best slides on prognostic significance of GGT in acute stroke

1. A STUDY ON CLINICAL &
PROGNOSTIC
SIGNIFICANCE OF GAMMA-
GLUTAMYL TRANSFERASE
IN PATIENTS WITH ACUTE
STROKE.
ABHISHEK KUMAR TIWARI, PG,
JLNMCH BHAGALPUR

2. BACKGROUND
Stroke has turned out
to be a major killer
of the current medical
scenario. Despite of
the battery of tests
and prognostic tools
available, the search
for an ideal option has
still been a puzzle for
the medical brains.

3. Stroke is considered as one of
the leading causes of death
and disability worldwide.

4. Gamma-glutamyl transferase (GGT) mediates intracellular
intake of extracellular glutathione which is an
important component of antioxidant mechanisms

7. When oxidative stress occurs,
decreased intracellular
glutathione levels induce
the formation of GGT in an
attempt to maintain the
normal intracellular
glutathione level.

8. Oxidative stress predisposes to vascular injury leading
to atherosclerosis, cardiovascular disease and stroke.

9. Several studies have found positive correlation between
serum Gamma-Glutamyl Transferase (GGT) and stroke
because of its involvement in oxidative stress pathway.

10. There are recent studies suggesting that GGT may also be
involved in the generation of reactive oxygen species
in the presence of iron or other transition metals thus
triggering cell death.

11. A study by Ryuichi et al suggested that higher CRP and GGT
levels were synergistically associated with Metabolic
syndrome and insulin resistance, independent of other
confounding factor in the general population.

12. A study by Sussan et al concluded that measurement of GGT
in first degree relativess of type 2 diabetic patients may be
useful in assessing the risk of diabetes; those with
chronically high levels of GGT should be considered as high
risk group for diabetes.

13. With this background, the
present study was conducted
with aim and objective to
evaluate relationship
between acute stroke and
serum GGT levels and to
assess the various types
of stroke in relation to the
levels of serum GGT.

14. A stroke or cerebrovascular accident is defined as the
abrupt onset of a neurological deficit that is attributable to a
focal vascular cause.

15. It is responsible for the largest proportion of neurological
disorders, causing both physical as well as mental
crippling.

16. The study was conducted in the Post graduate
Department of general Medicine JLNMCH, Bhagalpur
India, among patients admitted for acute stroke.
MATERIALS AND METHOD

17. Patients who reported within 2nd to 3rd day of acute
Cerebrovascular Accident (CVA) were included in the study
irrespective of their age and sex.

18. FOLLOWING WERE NOT
INCLUDED IN THE STUDY:
Patients with
1. CHRONIC LIVER DISEASE

19. FOLLOWING WERE NOT
INCLUDED IN THE STUDY:
Patients with
2. DISEASES OF BILIARY TRACT/PANCREAS/GALLBLADDER

20. FOLLOWING WERE NOT
INCLUDED IN THE STUDY:
3. PATIENTS WHO ARE CHRONIC ALCOHOLICS

21. FOLLOWING WERE NOT
INCLUDED IN THE STUDY
PATIENTS WHO ARE ON DRUGS LIKE PHENYTOIN, FIBRATES,
BARBITURATES, RIFAMPICIN

22. FOLLOWING WERE NOT
INCLUDED IN THE STUDY
ORAL CONTRACEPTIVE PILLS

23. FOLLOWING WERE NOT
INCLUDED IN THE STUDY:
Patients with
HISTORY OF STROKE OR TIA

24. FOLLOWING WERE NOT
INCLUDED IN THE STUDY:
Patients with
HISTORY OF CAD OR CHF

25. CAREFUL HISTORY WAS TAKEN AND PATIENTS
WERE SCREENED FOR RISK FACTORS LIKE
1. SYSTEMIC HYPERTENSION

26. CAREFUL HISTORY WAS TAKEN AND PATIENTS WERE
SCREENED FOR RISK FACTORS LIKE
1. SYSTEMIC HYPERTENSION
2. DIABETES MELLITUS

27. CAREFUL HISTORY WAS TAKEN AND PATIENTS WERE
SCREENED FOR RISK FACTORS LIKE
1. SYSTEMIC HYPERTENSION
2. DIABETES MELLITUS
3. OBESITY

28. CAREFUL HISTORY WAS TAKEN AND PATIENTS WERE
SCREENED FOR RISK FACTORS LIKE
1. SYSTEMIC HYPERTENSION
2. DIABETES MELLITUS
3. OBESITY
4. CKD

29. CAREFUL HISTORY WAS TAKEN AND PATIENTS WERE
SCREENED FOR RISK FACTORS LIKE
1. SYSTEMIC HYPERTENSION
2. DIABETES MELLITUS
3. OBESITY
4. CKD
5. SMOKING

30. They were thoroughly examined clinically and a detailed
neurological examination was done. For all patients, routine
blood investigations including
1. COMPLETE HEMOGRAM

31. They were thoroughly examined clinically and a detailed
neurological examination was done. For all patients, routine
blood investigations including
1. COMPLETE HEMOGRAM
2. BLOOD SUGAR

32. They were thoroughly examined clinically and a detailed
neurological examination was done. For all patients, routine
blood investigations including
1. COMPLETE HEMOGRAM
2. BLOOD SUGAR
3. SERUM UREA AND
CREATININE

33. They were thoroughly examined clinically and a detailed
neurological examination was done. For all patients, routine
blood investigations including
1. COMPLETE HEMOGRAM
2. BLOOD SUGAR
3. SERUM UREA AND
CREATININE
4. LIPID PROFILE

34. They were thoroughly examined clinically and a detailed
neurological examination was done. For all patients, routine
blood investigations including
1. COMPLETE HEMOGRAM
2. BLOOD SUGAR
3. SERUM UREA AND
CREATININE
4. LIPID PROFILE

35. They were thoroughly examined clinically and a detailed
neurological examination was done. For all patients, routine
blood investigations including
1. COMPLETE HEMOGRAM
2. BLOOD SUGAR
3. SERUM UREA AND
CREATININE
4. LIPID PROFILE
5. GAMMA GLUTAMYL
TRANSFERASE LEVELS

36. CT scan of brain (plain) was
done within 24-72 hours of
admission and analysed for
site and nature of
lesion, if infarct
whether single and if
haemorrhagic whether
parenchymal or evident
intraventricular
extension was present.

37. Strokes can broadly be divided into:
Ischaemic - Interrupted blood/O2 supply to an area of brain
Haemorrhagic - Bleeding into an area of the brain, due to
rupture of or abnormal vascular structure in the brain
Haemorrhagic strokes can further be distinguished into
intracerebral and subarachnoid strokes.

38. Of all strokes, 88% are ischaemic and 12% are
haemorrhagic in nature. Of the haemorrhagic strokes, 9%
are due to an intracerebral haemorrhage, and 3% are due
to a subarachnoid haemorrhage.

39. COMMONLY USED SYSTEMS FOR CLASSIFICATION OF
STROKE
1

40. 2. The Oxford Community Stroke Project classification
(OCSP, also known as the Bamford or Oxford classification)

42. RESULTS

45. The relationship between GGT and ischaemic stroke showed a
p-value = 0.0418 suggesting a strong relationship between
GGT and ischaemic stroke.

46. Mortality and morbidity
associated with stroke can be
reduced if patients at risk are
identified early, thereby enabling
the physician to plan primary
prevention strategies promptly.
GGT is a widely available
biochemical test and there is
supporting evidence suggesting a
prognostic role of GGT in
cerebrovascular diseases because
of its active involvement in
atherosclerosis through oxidative
and inflammatory mechanisms.

47. In our study, 64% of stroke
patients had elevated levels
of GGT when compared to
the control group. Consistent
results were found in a
similar study conducted by
Korantzopoulos P et al (2009)
in individuals >70 years of
age with first ischaemic/non-
embolic stroke where stroke
patients showed higher
concentrations of GGT
compared with control and
there was positive
associations between serum
GGT and stroke.

48. OTHER STUDIES SUPPORT THIS IDEA
Nurbanu Gubuzer et al (2014)
in their study found
statistically significant
relationship between
mean values of GGT and
infarct area and a
prominent increase was seen
in cases with relatively large
areas of infarct among
patients with ischaemic
stroke.

49. CONCLUSION
The positive relationship between
elevated levels of GGT and stroke
patients suggest that the estimation
of serum gamma-glutamyl
transferase level may serve as a
reliable, feasible and cost-
effective biochemical test,
which enables the physician to
provide prompt therapy for acute
stroke patients prevent the
associated morbidity and mortality
and provide a good quality of life for
the patient.

50. So, the estimation of serum gamma-glutamyl transferase
level may serve as a reliable biochemical test enabling the
physician and neurologist in planning primary treatment
strategies promptly and preventing the complications of
acute stroke.