Nihss

1. A STUDY OF SERUM ALBUMIN, SERUM CALCIUM AND
SERUM URIC ACID IN THE PREDICTION
OF NEUROLOGICAL SEVERITY AND SHORT TERM
OUTCOME IN ACUTE ISCHEMIC STROKE.
DR Roshan Yogendra
DR Shoukath A R
MR Medical College
Kalaburagi

2. INTRODUCTION
• A stroke is defined as a syndrome of “rapidly developing clinical signs
of focal (or global) disturbance of cerebral function with symptoms
lasting 24 hours or longer or leading to death with no apparent cause
other than of vascular origin.
• albumin exerts neuroprotective effects by reducing brain edema or by
reducing oxidative stress and apoptosis
• .Calcium (Ca2) ions play a physiological role in the multiple patho
mechanisms of cerebral ischemia.
• Uric acid is the final product of purine metabolism.Evidence from
epidemiological studies suggests that elevated serum uric acid (SUA)
levels may predict an increased risk for cardiovascular events,
including stroke

3. OBJECTIVES OF THE STUDY
• To study serum albumin uric acid and calcium as a predictor of
neurological severity in ischemic stroke
• To study serum albumin, calcium and uric acid as a prognostic
indicator in short term outcome in ischemic stroke.

4. MATERIALS AND METHODS:
• Source of Data:The present study will be conducted on patients coming to
Basaveshwara Teaching and General Hospital attached to Mahadevappa Rampure
Medical College Kalaburagi.
• Sample size:100
• Duration of the study:1st june 2022 to 1st June 2023
• Study design: prospective observational study.

5. Inclusion Criteria
• 1.Patients aged ≥40 years.
• 2.Diagnosed as having acute ischaemic cerebrovascular stroke within previous 72
hours by clinical examination and confirmed by either a CT scan or by a MRI scan .
Exclusion Criteria:.
• 1. Presenting with haemorrhagic stroke / subarachnoid haemorrhage / cerebral
venous sinus thrombosis.
• 2.Patients with previous history of Transient Ischaemic
Attack (TIA)/Cerebrovascular Accident (CVA).
• 3. Patients who are on thiazide diuretics/known cases of gout or show
clinical evidences of gout/Chronic Kidney Disease (CKD).
• 4. Patients who were of known cardiac diseases, which could be sources of emboli or
whose echocardiogram shown sources of emboli.
• 5. Patients with haematological abnormalities (leukaemia, other myeloproliferative
disorders).

6. • NIH stroke scale was used in all patients to assess the
neurological disability and Barthel index used to assess prognosis at
discharge.
• Serum Calcium, Serum Albumin, Serum Uric acid is done for all
patients at the time of admission.

7. Discusision
• A study on 463 patients with AIS pertaining to the multicenter
registry found that SUA ≤ 4.5 mg/dl was positively associated with
short-term outcome and concluded that low SUA concentration is
modestly associated with a very good short-term outcome.
• A study that included 444 patients with ischemic stroke. Outcome
was prognosticated by NIHSS & mRS. They showed high serum
albumin was independently associated with a better outcome and
lower mortality . Concluded that high serum albumin may be
neuroprotective in ischemic stroke in humans.

8. 44%
56%
NIHSS (n=100)
<10
>10
90.90%
8.90% 9.10%
91.10%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
<10(n=40) >10(n=5) <10(n=4) >10(n=51)
<7 in Males <5.7 in Females >7 in Males >5.7 in
Females
Percentage
Sr Uric Acid Levels
Serum Uric Acid Levels in Relation to NIHSS
0%
100% 100%
0%
0%
20%
40%
60%
80%
100%
120%
<10(n=0) >10(n=56) <10(n=44) >10(n=0)
<3.5 >3.5
Percentage
Sr Albumin Levels
Serum Albumin levels in relation to NIHSS
9.10%
100%
90.90%
0%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
<10(n=4) >10(n=56) <10(n=40) >10(n=0)
<8.6 >8.6
Percentage
Sr Calcium Levels
Serum Calcium levels in relation to NIHSS

9. 64
36
Barthels Index (n=100)
<60
>60
15.60%
97.20%
84.40%
2.80%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
<60(n=10) >60(n=35) <60(n=54) >60(n=1)
<7 in Males <5.7 in Females >7 in Males >5.7 in Females
Percentage
SR Uric Acid Levels
Serum Uric Acid levels in relation to Barthels Score
85.90%
2.80%
14.10%
97.20%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
<60(n=55) >60(n=1) <60(n=9) >60(n=35)
<3.5 >3.5
Percentage
Sr Albumin Levels
Serum ALbumin levels in relation to Barthels Score
87.50%
11.10% 12.50%
88.90%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
<60(n=56) >60(n=4) <60(n=8) >60(n=32)
<8.6 >8.6
Percentage
Sr Calcium
SerumCalcium levels in relation to Barthels Score

10. • In the study conducted. by Abha Gupta, Umesh Dubay, et,. al.. stated
that patients with high calcium had significantly less severity of the
stroke and during follow up after 7 days the prognosis is better in
patients. with high calcium compared to the lower levels of calcium,
which was statistically Significant.

11. Conclusion
• Low blood albumin and calcium levels and high blood uric acid levels
occurred in patients with NIHSS score (Severe Stroke category (21-
41)) consistently compared to patients with NIHSS score (Minor
Stroke category (1-4)) among ischemic stroke patients.
• Low blood albumin and calcium levels high blood uric acid
levels occurred in patients with poor outcome status as per barthel
index consistently.
• From all these, We can conclude that,Ischemic stroke patients with
low blood albumin and calcium amd high uric acid levels had bad
prognosis.

12. REFRENCES
• Sacco RL, Kasner SE, Broderick JP,Louis R Caplan, J J,Buddy Connors, Antonio Culebras et al An
updated definition of stroke for the 21st century: a statement for healthcare professionals from the
American Heart Association/American Stroke Association. Stroke 2013;44(7):2064-2089.
• Gupta G, Kishor S, Kumar A. Serum uric acid, lipid profile and alkaline phosphatase levels
in ischemic cerebrovascular accident patients. Int J Adv Med 2021;8:1171-7.
• Amudalapalli L AAlekhya , K. Indira Devi M.D. T. Manasa.Study of Serum Calcium as
a Prognostic Marker in Acute Ischemic Stroke.JMSCR 2020 Nov;08(11) :431-434.
• Dash PK, Behera S, Sahoo NC,Rattan R, Tripathy SK. Serum albumin level as prognostic indicator
of acute ischemic stroke in tertiary care hospital admitted patients. Int J Adv Med 2020;7:948-53.