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Ghosh et al. Neuroimmunol Neuroinflammation 2018;5:38 Neuroimmunology and
DOI: 10.20517/2347-8659.2018.28 Neuroinflammation

Original Article Open Access

Predictors of severity and outcome and roles of
intravenous thrombolysis and biomarkers in first
ischemic stroke

Kartick Chandra Ghosh, Ramesh Bhattacharya, Saikat Ghosh, Manoj Mahata, Sarbajit Das,
Suman Das, Gourango Prosad Mondal
Department of Neurology, Calcutta National Medical College, Kolkata PIN-700014, India.

Correspondence to: Dr. Suman Das, Department of Neurology, Calcutta National Medical College, Kolkata PIN-700014, India. E-mail:
dr.sumands@gmail.com

How to cite this article: Ghosh KC, Bhattacharya R, Ghosh S, Mahata M, Das S, Das S, Mondal GP. Predictors of severity and
outcome and roles of intravenous thrombolysis and biomarkers in first ischemic stroke. Neuroimmunol Neuroinflammation
2018;5:38. http://dx.doi.org/10.20517/2347-8659.2018.28

Received: 16 May 2018 First Decision: 14 Aug 2018 Revised: 20 Aug 2018 Accepted: 22 Aug 2018 Published: 27 Sep 2018
Science Editor: Athanassios P. Kyritsis Copy Editor: Yuan-Li Wang Production Editor: Huan-Liang Wu

ABSTRACT
Aim: Stroke is one of the leading causes of death and disability. The proportion of patients receiving recombinant
tissue plasminogen activator is low in our country. Biomarkers to identify patients at risk of severe disease, and
guide treatment and prognosis would be valuable. This article aims to identify the factors that can independently
prognosticate the acute phase of ischemic stroke.

Methods: All patients with the first episode of ischemic stroke admitted to the Neurology Department between
1st December 2017 to 31st March 2018 were included in this pilot study. Stroke severity was evaluated using the
National Institute of Health Stroke Scale (NIHSS). Patients being admitted within 4.5 h of onset of symptoms were
thrombolysed with injection alteplase. For each patient, 4 serum biomarkers (D-dimer, fibrinogen, C-reactive pro-
tein and neuron specific enolase) were evaluated at admission and 24 h later. Discharged patients were assessed on
an outpatient basis using the modified Rankin scale. The study primarily aimed to identify the factors predicting the
severity and outcome of stroke, and to evaluate the effect of thrombolysis on the outcome. The secondary aim was
to evaluate the role of biomarkers to predict the unfavorable outcome and the chance of post thrombolysis hemor-
rhage.

Results: Out of 30 patients included in the study, 10 had NIHSS 0-4, 12 had NIHSS 5-15 and 8 had NIHSS 16-42.
Sixteen patients had unfavorable outcome (mRS score ≥ 2), and 5 patients expired. Old age, history of diabetes,
CHADS2 score ≥ 2, and total anterior circulation stroke (TACS) independently affected stroke severity, whereas low

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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