Prognostic Value of Complete Blood Count and Electrolyte Panel during Emergency Department Evaluation for Acute Ischemic Stroke

Latha Ganti,Amy L Weaver,Robert D Brown,Rachel M Gilmore

doi:10.1155/2013/974236

Latha Ganti, Amy L Weaver + Show 2 more

Open Access

https://doi.org/10.1155/2013/974236

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Abstract

Objective. To determine whether routine laboratory parameters are predictors of early mortality after acute ischemic stroke (AIS). Methods. The cohort consisted of 522 consecutive patients with AIS presenting to the emergency department (ED) at a tertiary referral center during a 27-month period, residing within the surrounding ten counties. Serum laboratory values were obtained for all patients and categorized according to whether the levels were low, normal, or high. These laboratory results were evaluated as potential predictors of 90-day mortality using Cox proportional hazards models. The associations were summarized by calculating risk ratios (RRs) and 95% confidence intervals (CI). Results. The presence of elevated white blood cell count (RR 2.2, 95% CI 1.5–3.4), low bicarbonate (RR 4.2, 95% CI 2.6–6.7), low calcium (RR 2.9, 95% CI 1.4–5.9), and high glucose (RR 1.3, 95% 1.1–1.6) were each univariately associated with significantly higher mortality within the first 90 days. Based on fitting a multivariate Cox regression model, elevated white blood cell count, low bicarbonate, and high glucose were each identified as being jointly associated with early mortality (). Conclusion. Early leukocytosis, acidosis, and hyperglycemia and hypocalcemia in AIS appear to be associated with early mortality. Whether addressing these factors will impact survival remains to be investigated.

Highlights

For patients who present with chief complaint of acute ischemic stroke, the American Stroke Association recommends a set of diagnostic studies [1] to be done at presentation, with the intent of optimizing and expediting the care of these patients
The risk of death within 90 days increased twofold (RR 1.9; 95% confidence intervals (CI) 1.5–2.4; P < 0.001) for every increase of 10 years in age
The results of our study suggest that amongst the routine labs obtained in the emergency department (ED) evaluation of acute ischemic stroke, an elevated white blood cell count, a low bicarbonate, and a high glucose level are independent predictors of 90-day mortality in the setting of acute ischemic stroke

Summary

Introduction

For patients who present with chief complaint of acute ischemic stroke, the American Stroke Association recommends a set of diagnostic studies [1] to be done at presentation, with the intent of optimizing and expediting the care of these patients. From the Emergency Physicians’ perspective many tests are part of a routine battery, often without direct impact on emergency department (ED) management, diagnostic or prognostic value. We sought to determine whether the routine complete blood count (CBC) and electrolyte panel include any components that are markers of early mortality in acute ischemic stroke. The parameters of interest were those obtained as part of routine clinical investigation

Methods

Results

Conclusion