Role of serum ferritin as a prognostic marker in acute ischemic stroke: A preliminary observation

Abstract

Background: Acute ischemic stroke is an important cause of morbidity and mortality. Search has been on to find out the factors which can help in formulating the prognosis of acute ischemic stroke. One of the prognostic indicators, which has gained great clinical interest in recent times, is serum ferritin. Aims: To assess the serum ferritin levels in patients with acute ischemic stroke and to study the role of serum ferritin as a prognostic marker in these patients. Materials and Methods: This prospective, observational study was conducted on 50 patients of acute ischemic stroke aged ≥18 years who presented within 48 hours of onset of symptoms. Clinical severity of stroke was assessed at admission and on the 6 th day using Canadian Stroke Scale (CSS), and serum ferritin levels were measured at admission and on the 6 th day in all these subjects. Results: The mean serum ferritin levels at admission in patients with “more severe stroke” (CSS score at admission ≤7) and “less severe stroke” (CSS score at admission >7) were 282.77 ± 120.53 and 205.12 ± 110.96 ng/mL, respectively. The mean serum ferritin levels at admission were 173.71 ± 109.69 ng/mL in subjects who did not deteriorate and 336.86 ± 57.28 ng/mL in those who deteriorated, while the mean serum ferritin levels on the 6 th day were 193.29 ± 101.88 and 343.95 ± 52.34 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 ( P < 0.001), and the levels correlate with the outcome of the disease ( P < 0.001); the patients with higher serum ferritin at admission tend to deteriorate more as compared to those with lower levels. Thus, serum ferritin can be used as a prognostic marker in acute ischemic stroke.

Acute Inflammation in Cerebrovascular Disease: A Critical Reappraisal with Focus on Human Studies

“…Ferritin reduction is related to cerebral ischemia-induced hippocampal ferroptosis [ 112 ]. A study found that increased serum ferritin levels correlate with severity of stroke and size of the lesion [ 113 , 114 ]. Additionally, elevated serum ferritin levels at admission were associated with post-stroke depression [ 115 ].…”

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].…”

“…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].…”

Body fluids biomarkers associated with prognosis of acute ischemic stroke: progress and prospects

“…In addition, plasma endostatin [ 76 ], brain natriuretic peptide (BNP) [ 77 , 78 ], serum ferritin [ 79 , 80 ], plasma fibroblast growth factor [ 81 ], plasma trimethylamine-N-oxide content [ 82 ], hypersensitive cardiac troponin [ 83 ], coagulant-related factors C-type lectin receptor 2 and anti-phosphatidylserine [ 84 , 85 ], circulating IGF-1 [ 86 ], plasma lipid metabolism [ 87-89 ], plasma D-dimer [ 90 ] and other biochemical metabolites may be related to the prognosis of AIS. For example, Yang et al prospectively included patients with AIS pneumonia associated with atrial fibrillation (AF) and found significant increases in 3-month mortality and severe residual risk associated with high D-dimer levels and pneumonia AIS, suggesting that plasma D-dimer has prognostic value [ 91 ].…”