- Title
- The Role of Biomarkers in the Management of Stroke in Eastern Cape Province
- Creator
- Collin Asongapha Forka
- Date
- 2015
- Type
- Masters
- Identifier
- http://hdl.handle.net/11260/2846
- Identifier
- vital:42964
- Description
- ABSTRACT Stroke is defined as rapidly developed clinical signs of focal (or global) disturbance of the cerebral function, lasting more than 24 hours with no apparent cause other than a vascular origin. A biomarker is defined as “a physiological characteristic that can be objectively measured and evaluated as an indicator of normal biological or pathogenic process as well as pharmacological responses to a therapeutic interventions. The aim of this study was to investigate the role of biomarkers in defining inflammation, endogenous oxidants/antioxidant status (oxidative stress imbalance) and traditional cardiovascular risk factors. This case (stroke types and subtypes) – control (healthy) study (matched for gender and age) was conducted between December 2012 and June 2015. Mthatha Hospital complex served as the study setting. Nelson Mandela Academic Hospital (NMAH) is a tertiary facility that provides health care to South African population, majority of whom dwell in rural areas around the hospital. Student t-test and ANOVA served to compare means between 2 groups and across >3 groups. Chi – square test was used to compare proportions between 2 groups. Multivariate (multiple linear regression, binary logistic regression, and discriminant functions) analyses were used to identify the most important risk factors of all strokes and fibrinogen to discriminate stroke types and subtypes. ROC method obtained specific ethnic cut–off points of biomarkers that associated independently with all strokes. In total 67 participants were examined: 37 cases of strokes (11 ischemic, 26 haemorrhagic, 11 lacunar ischemic, 13 intra-cerebral hematomas and 8 haemorrhagic brain ischaemia) versus 28 controls. Low socio – economic status (OR=10.3 95%CI 3.3- 32.9 p<0.0001), physical inactivity (OR=13 95% CI 3.3-51.6 p<0.0001), rural residence(OR=6.5 95% CI 1.6-26.5 p=0.004), RDW(OR=3.7 95% CI 1.3-10.9 p=0.016), D – dimer (OR=17.4 95% CI 2.9-104 p=0.002), Fibrinogen (OR=35.1 95% CI 3.5-356.5 p=0.003), and BMI(OR=1.387 95% CI 0.985-2 p=0.06) were the most independent risk factors of all strokes. RDW, Platelets, D-dimer, and Neutrophils were the most discriminant of absence of strokes, ischaemic and haemorrhagic types of stroke. Only Fibrinogen and BNP were the most discriminant of stroke subtypes in low socio–economic status. Meanwhile, Platelets, Neutrophils, and CRP were the most discriminant of stroke subtypes in high socio – economic status. The cut-off points of RDW>14%, Fibrinogen>3.5 g/L, and D-dimer>0.5g/mL separated efficiently all stroke types and controls. Independent variations (R2 = 48%) of Fibrinogen in all participants were explained by increase in CRP (Beta = 0.315; P = 0.003), Platelets (Beta = 0.280; P = 0.004), BMI (Beta = 0.268; P = 0.006), and Monocytes (Beta = 0.241; P = 0.014).iii In conclusion, increased levels of Biomarkers of inflammation, thrombosis, hypercoagulability, but opposite variations of innate immunity (increase in monocytes, decrease or increase in neutrophils), overweight/Obesity, low socio-economic status, physical inactivity, and rural residence were the major risk factors of all strokes. Biomarkers of inflammation have superior performance to diagnose all strokes and to discriminate stroke types and to predict the severity of stroke subtypes than the few traditional cardiovascular risk factors. Education, adequate diet, exercise, reduction of poverty, other measures of secondary prevention, applied research, and integration of chemical pathology in the management of strokes are needed in personalised medicine with cheap tools (RDW, platelets and Fibrinogen) in absence of neuro – imaging in the poorest Eastern Cape province of South Africa.
- Format
- Contributor
- B. LONGO MBENZA
- Contributor
- E. BLANCO-BLANCO
- Publisher
- Walter Sisulu University
- Language
- English
- Rights
- Walter Sisulu University
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Faculty of Health Sciences
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