Evaluation of serum ferritin as a prognostic marker in acute ischemic stroke: a prospective observational study

Abstract

Background: Stroke is an important health problem causing of morbidity and mortality globally. Serum ferritin has gained clinical significance as a prognostic factor that can aggravate the cytotoxicity of brain ischemia. The present study investigated the prognostic significance of serum ferritin levels with the severity of stroke using NIHSS scale.Methods: It was a prospective observational study conducted on 60 patients with acute ischemic stroke admitted in the general medicine department of a tertiary care teaching hospital. Serum ferritin levels were assessed on all participants using the instrument “immulite”. National institute of health stroke scale scoring was applied at the time of admission and on the seventh day to assess the impairment caused by a stroke. IBM SPSS version 22 was used for statistical analysis.Results: The mean serum ferritin levels at admission in patients with severe stroke, moderate stroke and mild and less stroke were 337.41±58.76, 285.56±49.37, and 197.91±111.01 ng/mL, respectively. The mean serum ferritin levels at admission were 178.76±114.70 ng/mL and 341.91±62.292 ng/mL in subjects who did not deteriorate and those who deteriorated, respectively. Whereas the mean serum ferritin levels on the sixth day were 198.34±106.88 and 348.10±57.34 ng/mL in subjects who did not deteriorate and those who deteriorated, respectively.Conclusions: Serum ferritin has a significant positive correlation with the severity of acute ischemic stroke severity on admission (p<0.001) and negative correlation with the severity of acute ischemic stroke severity on seventh day of admission (p<0.001). Thus, serum ferritin can be used as a prognostic marker in acute ischemic stroke.

Effects of Hyperferritinemia on Functional Outcome in Acute Ischemic Stroke Patients with Admission Hyperglycemia

“…Another study in 79 North Indian AIS patients showed ferritin >370 ng/mL significantly increased the risk of having bad 6-month outcome (defined as mRS ≥2) [14]. Another two observational studies performed Pearson's r correlation and found admission serum ferritin level was correlated with Canadian stroke scale scores on the 6th day (p < 0.001) [16] and mRS score after 4 weeks (p = 0.00001) [17], which can be used as a prognostic marker in AIS patients. Controversially, higher admission serum ferritin could not predict 3-month functional disability assessed by the Functional Independence Measure and Functional Ambulation Scale in 62 AIS patients [18].…”

“…The interval time from stroke onset to blood sampling may affect the association between serum ferritin level and clinical outcome if there was a dynamic change in serum ferritin levels. Most of the previous studies only investigated the relationship between initial ferritin level and clinical outcome [14,17,18]. Few studies reported no sharp increase during the first 72 h after thrombolysis [15] or at 3 months after stroke onset [18].…”

“…However, whether elevated serum ferritin is related to poor outcome of AIS patients remains controversial. Some studies reported elevated serum ferritin is related to poorer prognosis of ischemic stroke [14][15][16][17], whereas other study found higher serum ferritin could not predict functional disability at 3 months [18]. Besides, high iron status may have a cooperative effect on the process of cell damage and dysfunction induced by hyperglycemic status [19,20].…”

Serum Ferritin Levels as a Prognostic Indicator in Acute Ischemic Stroke: A Comprehensive Clinical Study

“…Serum ferritin is one of the predictive biomarkers that have recently gained considerable clinical attention. Serum fibrillation was initially thought of as a stressrelated response to stroke but is now being studied as a prognostic marker [16][17][18].…”