A SYSTEMATIC REVIEW OF PROGNOSTIC BIOMARKERS: SERUM FERRITIN, CRP, AND RDW AS PREDICTORS OF ACUTE ISCHAEMIC STROKE SEVERITY

JEYARAMAN SAI PRITAM,D. KANIMOZHI,R. KANNAN

Background: Acute ischemic stroke (AIS) is a leading cause of global morbidity and mortality, emphasizing the need for reliable biomarkers to predict stroke severity and outcomes. Serum ferritin, C-reactive protein (CRP), and red cell distribution width (RDW) have been studied as potential prognostic indicators in AIS due to their links with inflammation and oxidative stress.

Objective: This systematic review assesses the prognostic value of serum ferritin, CRP, and RDW levels in predicting AIS severity and functional outcomes, focusing on their roles in early risk stratification and patient management.

Methods: A comprehensive literature search in PubMed, Embase, and Web of Science was conducted through November 2023, identifying studies that examined serum ferritin, CRP, or RDW in relation to AIS severity. Key measures included the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Meta-analyses were performed where feasible, with results expressed as odds ratios (OR) and 95% confidence intervals (CI).

Results: This review encompassed a total of 24 studies, including over 11,000 patients with AIS. Elevated RDW levels were consistently associated with higher mortality and poorer functional outcomes, with odds ratios ranging from 1.18 to 1.23 for 3-month mortality. Elevated serum ferritin correlated with greater stroke severity (NIHSS) and poor functional outcomes, showing significant outcome disparities above specific ferritin thresholds. CRP levels, particularly above 10 mg/L, were linked to higher mortality and more severe strokes, with pooled ORs for adverse outcomes reaching up to 4.89. Integrating these biomarkers significantly improved risk stratification, supporting the value of their inclusion in AIS management.

Conclusion: Serum ferritin, CRP, and RDW are promising biomarkers for assessing AIS severity and prognosis, facilitating early stratification and more tailored interventions. This review underscores the clinical value of incorporating these biomarkers into AIS protocols and highlights areas for further research to optimize their predictive accuracy.