D had an inverse association with NIHSS, meaning that the higher vitamin A and D serum levels, the better the clinical outcome would be.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Both serum vitamin A and D levels in the acute phase of Ischemic Stroke was correlated strongly with short time clinical outcome. The higher vitamin A and D serum levels in the acute phase, the better the clinical outcome would be for Ischemic Stroke patients.</jats:p> </jats:sec>

A systematic review examining the effect of vitamin D supplementation on functional outcomes post-stroke

“…Overall, five studies showed an improvement in stroke impairment. Kadri et al 18 and Hesami et al 24 both found improvements on the National Institute of Health Stroke Scale in the vitamin D supplementation group. Narasimhan et al 20 and Acharya et al 23 used the Scandinavian Stroke Scale, and while Narasimhan et al 20 noted statistical improvement, in the study by Acharya et al 23 an improvement was suggested, however only within group comparisons were reported (mean improvement in scores 12.59 in vitamin D group vs 3.25 in control group), with no standard deviations so between group differences could not be calculated.…”

“…A total of 43 articles underwent full text review of which 33 studies were subsequently excluded (Figure 1 and Appendix B for list of excluded studies at full text stage). Ten studies were included in this systematic review, including eight randomized controlled trials 7,[18][19][20][21][22][23][24] and two non-randomized studies of intervention, 3,25 examining a total of 691 patients (Table 1).…”

“…This impacts the ability to understand the findings clearly and to generalize to other areas. Second, there was wide variability in treatment protocols, with some providing vitamin D once (300,000–600,000 international units), 20 , 21 , 23 , 24 whereas others delivered the treatment on a daily (2000 international units), 3 , 19 , 22 weekly (50,000 international units), 18 , 25 or monthly (60,000 international units) 7 basis. Because of this, it is still unclear what the optimal dose of vitamin D for supplementation may be.…”

“…Because of this, it is still unclear what the optimal dose of vitamin D for supplementation may be. Additionally, inclusion criteria varied, with some studies appearing to include anyone regardless of vitamin D status, 18 , 19 , 22 , 25 while others only included those who were insufficient or deficient in vitamin D. 3 , 7 , 20 , 21 , 23 , 24 Overall, this variability limits the ability to draw conclusions on if and how individuals post-stroke should be supplemented. Third, although each study evaluated functional outcomes using common, validated outcome measures, there was little overlap between them, and results were often poorly reported, precluding combination for a meaningful meta-analysis.…”

Efektivitas Pemberian Vitamin D Selama Masa Perawatan Pada Pasien Stroke

“…Pada studi ini, didapatkan bahwa 7 artikel studi yang digunakan dalam evidence based case study ini menggunakan desain uji terkontrol acak atau randomized controlled trials (RCT) (Gupta et al, 2016;Hesami et al, 2022;Kadri et al, 2020;Karasu & Karataş, 2021;Narasimhan & Balasubramanian, 2017;Rezaei et al, 2021;Torrisi et al, 2021). Usia pasien yang terlibat dalam studi penelitian yang disertakan berkisar antara 18-80 tahun.…”