Stroke Mortality: Predictive Value of Simple Laboratory Tests and APACHE III Scoring System

Background: Stroke is the third major cause of death worldwide, and physicians are required to predict the outcome, as early as possible. Objective: Study the prognostic value of routine some simple blood parameters and APACHE III scoring system (Acute Physiology, Age, and Chronic Health Evaluation), on the first month fatality in patients of first-time acute stroke. Methods: Ninety-three stroke patients, (first-time), within 48 hours of onset were included. Clinical evaluation; neuroimaging, blood and urine investigations and APACHE III scoring system were performed. Patients followed up for a maximum period of 1 month from the onset of stroke. Logistic regression analysis carried out among the significant parameters to identify independent predictors of fatality. APACHE III score was correlated with the outcome within the first month. Results: Seventeen patients (18%) out of the 93 died during the first month. Logistic regression analysis of the blood parameters and Glasgow Coma Scale (GCS) demonstrated that, a low GCS score along with some parameters such as high serum creatinine, Serum glutamic pyruvic transaminase (SGPT), erythrocyte sedimentation rate (ESR) and total leukocyte count (TLC) correlated with death. The sensitivity of APACHE III scoring system was 88% and 89%, for cerebral hemorrhage (C.hge) and cerebral infarction (C.infarction) respectively. Conclusion: Impaired consciousness, high TLC, ESR, creatinine and SGPT levels, estimated within 48 hours of stroke onset, are the most important indicators of 1-month mortality in patients with first-time stroke. Also APACHE III scoring system was found to be sensitive and reasonably specific in predicting short term outcome. [Egypt J Neurol Psychiat Neurosurg. 2010; 47(3): 489-495]