Estimation Of Ischemia Modified Albumin In Acute Stroke With And Without Diabetes Mellitus: A One Year Cross Sectional Study

Abstract

Background and Objectives: Stroke is a leading cause of mortality and morbidity all over the world. Diabetes Mellitus is frequently associated with it. Currently the diagnosis of stroke is mainly based on neuro imaging techniques which are not devoid of limitations. Thus the alternate approach would be using biomarkers to support the clinical diagnosis of acute stroke. Ischemia Modified Albumin is one such marker of ischemia approved by FDA of US. Primary objective of the present study was to estimate and compare the IMA levels in ‘Stroke with DM’, ‘Stroke without DM’ and ‘Healthy Control’ groups. Secondary objective was to assess the diagnostic efficacy of the IMA in both the patient groups. Materials and methods: This one year cross sectional study included 90 subjects of either sex, of which 30 cases of acute stroke with diabetes, 30 cases of acute stroke without diabetes and 30 normal healthy controls after obtaining informed and written consent. Blood sample was collected from stroke patients soon after the clinical diagnosis and included in the study after radiological confirmation of acute stroke. Blood sample from healthy volunteers attending the blood bank was taken as controls. IMA was estimated using Albumin Cobalt Binding test using a spectrophotometer. Results of IMA were expressed in absorbance units (ABSU). Serum albumin was also estimated in all the subjects involved in the study. Results were tabulated and subjected to appropriate statistical analyses. Results: Mean IMA values were high in ‘Stroke with DM’ (0.23± 0.03) and ‘Stroke without DM’ (0.21 ± 0.03) groups when compared with the ‘Controls’ (0.16 ± 0.03). There was a statistically significant difference between the three groups when compared by ANOVA (p <0.001). Comparison of IMA values of three groups with each other by Post-hoc Bonferroni test showed statistically significant difference between ‘Stroke with DM’ and ‘Controls’(p <0.001), ‘Stroke without DM’ and ‘Controls’(p <0.001). However the difference in mean IMA levels between ‘Stroke with DM’ and ‘Stroke without DM’ was not significant statistically (p= 0.116). There was no significant correlation between serum albumin and IMA in all the three groups (p>0.05). In ‘Stroke with DM’ group, area under the ROC curve was 0.968 and at a cut off of 0.196 ABSU, sensitivity was 90% and specificity was 87%. In ‘Stroke without DM’ group, area under the ROC curve was 0.917 and at a cut off of 0.192 ABSU, sensitivity was 87% and specificity was 83%. Interpretation and conclusion: Ischemia Modified Albumin levels were found to be significantly higher in ‘Stroke with DM’ and ‘Stroke without DM’ patients than healthy controls. Though there was no statistically significant difference in IMA levels between the two groups, ‘Stroke with DM’ patients had higher IMA levels than ‘Stroke without DM’ patients. ROC analysis showed higher AUC for IMA in ‘Stroke with DM’ than ‘Stroke without DM’ group. In both the groups IMA was found to be having excellent diagnostic efficacy for the diagnosis of acute stroke. According to the present study there was no significant correlation of serum albumin with IMA levels in both stroke patients and controls. Hence we suggest that estimation of IMA could serve as an aid in the diagnosis of acute stroke in patients both with and without DM. Albumin cobalt binding test can be used for the estimation of IMA, which is a simple and cost-effective method.