title: Lipoprotein(a), ferritin, and albumin in acute phase reaction predicts severity and mortality of acute ischemic stroke in North Indian Patients.
abstract: BACKGROUND
  Inflammation plays a crucial role in the pathogenesis and prognosis of stroke. We studied the behavior of lipoprotein(a) [Lp(a)], ferritin, and albumin as acute phase reactants and their roles in the severity and mortality of stroke.
  
  
  METHODS
  We recruited 100 consecutive patients with acute ischemic stroke and 120 controls. Blood samples were drawn on days 1 and 7 and at both 3 and 6 months. Stroke was classified using Trial of Org 10172 in Acute Stroke Treatment classification. Stroke severity was assessed using the National Institutes of Health Stroke Scale. Prognosis at 6 months was assessed using the modified Rankin Scale, and mortality was assessed using the Kaplan-Meier analysis. Serum levels of interleukin-6 (IL-6), Lp(a), ferritin, and albumin were measured using enzyme-linked immunosorbent assay, immunoturbidimetry, and chemiluminescence commercial kits, respectively.
  
  
  RESULTS
  Levels of IL-6, Lp(a), and ferritin were consistently higher among cases than controls (P < .0001). Serum Lp(a) levels peaked at day 7 after stroke and tapered thereafter. Albumin levels were lower than controls on admission day and increased subsequently. In our study, Lp(a) acted as an acute phase reactant while albumin acted as a negative acute phase reactant. There was no association between Trial of Org 10172 in Acute Stroke Treatment subtype and elevated serum levels of Lp(a), albumin, and ferritin. Lp(a) and ferritin were high in patients with severe stroke. Albumin was negatively correlated with stroke severity. Serum levels of Lp(a) ≥ 77 mg/dL, albumin ≤ 3.5 g/dL, and ferritin ≥ 370 ng/dL is associated with a significantly increased risk of having a poorer outcome in stroke. Serum levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL were also associated with increased mortality.
  
  
  CONCLUSIONS
  High levels of Lp(a) and ferritin and low levels of albumin are associated with increased severity and poorer long term prognosis of stroke. Patients with admission levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL had increased mortality.
authors.affiliation: Department of Biochemistry, Dr. D. Y. Patil Medical College, Mumbai, India. Electronic address: dr.baidarbhi@gmail.com.
authors.forename: Baidarbhi
authors.initials: B
authors.lastname: Chakraborty
authors.forename: Gaurav
authors.initials: G
authors.lastname: Vishnoi
authors.forename: Binita
authors.initials: B
authors.lastname: Goswami
authors.forename: Srinivas H
authors.initials: SH
authors.lastname: Gowda
authors.forename: Debashish
authors.initials: D
authors.lastname: Chowdhury
authors.forename: Sarita
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000210:Acute-Phase Reaction / Q000097:blood / Q000209:etiology / Q000401:mortality*; D000368:Aged; D002545:Brain Ischemia / Q000097:blood / Q000150:complications / Q000401:mortality*; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007194:India; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012709:Serum Albumin; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000150:complications / Q000401:mortality*
chemical_list: D017270:Lipoprotein(a); D012709:Serum Albumin; D005293:Ferritins