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July2010 Vol.47 Issue:      3 (Supp.) Table of Contents
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Stroke Mortality: Predictive Value of Simple Laboratory Tests and APACHE III Scoring System

Wafik M. El-Sheikh

 

Department of Neurology, Minoufiya University; Egypt

 



ABSTRACT

Background: Stroke is the third major cause of death worldwide, and physicians are required to predict the outcome, as early as possible. Objective: Study the prognostic value of routine some simple blood parameters and APACHE III scoring system (Acute Physiology, Age, and Chronic Health Evaluation), on the first month fatality in patients of first-time acute stroke. Methods: Ninety-three stroke patients, (first-time), within 48 hours of onset were included. Clinical evaluation; neuroimaging, blood and urine investigations and APACHE III scoring system were performed. Patients followed up for a maximum period of 1 month from the onset of stroke. Logistic regression analysis carried out among the significant parameters to identify independent predictors of fatality. APACHE III score was correlated with the outcome within the first month. Results: Seventeen patients (18%) out of the 93 died during the first month. Logistic regression analysis of the blood parameters and Glasgow Coma Scale (GCS) demonstrated that, a low GCS score along with some parameters such as high serum creatinine, Serum glutamic pyruvic transaminase (SGPT), erythrocyte sedimentation rate (ESR) and total leukocyte count (TLC) correlated with death. The sensitivity of APACHE III scoring system was 88% and 89%, for cerebral hemorrhage (C.hge) and cerebral infarction (C.infarction) respectively. Conclusion: Impaired consciousness, high TLC, ESR, creatinine and SGPT levels, estimated within 48 hours of stroke onset, are the most important indicators of 1-month mortality in patients with first-time stroke. Also APACHE III scoring system was found to be sensitive and reasonably specific in predicting short term outcome. [Egypt J Neurol Psychiat Neurosurg. 2010; 47(3): 489-495]                                     

 

Key Words: mortality-prediction- stroke.

 

Correspondence to Wafik M. El-Sheikh, Department of Neurology, Minoufiya University; Egypt.

Tel.: +20105257956. Email: dr.wafeek@yahoo.com.





INTRODUCTION

 

Stroke is the third major cause of death worldwide and the second in the western world after heart disease and before cancer. The world wide incidence has been quoted as 2/1000 population/ annum and about 4/1000 in people aged 45-84 years.1

In Egypt the incidence of cerebrovascular disease was found to be 2.5/1000 population/year in a study conducted at the New Valley by the department of neurology Assiut university at 2007. The prevalence and incidence rates in Assiut study, increase steadily with advancing age to be 53.8/1000 (prevalence) and 23.1/1000 (incidence) among aged persons (>60 years)2. A WHO study, in 1990 quoted incidence of mortality due to stroke in developing countries to be 73/100,000 per year3. Physicians are faced with the task of predicting the immediate and long term outcome in variety of emergency situations, but it is most difficult to do so in stroke patients. The survival, recovery and ultimate outcome in stroke patients depends on various variables as shown in Table (1).

 

Table 1. Factors Associated with Poor Outcome- after Stroke.4

 

1-                Demographic features: Increasing age

2-                Clinical features:

*          General: Atrial fibrillation, cardiac failure. Ischemic heart disease, diabetes mellitus, fever, urinary incontinence, previous stroke

*          Neurological: Reduced levels of consciousness, severe motor deficit, impaired proprioception, visuospatail dysfunction, cognitive impairment, total anterior circulation syndrome.

3-        Simple laboratory tests: Hyperglycemia, high haemotocrite. Abnormal ECG.

4-        CT and MRI: Large lesion, mass effects, inter ventricular bleeding, hydrocephalus and cerebellar stroke.

 

Many studies have highlighted the prognostic importance of various laboratory parameters like blood sugar, total leukocyte count, and erythrocyte sedimentation rate (ESR).5,6,7 However, few studies are available which have studied collectively the prognostic value of these parameters on multivariate analysis.6,8 Some others considered other important ones which are demographic, underlying medical disorders related, lesion related and specific therapy related4.

There are many scoring systems that predict outcome in stroke patients.4,9 The APACHE III scoring system has been used effectively for prognosticating outcome in critically ill patients.10 

In this prospective study, we aimed to evaluate the significance of routine some simple blood parameters and APACHE III scoring system as methods of prediction of 1-month mortality in stroke patients.

 

PATIENTS AND METHODS

 

This study was conducted on (93) patients of acute stroke (ischemic & hemorrhagic) for the first time who admitted to El-Rehab hospital in Tanta city; Egypt, from February 2007 to October 2008. All patients included in the study had a clinical diagnosis of stroke supported by immediate neuroimaging (brain C.T. or MRI). Stroke was defined, according to the WHO definition, as rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than of vascular origin. The time of onset of the stroke was defined as the time when the patient or observer first became aware of the symptoms11. All the patients who presented within 48 hours of onset, irrespective of age, sex or type of stroke, were included in the study.

Patients with previous history of stroke-or who passed >48 hours from onset of stroke-or patient who did not follow up were excluded. After inclusion, each patient was subjected to a detailed history, clinical neurological evaluation and neuroimaging (brain C.T. or MRI). A Glasgow coma scale (GCS) score was obtained for each patient. Blood samples were collected immediately after admission, before starting any intravenous infusion. Blood samples were immediately sent to the laboratory that used standard commercial reagent kits for evaluation. Blood investigations which were done include hemoglobin, total leukocyte count, platelet count, ESR (1st h), blood sugar, urea, creatinine, sodium, potassium, and serum cholesterol. For the assessment of liver functions, bilirubin, serum transaminases (SGOT and SGPT), albumin and globulin were done. Also, hemotocrit & urine output/24h. estimations were performed; that's required in APACHE III scoring system.

APACHE III scoring system was applied for each patient. We selected this scoring system because it considers various other parameters like physiological variables, vitals, urine output, age related parameters and co-morbid conditions (which may have a significant impact on the outcome of these critically ill patients), in addition to the neurological deficit. So, this scoring system may be a good, effective predictor of short term outcome in cerebral stroke patients. The sensitivity and specificity of this score was calculated at a cutoff point of 40.10

Subsequently, the patients were treated and the study in no way interfered with the treatment. The patients were followed up for a maximum period of 1 month from the onset of stroke, and patients who expired were grouped as 'expired' and the rest as 'survivors'. Patients discharged from the hospital before this period, were asked to visit our outpatient clinic at weekly intervals. Those failing to turn up for weekly follow-up were inquired for outcome either by telephone or by home visit. Those patients who did not follow medical advice were excluded from the study.

 

APACHE III scoring system consists of the sum of scores [0-299] from evaluation of the following:

·          Vital signs (pulse-B.P.-temp.-R.R.) & Laboratory results (WBCS - haematocrite - creatinin - urea  - sodium - albumin – bilirubin - glucose and urine output) [0-175]

·          Neurological score [0-77]

·          Age score [0-24]

·          Chronic health score [0-23]10.

 

Statistical Analysis

The laboratory results obtained were recorded and analyzed by using (the student 't' test for normally distributed variables and Mann Whitney test for non normally distributed variable). Multiple logistic regression analysis was done for parameters found significant in univariate analysis.

The score of each patient in APACHE III scoring system was calculated and from it the sensitivity and specificity measured. The score was correlated with the outcome of these patients. Chi square test(x2) was used to compare qualitative variables. 

 

RESULTS

 

A total of 93 patients (61 males and 32 females) with the inclusion criteria of stroke were admitted during the study period. The demographic characteristics of all 93 patients are summarized in Table (2). Thirty per cent (8 out of 27) patients with intracerebral hemorrhage expired whereas 14% (9 out of 66) patients with cerebral infarction expired. The mean duration of hospital stay in expired patients was shorter (6.5±3.5 days) as compared to survivors (10.5±4.5 days).

The mean GCS score at admission was significantly lower (P.value <0.05) in expired, patients (6±3) as compared to survivors (12±3). After univariate analysis, high total leukocyte count and ESR, at admission, correlated significantly with undesirable outcome (P.value <0.05). Elevated urea, creatinine, serum transaminases (SGOT and SGPT) and globulin levels were found to be correlated significantly with death (P.value <0.05). Other parameters; hemoglobin, platelet count, random blood sugar, sodium, potassium, bilirubin, albumin and cholesterol, did not differ significantly (P.value  >0.05) in the survivors and expired patients (Table 3).

Logistic regression analysis was carried out amongst the significant parameters to identify independent predictors of 1-month fatality in acute stroke. It revealed that high serum creatinine, SGPT, ESR and total leukocyte count were correlated with death. A low GCS score was also included in the model and was found to be significantly lower in the expired patients (Table 4).

The sensitivity and specificity of APACHE III scoring system in predicting mortality in our results was 88% and 74% respectively, in patients with C.hemorrhage. But it was 89% and 70% respectively for ischemic stroke; when a cutoff point of 40 was taken. It was also observed that the likelihood of mortality is significantly (P<0.05) increased in patients who have score >40, in comparison to those who have score <40 (Tables 5 and 6).


 

 

 

Table 2. Characteristic of patients with acute stroke (N=93).

 

Demographics characteristics

 

Age (years) (Mean±SD)

58.5±10.5

Sex (M:F) (Ratio)

61:32

GCS Score (Mean±SD)                                               

10.5±4.5

Systolic blood pressure (mm Hg) (Mean±SD)

155±35

Diastolic blood pressure [mm Hg) (Mean±SD)                 

95±20

No and % of:

-                  Hypertension

-                  Diabetes

-                  Smoking

-                  Stroke type

C.hge

C. infraction

 

54(58%)

60(65%)

52(56%)

 

27(29%) _____8 (30%)died

66(71%) _____9 (14%)died

Total expired = 17 (8 C.hge. -9 C.infarction).

GCS Glasgow coma scale

 

 

 

Table 3. Distribution of parameters (GCS & laboratory tests) in relation to stroke outcome (survivors/Expired).

 

Parameters

Outcome

P value

Survivors (n=76)

(Mean±SD)

Expired (n=17)

(Mean±SD)

GCS

12±3

6±3

<0.001*

Laboratory tests

 

 

 

-                  Hemoglobin (g/dl)

11.4±1.9

13.7±11.2

0.10

-                  TLC

10050±2750

11600±3750

0.01*

-                  ESR mm/hour

23±13

32±14

<0.001*

-                  Platelets/thousand/cm

214±63

206±55

0.47

-                  RBS mg/dl

148±98

172±95

0.20

-                  Urea mg/dl

43±26

70±72

0.004*

-                  creatinine mg/dl

1.2±0.4

2.1±2.3

0.002*

-                  Sodium meq/l

140±6

138±10

0.11

-                  Potassium meq/l

4.9 ±5.2

4.2±0.90

0.36

-                  Bilirubin mg/dl

0.8±0.3

0.90±0.45

0.11

-                  SGOT IU/L

31±25

55±83

0.03*

-                  SGPT IU/L

27±14

39±36

0.01*

-                  Albumin g/dl

4.4±5.4

3.3±0.9

0.18

-                  Globulin g/dl

3.3±0.6

3.8±0.7

0.001*

-                  Cholesterol mg/dl

185±46

198±36

0.114

Mann Whitney test was used.

GCS Glasgow coma scale, RBS Random blood sugar.

* Significant at p <0.05

 

Table 4. Multivariate logistic regression model showing most significant parameters predicting mortality of acute stroke.

Parameters

Beta  coefficient

Standard

Significance

Adjusted Odds Ratio

Creatinine

1.3160

0.7174

0.0466

3.73

Erythrocyte sedimentation rate

0.0526

0.0261

0.0439

3.65

SGPT

0.0265

0.0131

0.0429

3.50

Total leukocyte count

0.0002

0.0001

0.0476

3.20

Glasgow coma scale score

-4.1341

0.8675

0,000

0.02

 

Table 5. APACHE III Score- In cerebral hemorrhage.

 

Score

Outcome

Total

X2

P-value

Death

Survival

No.

%

No.

%

No.

%

<40

1

6.7

14

93.3

15

100

6.24

<0.05

>40

7

58.3

5

41.7

12

100

Total

8

29.6

19

70.4

27

100

Sensitivity = 7/8 =88%                                                           Specifity = 14/19 = 74%

 

Table 6. APACHE III Score-in cerebral infarction.

 

Score

Outcome

Total

X2

P-value

Death

Survival

No.

%

No.

%

No.

%

<40

1

2.4

40

97.6

41

100

9.15

<0.05

>40

8

32

17

68

25

100

Total

9

13.6

57

86.4

66

100

Sensitivity = 8/9 =89%                                                           Specifity = 40/57 = 70%

 

 


DISCUSSION

 

Acute stroke is a heterogeneous condition with respect to prognosis. It is impossible to predict outcome in an individual with greater accuracy.2 In acute stroke the chances of survival depend on various factors like neurological damage and systemic dysfunction. Brenn and Sheikh12 observed that factors associated with adverse outcome in stroke include male sex, unconsciousness, Glasgow coma scale of <8, gaze palsy, pupillary changes and incontinence. The risk of death in first few days is best gauged by three clinical variables i.e. coma, paresis and incontinence, the indicators of severity of neurological dysfunction, along with cardiac variables like heart failure, atrial fibrillation and peripheral vascular disease. Patients with none of these factors are more likely to survive. Features suggestive of early brain stem dysfunction are indicators of poor outcome.13 Though the stroke related mortality is steadily declining in the west. The total mortality observed in our study group was 18% [17/93]. The patients with C.hemorrhage have a higher mortality [30%] and those with infarction having a lower mortality [14%]. The early mortality in stroke is reported to be around 20% in white population.2 Bayir et al.14 reported an overall mortality, due to all causes, of 20% in all stroke patients. The stroke mortality observed in our study group [18%], is comparable to other studies.

In this study the prognostic value of various clinical and blood, parameters have been evaluated. Like several studies in the past11,15, our study also suggested that a low GCS score was predictive of poor outcome.

Possibly, changes in hematological parameters at the onset of stroke play an important role in altering the cerebral blood flow.7,8,16

In our study, hemoglobin and platelet counts did not show any significant difference among expired patients and survivors. In another study, platelet count obtained within 48 hours was significantly lower in patients of ischemic stroke than the control group. The platelet count was also significantly lower in patients who later expired than who survived.17

Leukocytosis also influences the prognosis. Several mechanisms by which leukocytes may be implicated in parenchymal brain injury include vessel plugging, release of hydrolytic enzymes, oxygen free radicals or initiation of thrombosis.18 Leukocytosis might also be a manifestation of some common causes of fever (e.g., pulmonary or urinary tract infections, sepsis, or pulmonary embolism from deep vein thrombosis). Czlonkowska et al.8 have also demonstrated increase leukocytes as an independent predictor of 1-month case fatality in stroke patients. In our study, total leukocyte counts were significantly higher in expired patients, both on univariate and multivariate analysis; that go with the previous results.

A high ESR value has been associated with large ischemic lesions and more severe deficits.7 An elevated ESR value may indicate a greater increase in the concentration of fibrinogen; a more pronounced reduction in the cerebral blood flow, a larger lesion and a poor outcome.19 Like Czlonkowska et al.8 study, our results reveled that a high ESR was associated with a poor prognosis. Elevated blood glucose has been implicated as a poor prognostic factor for cerebral ischemia and hemorrhage.20 Animal studies have demonstrated the aggravation of ischemic injury by hyperglycemia.21 Diabetes predisposes to occlusive vascular disease but not to intracerebral hemorrhage.22 However, in hemorrhagic strokes it predisposes to larger size of hematoma and increased mortality at 30 days.23 In diabetics, ischemic strokes are often associated with large infarct size and poor outcome due to decreased autoregulation and changes in blood coagulability.22 Even in non-diabetic patients with hyperglycemia, the size of the lesion and neurological deficit were worse.24 Many studies deny the prognostic significance of elevated blood glucose.25,26 Our study also did not observe prognostic significance of blood sugar.

In our results, on univariate analysis, blood urea and creatinine levels were found significantly higher in patients who later expired. High creatinine was significantly associated with poor outcome on multivariate analysis. No independent effect of urea was noted on mortality. Woo et al.26 have demonstrated that higher plasma urea and creatinine levels are associated with more severe stroke and a low GCS score, however, these parameters have no independent effect on mortality.26

We could not observe any prognostic value of electrolyte estimations in our results, this also go with the results of Woo et al.26. Among liver function tests, our results revealed that serum transaminases (SGOT & SGPT) and globulin levels found to be significantly associated with poor outcome on univariate analysis. After multivariate analysis, only SGPT correlated with poor outcome. Low albumin levels related to increased incidence of hemorrhagic stroke. Low albumin, globulin ratio found to predispose to recurrent strokes.27 Serum lipids have been linked to a higher risk of ischemic stroke.28 An inverse association exists for total cholesterol and cerebral hemorrhage. A greater mortality is observed from hemorrhagic stroke with serum cholesterol levels under 160 mg/dL.29 In a recent study total cholesterol measured within 24 hours suggested that higher levels of cholesterol were associated with a favorable early outcome after ischemic stroke.30 We could not establish any prognostic significance of cholesterol levels.

Most of the scoring systems, used to determine short term outcome in stroke, consider only the neurological deficit related parameters when evaluating these patients4,9, while APACHE III scoring system takes into consideration various other parameters in addition to the neurological deficit. Thus, it may be a better alternative and a good, effective predictor of short-term outcome in cerebrovascular accident patients.10

In the present study we did observe that the likelihood of mortality increased as the score increased and the most noticeable increase was seen when the score was more than 40. The sensitivity of this score, in our results, at a cutoff point of 40 was about 90% (88% for hemorrhage and 89% for infarction). However, the specificity observed was a little lower. (74% for C.hge. & 70% for C.infarction) this is going with the results of Bhalla et al.31, who found sensitivity 94% in C.Hge. and 90% in C.infarction. Among the various scoring systems in vogue for prognosticating outcome in stroke is the National Institute of Health score that also has a predictive accuracy of outcome around 80% in all patients9.

 

Conclusion

Impaired consciousness, high total leukocyte count, raised ESR, elevated creatinine and SGPT levels, estimated within 48 hours of stroke onset, are the most important indicators of 1-month mortality in patients with first-time stroke.

APACHE III scoring system, which use simple measures and can be applied easily in every patient, was found to be sensitive and reasonably specific in predicting short term, outcome in critically ill patients having cerebral stroke.

 

[Disclosure: Authors report no conflict of interest]

 

REFERENCES

 

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5.      Woo E, Chan YW, Yu YL, Huang CY. Admission glucose level in relation to mortality and morbidity outcome in 252 stroke patients. Stroke. 1988; 19:185-91. 

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8.      Czlonkowska A, Ryglewicz D, Lechowicz W. Basic analytical parameters as the predictive factors for 30 day case fatality rate in stroke. Acta Neurol Scand. 1997; 95:121-4.    

9.      Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurement of acute cerebral infarction: A clinical examination scale. Stroke. 1989; 20: 864-70. 

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11.    Hatano S. Experience from multicentric stroke register-a preliminary report. Bull World Health Organ. 1976; 54:541-53

12.    Brenn PJ, Sheikh K. Prediction of mortality and morbidity in stroke. J Epidemol Community Health. 1983; 32: 70-4.       

13.    Yadav P, Tripathy BK, Agarwal AK. Prognostication in stroke. In: Bansal BC, editor. Recent concepts in stroke. New Delhi: Indian college of Physicians; 1999. p.301-9.       

14.    Bayir A, Ak A, Kara H, Sahin TK. Serum and cerebrospinal fluid magnesium levels, Glasgow Coma Scores, and in-hospital mortality in patients with acute stroke. Biol Trace Elem Res. 2009 Jul; 130(1):7-12.    

15.    Demchuk AM, Buchan AM. Predictors of stroke outcome. Neurol Clin. 2000; 18(2): 455-73.      

16.    Chambers BR, Norris JW, Shurvell BL Hachinski VC. Prognosis of acute stroke. Neurology. 1987; 37(2):221-5.

17.    D'Erasmo E, Aliberti G, Celi FS, Romagnoli E, Vecci E, Mazzuoli GF. Platelet count, mean platelet volume and their relation to prognosis in cerebral infarction. J Intern Med. 1990; 227(1):11-4.

18.    Wilhelmsen L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med. 1984; 311(8):501-5.

19.    Rallidis LS, Vikelis M, Panagiotaks DB, Liakos GK, Krania E, Kremastinos DT. usefulness of inflammatory and haemostatic markers to predict short term risk for death in ischemic stroke. Acta Neurol Scand. 2008; 117(6): 415–20.

20.    Nedergaard M. Transient focal ischemia in hyperglycemic rats is associated with increased cerebral infarction. Brain Res. 1987; 408(1-2):79-85

21.    Alex M, Baron EK, Goldenberg S, Blumenthal HT. An autopsy study of cerebrovascular accident in diabetes mellitus. Circulation. 1962; 25:663-73.

22.    Helgason CM. Blood glucose and stroke. Stroke. 1988;19;1049-1053.      

23.    Candelise L, Landi G, Orazio EN, Boccardi E. Prognostic significance of hyperglycemia in acute stroke. Arch Neurol. 1985; 42(7):661-3.    

24.    Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F. Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med. 1983; 74:540-4.    

25.    Adams HP, Olinger C, Biller J. Usefulness of admission blood glucose in predicting outcome of acute cerebral infarction (abstract). Stroke. 1987; 18:296.      

26.    Woo J, Lau E, Kay R, Lam CW, Cheung CK, Swaminathan R, et al. A case control study of some hematological and biochemical variables in acute stroke and their prognostic value. Neuroepidemiology. 1990; 9:315-20.

27.    Beamer N, Coull BM, Sexton G, de Garmo P, Knox R, Seaman G. Fibrinogen and the albumin-globulin ratio in recurrent stroke. Stroke. 1993; 24: 1133-9.

28.    Lee YS, Chen DY, Chen YM, Chuang YW, Liao SC, Lin CS, et al. serum lipid level and 3 – months prognosis in Chinese patients with acute stroke. Adv Ther. 2008; 25:329-41

29.    Lindenstrom E, Boysen G, Nyboe J. Influence of total cholesterol, high density lipoprotein cholesterol and triglycerides on risk of cerebrovascular disease: The Copenhagen City Heart Study. Br Med J. 1994; 309:11-5.      

30.    Vauthey C, deFreitas GR, van Melle G, Devuyst G, Bogousslavsky J. Better outcome after stroke with higher serum cholesterol levels. Neurology. 2000; 54:1944-9.  

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الملخص العربى

 

 

الوفاة الناتجة عن السكتة المخية: القيمة التنبؤية لبعض التحاليل البسيطة ومقياس APACHEIII

 

تعتبر السكتة المخية ثالث أسباب الوفاة عالميا فى الترتيب بعد أمراض القلب والسرطان. ولكون الطبيب مطالبا من قبل أهل المريض بمعرفة مآل المرض منذ الساعات الأولى لحدوث المرض, فقد صمم هذا البحث لمعرفة مآل السكتة المخية فى الشهر الأول من حدوثها. وذلك من خلال عمل بعض الأبحاث المعملية البسيطة, وكذلك من خلال معرفة درجة المريض علي مقياس APACHE III للتقييم. تم إجراء البحث على عدد 93 مريضا بالسكتة المخية "سواء الناتجة عن نزيف أو جلطة بالمخ"، بشرط أن تكون الحالة حادة، ولم يمض على حدوثها أكثر من 48 ساعة، ولم يسبق للمريض إصابته بها من قبل. بعد اخذ التاريخ المرضى تفصيلا, يتم الفحص الاكلينيكى العام، ثم الخاص بالجهاز العصبى مع قياس درجة الوعى على مقياس جلاسكو للغيبوبة يتم اخذ عينة من دم المريض قبل بدء العلاج لإجراء بعض الفحوصات المعملية  ]نسبة هيموجلوبين - عدد كرات الدم البيضاء والصفائح الدموية - سرعة الترسيب فى الساعة الأولى - نسبة السكر والبولينا والكرياتينين - صوديوم - بوتاسيوم - كوليسترول - بالإضافة إلى نسبة الصفراء وإنزيمات الكبد (SGOT, SGPT) والالبيومين والجلوبيولين[، ثم عمل اشعة على المخ، واحتساب كمية البول خلال 24 ساعة. كذلك يتم حساب درجة المريض على مقياس APACHE III للتقييم والذى يتكون من (صفر-299) درجة.

-        بتحليل نتائج البحث أتضح أن ارتفاع نسبة الكرياتينين، وسرعة الترسيب، وإنزيم الكبد، SGPT، وعدد كرات الدم البيضاء فى أول 48 ساعة من حدوث السكتة المخية، بالإضافة لوجود اضطراب فى درجة الوعى، تعتبر دلائل قوية على أن المرض قد يؤدى للوفاة أو إلى حدوث مضاعفات خطيرة فى خلال الشهر الأول من حدوث السكتة المخية.

-      كما اثبت البحث أن مقياس APACHE III هو طريقة سهلة وذو حساسية عالية (90% تقريبا) فى التنبؤ بحدوث مضاعفات أو وفاة للمريض، إذا تم التقييم فى خلال 48 ساعة من بداية المرض.

 



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