A Study on the correlation between platelet indices and severity score in acute ischemic stroke

A Study on the correlation between platelet indices and severity score in acute ischemic stroke Govind D.1, Malleswara Rao M.2*, Sudheer K.3 DOI: https://doi.org/10.17511/ijmrr.2020.i05.04 1 Dasari Govind, Assistant Professor, Department of Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India. 2* Mallipeddi Malleswara Rao, Associate Professor, Department of Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India. 3 Sudheer K., Professor, Department of Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India.


Introduction
Acute ischemic stroke is not only a severe disabling cerebrovascular event [1] but also has a great impact on a patient's life and socioeconomic burden [2]. Although it can be prevented by controlling relevant risk factors [3], its prevalence and incidence remain rising with the aging and atherosclerotic process [4]. It is the comment cause of mortality after coronary artery disease and the commonest cause of chronic adult disability [5].
Acute ischemic stroke results from the sudden loss of blood circulation to an area of cerebral hemispheres leading to irreversible brain injury and neurological deficits persisting for more than 24 Since Acute Ischemic stroke is an inflammatory event where the ischemic tissue releases chemokines and cytokines, and recruit peripheral circulating leucocytes [16]. Lymphocytes also infiltrate the ischemic tissues and mediate inflammatory responses [16]. Among the leucocytes, neutrophils were found to be an important mediator and early neutrophilia was found to be associated with larger stroke volumes and poor prognosis [17].
In recent years, the platelet to lymphocyte ratio (PLR) has emerged as a well-accepted biomarker for the assessment of overall inflammatory status.
These are simple and cost-effective biomarkers [18].
Elevated levels of PLR are related to oxidative stress and increased cytokine production in patients [19].
The PLR has been used to predict poor prognoses, the rate of insufficient recanalization, and the size of the infarcted area following stroke [20].

Aim of the Study
Our present study aims to investigate the relationship between platelet indices and stroke severity scores in acute ischemic stroke.

Materials and Methods
The study is conducted in the Department of

Results
In the present study, out of 80 patients, 64 were males and 16 were females. Most of the patients were in the 50-70 years age group.
Around 62.5% were in the 45-60 years age group, 26.25% were in the 61-70 years age group. 6.25% were in the <45 years age group and 5% were in the >70 years age group (Table 1).  Table   2. In the present study, these 80 patients are divided into two groups basing on the National Institute of Health Stroke Scale (NIHSS) score.
The set of patients whose NIHSS score is less than 6 is taken as 'Group 1' and the set of patients whose NIHSS score is more than or equal to 6 is taken as 'Group 2'. The number of patients under 'Group 1' is 46 and those under 'Group 2' are 34. In the present study, the laboratory findings showed that Leukocyte count, Neutrophil, Lymphocyte, and Platelet count doesn't differentiate between these two groups of patients (Table 3).

Data Expressed is Means ± standard deviation
In the present study, the platelet indices don't differ significantly between these two groups of patients (Table 4).
But Platelet-to-Lymphocyte ratio is significantly more in Group 2 thereby indicating a positive correlation of PLR with a high Stroke Severity Score and poor prognosis (Table 5).  [21] with the prevalence percentage of hypertension as 74% and A.Muscari et al [22] with the prevalence of 84%. Diabetes is the second prevalent cause which was in lines with studies conducted by Lok U et al [21], George J et al [23], and Maydadomac F et al [24]. Dyslipidemia being the least prevalent risk factor in the present study which is 33.7% is similar to the study by Muscari A et al [22] which is 40.1%. The laboratory findings showed that the leukocyte, neutrophil, lymphocyte, and platelet counts did not differ between these two groups of patients. There is no sign of these findings since it is almost similar in both groups with NIHSS < 6 and those with NIHSS > 6. In the present study, there is no sign of MPV concerning Stroke Score which is consistent with the study conducted by Al-Tameemi et al [25] but studies conducted by Butterworth et al [26], Ghahremanfard F et al [27] and Shah P et al [28] have shown significant raise in the MPV. There is also no significance of PDW in the present study which is consistent with the study conducted by Al-Tameemi et al [25] but a study conducted by; Shah P et al [28] has shown significant raise in the PDW.
Some studies have shown that there is an increase in these platelet indices in stroke patients in comparison to healthy patients but these indices are not significant to differentiate the stroke severity score. The present study showed a positive relationship between PLR and Stroke Severity Score.
There is a significant rise in PLR in patients with NIHSS score >6 i.e., Group 2. This is consistent with a study conducted by Pei Hsun sung et al [29].

Conclusion
The present study has shown a significant difference in the values of PLR about Stroke Severity Score. Therefore, PLR is strongly related to the Stroke Severity Score thereby associated with the prognosis of the stroke.

What does the study add to the existing knowledge
There is no significant difference in MPV and PDW concerning Stroke Severity Score but these platelet indices can be used as biomarkers in stroke patients since there is a significant rise in these indices in stroke patients to healthy people.
It is also found that Hypertension is the most predominant risk factor among ischemic stroke patients.