Serum Vitamin D Level and Initial Severity of Acute Ischemic Stroke

Objective: The purpose of this study is to determine the association between the serum vitamin D level and initial severity in patients with acute ischemic stroke in Mandalay General Hospital. This study is designed to describe age and sex distribution, initial severity of stroke and serum vitamin D level.

Study design and method: It is a hospital based cross-sectional analytic study. Total 88 patients who met the inclusion criteria were enrolled. Thorough history taking, general and neurological examinations were done. Measurement of serum vitamin D level was done within 72 hours of admission. All patients were examined and scored by National Institute of Health Stroke Scale(NIHSS) on the day of admission. Initial severity was assessed in association with serum vitamin D level.

Result: The most common age group having stroke was over 60 years with mean age of 61±13 years. Regarding the gender, there was a higher incidence of stroke in male(60.2%) compared to female(39.8%). The mean NIHSS score on admission was 13.2±5.9. The mean serum vitamin D level on admission was 20.41±11.82 ng/ml. In patients with hypovitaminosis D, only 34% of patients had severe stroke. There was no statistical significance regarding the association of admission serum vitamin D level and severity of stroke on admission day(X2=1.0498, p=0.306).

Conclusion: There was no significant association between serum vitamin D level and initial severity of acute ischemic stroke.

Some highlights to GPs( Comments )

• Although the number of patients with increasing severity of stroke should have a lower vitamin D level according to some reference studies, the findings in this study were interestingly different.
• In this study, there was no significant association between serum vitamin D level and initial severity of acute ischemic stroke.
• On reviewing the literature, the association between a low serum vitamin D level and the initial severity of acute ischemic stroke was not consistent in all studies.
• One possible explanation lies in a high degree of variability in measuring serum vitamin D level due to different factors such as different ethnicity, occupation, lifestyle and environmental conditions, exposure to sun, seasonal variations and nutritional status.
• The lack of normal values of Myanmar population should be considered as another important fact.
• Therefore, further studies are necessary for standardization of normal vitamin D values in Myanmar population and for the evaluation of whether serum vitamin D level predicts the 90 days functional outcome in patients with acute ischemic stroke.

Comments

Another reviewer added that although the relationship between Vitamin D and severity of stroke may be academically interesting but it will be of little interest and practical value to General Practioner. They would not care less whether a person with stroke has Vitamin D deficiency or not. Anyhow, Vitamin D deficiency (to her knowledge) is probably uncommon in Myanmar.

Professor Aung Than Batu