The Relationship between Serum Vitamin D Level, Ischemic Stroke Severity and Lesion Volume in Ischemic Stroke Patients in Iran, 2019: An Analytic Cross-sectional Study

Document Type: Original Article

Authors

1 Neurologist, Neurology ward, Department of Internal Medicine, Kosar Hospital, Medical school, Semnan University of Medical Sciences, Semnan, Iran

2 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran

3 Kosar Hospital, Medical school, Semnan University of Medical Sciences, Semnan, Iran

4 Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

10.22034/jchr.2020.1890656.1089

Abstract

Vitamin D deficiency is a major global problem. The relationship between serum vitamin D level, ischemic stroke severity, and the resulted lesion volume is controversial. This study is aimed at investigating the relationship between serum vitamin D level, severity of ischemic stroke, and lesion volume compared to the control group. This analytic cross-sectional study was performed on 93 ischemic stroke patients compared to the control group during 2019. Brain imaging, lesion volume measuring, and record were performed for all patients. Severity of stroke was assessed by MRS score at the time of admission and discharge. Serum 25(OH) D levels were measured by enzyme-linked immunosorbent assay (ELISA). In the end, the data were analyzed by SPSS19 software. The mean ±standard deviation of vitamin D was 28.78±9.5 ng.ml-1 with the range of (10-49) in patients, and 29.11±8.7 with range of (12-51) in control group. Vitamin D level significantly decreased depending on age (P=0.003). The mean vitamin D levels had a significant negative relationship with the first and second MRS scores (P<0.001). Mean vitamin D levels had a significant negative relationship with the severity of stroke and lesion volume (P<0.001). Reduced vitamin D serum level is associated with higher severity of stroke and lesion volume.

Keywords


1. Haacke C., Althaus A., Spottke A., Siebert U., Back T., Dodel R., 2006. Long-term outcome after stroke: evaluating health-related quality of life using utility measurements. Stroke. 37(1), 193-198.

2. Woo J., Yuen Y.K., Kay R., Nicholls M.G., 1992. Survival, disability, and residence 20 months after acute stroke in a Chinese population: implications for community care. Disabil Rehabil. 14(1), 36-40.

3. Herrmann N., Black S.E., Lawrence J., Szekely C., Szalai J.P., 1998. The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome. Stroke. 29(3), 618-624.

4. Patel M.D., Tilling K., Lawrence E., Rudd A.G., Wolfe C.D., McKevitt C., 2006. Relationships between long-term stroke disability, handicap and health-related quality of life. Age Ageing. 35(3), 273-279.

5. Heidarinejad Z., Kavosi A., Mousapour H., Daryabor M.R., Radfard M., Abdolshahi A., 2018. Data on evaluation of AQI for different season in Kerman, Iran, 2015. Data in brief, 20, 1917-1923.

6. Krishnamurthi R.V., Feigin V.L., Forouzanfar M.H., Mensah G.A., Connor M., Bennett D.A., Moran A.E., Sacco R.L., Anderson L.M., Truelsen T., O'Donnell M., Venketasubramanian N., Barker-Collo S., Lawes C.M., Wang W., Shinohara Y., Witt E., Ezzati M., Naghavi M., Murray C., 2013. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 1(5), e259-281.

7. Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M., de Ferranti S., Despres J.P., Fullerton H.J., Howard V.J., Huffman M.D., Judd S.E., Kissela B.M., Lackland D.T., Lichtman J.H., Lisabeth L.D., Liu S., Mackey R.H., Matchar D.B., McGuire D.K., Mohler E.R., Moy C.S., Muntner P., Mussolino M.E., Nasir K., Neumar R.W., Nichol G., Palaniappan L., Pandey D.K., Reeves M.J., Rodriguez C.J., Sorlie P.D., Stein J., Towfighi A., Turan T.N., Virani S.S., Willey J.Z., Woo D., Yeh R.W., Turner M.B., 2015. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 131(4), e29-322.

8. Della-Morte D., Guadagni F., Palmirotta R., Testa G., Caso V., Paciaroni M., Abete P., Rengo F., Ferroni P., Sacco R.L., Rundek T., 2012. Genetics of ischemic stroke, stroke-related risk factors, stroke precursors and treatments. Pharmacogenomics. 13(5), 595-613.

9. Braunwald E., Kasper D.L., Hauser S.L., Longo D.L., Jameson J.L., Loscalzo J., 2001. Harrison's principles of internal medicine.

10. Brass L.M., Isaacsohn J.L., Merikangas K.R., Robinette C.D., 1992. A study of twins and stroke. Stroke. 23(2), 221-223.

11. Kumar A., Sagar R., Kumar P., Sahu J.K., Grover A., Srivastava A.K., Vivekanandhan S., Prasad K., 2013. Identification of genetic contribution to ischemic stroke by screening of single nucleotide polymorphisms in stroke patients by using a case control study design. BMC Neurol. 13, 136.

12. Nasr R., Hasanzadeh H., Khaleghian A., Moshtaghian A., Emadi A., Moshfegh S., 2018. Induction of apoptosis and inhibition of invasion in gastric cancer cells by titanium dioxide nanoparticles. Oman Medical Journal. 33(2), 111-117.

13. Gonzalez-Parra E., Rojas-Rivera J., Tunon J., Praga M., Ortiz A., Egido J., 2012. Vitamin D receptor activation and cardiovascular disease. Nephrol Dial Transplant. 27 Suppl 4, iv17-21.

14. Dusso A.S., Brown A.J., Slatopolsky E., 2005. Vitamin D. Am J Physiol Renal Physiol. 289(1), F8-28.

15. Holick M.F., 2007. Vitamin D deficiency. N Engl J Med. 357 (3), 266-281.

16. Resnick L.M., Muller F.B., Laragh J.H., 1986. Calcium-regulating hormones in essential hypertension. Relation to plasma renin activity and sodium metabolism. Ann Intern Med. 105(5), 649-654.

17. Dobnig H., Pilz S., Scharnagl H., Renner W., Seelhorst U., Wellnitz B., Kinkeldei J., Boehm B.O., Weihrauch G., Maerz W., 2008. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. 168(12), 1340-1349.

18. Pilz S., Tomaschitz A., Drechsler C., Zittermann A., Dekker J.M., Marz W., 2011. Vitamin D supplementation: a promising approach for the prevention and treatment of strokes. Curr Drug Targets. 12(1), 88-96.

19. Wang Y., Ji H., Tong Y., Zhang Z.B., 2014. Prognostic value of serum 25-hydroxyvitamin D in patients with stroke. Neurochem Res. 39(7), 1332-1337.

20. Turetsky A., Goddeau R.P., Henninger N., 2015. Low Serum Vitamin D Is Independently Associated with Larger Lesion Volumes after Ischemic Stroke. J Stroke Cerebrovasc Dis. 24(7), 1555-1563.

21. Sun Q., Pan A., Hu F.B., Manson J.E., Rexrode K.M., 2012. 25-Hydroxyvitamin D levels and the risk of stroke: a prospective study and meta-analysis. Stroke. 43(6), 1470-1477.

22. Poole K.E., Loveridge N., Barker P.J., Halsall D.J., Rose C., Reeve J., Warburton E.A., 2006. Reduced vitamin D in acute stroke. Stroke. 37(1), 243-245.

23. Kojima G., Bell C., Abbott R.D., Launer L., Chen R., Motonaga H., Ross G.W., Curb J.D., Masaki K., 2012. Low dietary vitamin D predicts 34-year incident stroke: the Honolulu Heart Program. Stroke. 43(8), 2163-2167.

24. Daubail B., Jacquin A., Guilland J.C., Khoumri C., Aboa-Eboule C., Giroud M., Bejot Y., 2014. Association between serum concentration of vitamin D and 1-year mortality in stroke patients. Cerebrovasc Dis. 37(5), 364-367.

25. Daubail B., Jacquin A., Guilland J.C., Hervieu M., Osseby G.V., Rouaud O., Giroud M., Bejot Y., 2013. Serum 25-hydroxyvitamin D predicts severity and prognosis in stroke patients. Eur J Neurol. 20(1), 57-61.

26. Brondum-Jacobsen P., Nordestgaard B.G., Schnohr P., Benn M., 2013. 25-hydroxyvitamin D and symptomatic ischemic stroke: an original study and meta-analysis. Ann Neurol. 73(1), 38-47.

27. Pilz S., Dobnig H., Fischer J.E., Wellnitz B., Seelhorst U., Boehm B.O., Marz W., 2008. Low vitamin d levels predict stroke in patients referred to coronary angiography. Stroke. 39(9), 2611-2613.

28. Iranmanesh F., Gadari F., 2011. Vitamin D and ischemic stroke. Hormozgan Medical Journal. 15(3), 178-183.

29. Gupta A., Prabhakar S., Modi M., Bhadada S.K., Lal V., Khurana D., 2014. Vitamin D status and risk of ischemic stroke in North Indian patients. Indian J Endocrinol Metab. 18(5), 721-725.

30. Quinn T., Dawson J., Walters M., 2008. Dr John Rankin; his life, legacy and the 50th anniversary of the Rankin Stroke Scale. Scottish Medical Journal. 53(1), 44-47.

31. Sims J.R., Gharai L.R., Schaefer P.W., Vangel M., Rosenthal E.S., Lev M.H., Schwamm L.H., 2009. ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology. 72(24), 2104-2110.

32. Evans M.A., Kim H.A., De Silva T.M., Arumugam T.V., Clarkson A.N., Drummond G.R., Zosky G.R., Broughton B.R., Sobey C.G., 2018. Diet-induced vitamin D deficiency has no effect on acute post-stroke outcomes in young male mice.J Cereb Blood Flow Metab. 38 (11), 1968-1978.

33. Narasimhan S., Balasubramanian P., 2017. Role of Vitamin D in the Outcome of Ischemic Stroke- A Randomized Controlled Trial. J Clin Diagn Res. 11(2), Cc06-cc10.