Elevated Plasma Fibrinogen and the Risk of Stroke: A Hospital Based Prospective Case-Control Study in Uyo, Nigeria

Background: Stroke is one of the leading causes of morbidity and mortality globally. In recent time, there is increasing evidence that suggest that increased plasma fibrinogen is associated with increased risk of stroke with unfavourable clinical outcome. Objectives: To determine the plasma fibrinogen levels in stroke patients and compare with healthy controls. Study Design: The study design was Prospective case- control study. Place and Duration of Study: The study was conducted in the department of Internal Medicine (Neurology Unit) and the department of Haematology between March to August, 2019. Methodology: A case- control study consisting of 41 patients (21M: 19F) diagnosed with stroke in line with WHO definition and confirmed by CT-Scan of the brain were recruited consecutively into the study. 20 (10M: 10F) healthy age and gender matched consenting adults were used as controls. Plasma fibrinogen was determined for both the patients and controls using ELISA method. Also, socio-demographic and clinical data were collected using questionnaire designed for the study. The level of significance was set at P=.05. Results: The mean plasma fibrinogen level of 458.0 ± 89.1 was significantly higher in the stroke patients compared to the controls 307.8 ± 61.5 (P<0.001). An increasing level of plasma fibrinogen was observed with increasing age in both the patients and controls. However, this increase was not statistically significant (P=0.98). Also, the plasma fibrinogen level was significantly higher in the female patients (501.21±83.96) than the males 420.59±77.02 (P=0.003). Conclusion: Plasma fibrinogen was significantly higher in the stroke patients compared to the controls with female patients having a significantly higher levels than males. Also, the plasma fibrinogen levels appear to increase proportionally with increasing age.

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Disruptions of Anaerobic Gut Bacteria Are Associated with Stroke and Post-stroke Infection: a Prospective Case–Control Study

Translational Stroke Research ◽

10.1007/s12975-020-00863-4 ◽

2020 ◽

Cited By ~ 1

Author(s):

Bastiaan W. Haak ◽

Willeke F. Westendorp ◽

Tjitske S. R. van Engelen ◽

Xanthe Brands ◽

Matthijs C. Brouwer ◽

...

Keyword(s):

Hospital Admission ◽

Hemorrhagic Stroke ◽

Case Control Study ◽

Case Control ◽

Gut Bacteria ◽

Stroke Patients ◽

Post Stroke ◽

The Impact ◽

Control Study ◽

Prospective Case Control Study

Abstract In recent years, preclinical studies have illustrated the potential role of intestinal bacterial composition in the risk of stroke and post-stroke infections. The results of these studies suggest that bacteria capable of producing volatile metabolites, including trimethylamine-N-oxide (TMAO) and butyrate, play opposing, yet important roles in the cascade of events leading to stroke. However, no large-scale studies have been undertaken to determine the abundance of these bacterial communities in stroke patients and to assess the impact of disrupted compositions of the intestinal microbiota on patient outcomes. In this prospective case–control study, rectal swabs from 349 ischemic and hemorrhagic stroke patients (median age, 71 years; IQR: 67–75) were collected within 24 h of hospital admission. Samples were subjected to 16S rRNA amplicon sequencing and subsequently compared with samples obtained from 51 outpatient age- and sex-matched controls (median age, 72 years; IQR, 62–80) with similar cardiovascular risk profiles but without active signs of stroke. Plasma protein biomarkers were analyzed using a combination of nuclear magnetic resonance (NMR) spectroscopy and liquid chromatography–mass spectrometry (LC-MS). Alpha and beta diversity analyses revealed higher disruption of intestinal communities during ischemic and hemorrhagic stroke compared with non-stroke matched control subjects. Additionally, we observed an enrichment of bacteria implicated in TMAO production and a loss of butyrate-producing bacteria. Stroke patients displayed two-fold lower plasma levels of TMAO than controls (median 1.97 vs 4.03 μM, Wilcoxon p < 0.0001). Finally, lower abundance of butyrate-producing bacteria within 24 h of hospital admission was an independent predictor of enhanced risk of post-stroke infection (odds ratio 0.77, p = 0.005), but not of mortality or functional patient outcome. In conclusion, aberrations in trimethylamine- and butyrate-producing gut bacteria are associated with stroke and stroke-associated infections.

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