Our study included 280 patients, 174 of whom were diagnosed with acute ischemic stroke and 106 of whom were healthy. The mean age of the patient group was 70.14 ± 12.21, while that of the control group was 41.12 ± 14.95. The mean age difference between the two groups was statistically significant (p 0.001). Women (43.1%) were significantly more prevalent in the ischemic stroke group than in the control group (25.5%) (p = 0.003). When the two groups were examined in terms of the distribution of comorbidities, HT (83.3% vs. 7.5%; p < 0.001), DM (59.8% vs. 2.8%; p < 0.001), and CAD (43% vs. 0.9% p < 0.001), previous stroke (32.8% vs. 0%; p < 0.001), and CHF (13.2% vs. 0%; p < 0.001) were found significant in patients with ischemic stroke.
Ischemic stroke patients had significantly lower leukocyte (p = 0.005), neutrophil (p = 0.030), lymphocyte (p = 0.003), hemoglobin (p < 0.001), and albumin (p < 0.001) values than the control group. In contrast, however, BUN (p < 0.001) and creatinine (p = 0.047) values were significantly higher than those of the control group. The CRP values of patients with ischemic stroke were higher, but this difference was not statistically significant (p = 0.056). Ischemic stroke patients had higher CRP/albumin and BUN/creatinine values than the control group (p = 0.021 and p < 0.001). Table 1 provides information on the general characteristics of ischemic stroke patients and the control group.
Table 1
Patient characteristics by study groups
Variables
|
Control (n = 106)
|
Patient (n = 174)
|
p
|
Age (year), avg ± SS
|
41.12 ± 14.95
|
70.14 ± 12.21
|
0.001
|
Male gender
|
79(74.5)
|
99(56.9)
|
0.003
|
Other disease, n(%)
|
|
|
|
HT
|
8(7.5)
|
145(83.3)
|
<0.001
|
DM
|
3(2.8)
|
104(59.8)
|
<0.001
|
CAD
|
1(0.9)
|
76(43.7)
|
<0.001
|
Stroke
|
0(0)
|
57(32.8)
|
<0.001
|
CHF
|
0(0)
|
23(13.2)
|
<0.001
|
Leukocyte
|
9315(7810–12300)
|
8585(7150–10450)
|
0.005
|
Platelet
|
252000(210000–288000)
|
230500(188000–276000)
|
0.049
|
BUN (mg/dL)
|
13(10.5–16)
|
19.05(14.76–25.24)
|
<0.001
|
Creatinine (mg/dL)
|
0.9(0.79–1.09)
|
0.96(0.81–1.23)
|
0.047
|
Albumin (g/L)
|
44(41–46)
|
40(38–43)
|
<0.001
|
CRP (mg/L)
|
3(1–12)
|
5(2–12)
|
0.056
|
NLR
|
2.56(1.72–4.27)
|
2.86(1.9–4.5)
|
0.269
|
PLR
|
105.88(79.27-157.69)
|
122.66(87.06-171.71)
|
0.060
|
CRP/Albumin
|
0.07(0.02–0.39)
|
0.13(0.05–0.29)
|
0.021
|
BUN/Creatinine
|
13.78(11.88–17.55)
|
17.92(14.9-23.17)
|
<0.001
|
HT: hypertension; DM: diabetes mellitus; CAD: coronary artery disease; CHF: congestive heart failure; CRP: C-reactive protein; BUN: blood urea nitrogen; NLR: neutrophil lymphocyte ratio; PLR: platelet lymphocyte ratio |
Independent t test, Pearson chi-square test, Fisher-Freeman-Halton test.
The findings are presented as the median (IQR). Mann‒Whitney U test.
It was statistically significant that the wild-type genotype ratio (65.1%) was higher in the control group than in the patient group (48.9%), and the heterozygous genotype ratio (48.9%) was higher in the patient group than in the control group (34%) (p = 0.024). In the ischemic stroke patient group (26.7%), the rate of T alleles was significantly higher than that in the control group (17.9%) (p = 0.017). Table 2 shows the genotype distribution of the ABCB1 C3435T polymorphism in the patient and control groups.
Table 2
Genotype distribution of gene polymorphism (ABCB1 C3435T) of the patient and control groups
|
Control (n = 106)
|
Patient (n = 174)
|
|
|
n
|
%
|
N
|
%
|
p
|
Genotype (n = 280)
|
|
|
|
|
|
Wild type (CC)
|
69
|
65.1a
|
85
|
48.9b
|
0.024
|
Heterozigot (CT)
|
36
|
34.0a
|
85
|
48.9b
|
|
Homozigot (TT)
|
1
|
0.9a
|
4
|
2.3a
|
|
Allel (n = 560)
|
|
|
|
|
|
C
|
174
|
82.1
|
255
|
73.3
|
0.017
|
T
|
38
|
17.9
|
93
|
26.7
|
|
Fisher-Freeman-Halton test, Pearson chi-square test. The same letters in a row indicate no statistically significant difference between groups.
Aspirin resistance was found in 37 (21.3%) acute ischemic stroke patients, while aspirin sensitivity was found in 137 patients (78.7%). Table 3 illustrates the distribution of ischemic stroke patients according to their resistance to aspirin.
Table 3
Aspirin resistance and aspirin sensitivity in ischemic stroke patients (n = 174)
Aspirin resistance-sensitive
|
n
|
%
|
Aspirin resistance
|
37
|
21,3
|
Aspirin sensitive
|
137
|
78,7
|
Aspirin-sensitive individuals (54.7%) had a higher genotype ratio of wild type (CC) than aspirin-resistant individuals (27%). In the aspirin-resistant group, the heterozygous (CT) genotype ratio was 64.9%, while in the aspirin-sensitive group, it was 44.6%. Homozygous (TT) genotype ratio was found to be statistically significantly higher in the aspirin-resistant group (8.1%) than in the aspirin-sensitive group (0.7%) (p = 0.001). Aspirin-resistant individuals had a significantly higher rate of the T allele (40.5%) than aspirin-sensitive individuals (23%). Table 4 presents the genotype distribution of the ABCB1 C3435T polymorphism concerning AR and aspirin sensitivity among acute ischemic stroke patients.
Table 4
Genotype distribution of gene polymorphisms according to aspirin resistance and aspirin sensitivity in the acute ischemic stroke patient group (n = 174)
|
Aspirin resistance (n = 37)
|
Aspirin sensitive (n = 137)
|
|
|
n
|
%
|
N
|
%
|
p
|
Genotype (n = 174)
|
|
|
|
|
|
Wild type (CC)
|
10
|
27.0a
|
75
|
54.7b
|
0.001
|
Heterozigot (CT)
|
24
|
64.9a
|
61
|
44.6b
|
|
Homozigot (TT)
|
3
|
8.1a
|
1
|
0.7b
|
|
Allel (n = 358)
|
|
|
|
|
|
C
|
44
|
59.5
|
211
|
77.0
|
0.002
|
T
|
30
|
40.5
|
63
|
23.0
|
|
Fisher-Freeman-Halton test, Pearson chi-square test. The same letters in a row indicate no statistically significant difference between groups. |
Fisher-Freeman-Halton test, Pearson chi-square test. The same letters in a row indicate no statistically significant difference between groups.
Based on multivariate logistic regression analysis, the following results were found regarding the factors associated with AR in acute ischemic stroke patients. Hypertension (OR: 5.679; 95% CI: 1.144–28.19; p = 0.034), heterozygous (CT) genotype (OR: 2.557; 95% CI: 1.126–5.807; p = 0.025), an increased platelet value in patients with acute ischemic stroke (OR: 1.005; 95% CI: 1.001–1.009; p = 0.029) and a higher CRP/albumin ratio (OR: 1.547; 95% CI: 1.005–2.382; p = 0.047) were associated with increased AR. Table 5 summarizes the results of the multivariate logistic regression analysis performed to determine the independent risk factors that may contribute to the development of AR.
Table 5
Multivariate logistic regression analysis of factors associated with aspirin resistance in patients with acute ischemic stroke
Variables
|
OR (%95 GA)
|
P
|
Hypertension
|
5,679(1,144 − 28,19)
|
0,034
|
Heterozigot
|
2,557(1,126-5,807)
|
0,025
|
Leukocyte
|
1,123(0,987-1,279)
|
0,079
|
Platelet
|
1,005(1,001–1,009)
|
0,029
|
CRP/Albumin
|
1,547(1,005 − 2,382)
|
0,047
|
Variables that were significant in univariate analysis were included in the model.