The “Cerebrovascular Disease” or “Stroke” is one of the leading causes of mortality and morbidity in adults worldwide, having serious medical, socio- economic and rehabilitation problems.

According to WHO stroke is defined as “rapidly developing clinical signs of focal (or global) neurological impairment, lasting for more than 24 hours having vascular origin.”^[1]

Stroke is also called ‘Brain Attack’ because it involves an acute insult to the brain, is a major disabling disease. But throughout the world, lack of prevention programs, unfavourable trends in stroke risk factor profile, lack of awareness of stroke risk factors and warning signals by the public and lack of emphasis on prevention training in medical schools, has lead to high stroke rates and serve to widen the stroke prevention gap.^[2,3,4]

The markers of inflammation like intercellular adhesion molecule-1, C- reactive protein, lipoprotein associated phospholipase A2, elevated white blood cell count, interleukins, endothelial nitric oxide synthase; infectious agents like Chlamydia pneumoniae, Helicobacter pylori and Cytomegalovirus; Homocysteine, Tissue factor, Fibrinogen, Lipoprotein (a), Cytokine transforming growth factor, etc., have been proposed as new risk factors for stroke. One more addition to the growing list is ‘Microalbuminuria’.^[5,6]

Micro-albuminuria is defined as an increase in urinary albumin excretion ranging from 30 to 300 mg per 24 hours or 30 to 300 µg/mg of creatinine on spot urine sample. It reflects glomerular component of systemic capillary leak which is fundamental to the pathogenesis of any acute stress condition. Microalbuminuria has been associated with many disease entities like diabetic nephropathy, hypertension and renal diseases, etc. Microalbuminuria has been associated with clinical risk factors for stroke like diabetes, hypertension, ageing, history of myocardial infarction, obesity, smoking and left ventricular hypertrophy.^[7,8]

But there was little information regarding microalbuminuria as an independent risk factor for stroke or as a predictor of stroke outcome. With the availability of sensitive and relatively inexpensive methods for detection of microalbuminuria, many studies were conducted in different parts of the world to determine the potential use of microalbuminuria, as a marker of stroke risk and outcome in non-diabetic non hypertensive population.

It was a Cross Sectional Observational Study. The present study comprises 50 patients, with history and clinical features suggestive of acute ischemic stroke, admitted in tertiary Hospital from 8^th May, 2023 to 8^th November, 2024.

WHO defines stroke as “Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting for more than 24 hours with no apparent cause other than vascular origin. “Micro-albuminuria is defined as an increase in urinary albumin excretion ranging from 30 to 300 mg per 24 hours or 30 to300 µg/mg of creatinine on spot urine sample.^[9]

Inclusion Criteria:

• Patients of 18 years & above age with ischemic stroke within 72 hours of onset of symptoms, the diagnosis of stroke being established by WHO definition of stroke.
• Ischemic lesion confirmed by CT scan brain/MRI Brain.
• Patients willing to give informed consent and if patient is not able to give so, then informed consent from care taker.

Exclusion Criteria (All/Any of the following):

• Patients with haemorrhagic stroke, subarachnoid haemorrhage or vertebral venous thrombosis.
• Patients with
• Patients with
• Renal disease
• Neoplastic
• Recent history of surgery or

Sample Size:

Sample size is calculated as

N = Z² pq / L²

[z = level of significance 95% =1.96, P = proportion of acute ischemic CV stroke patient (non-diabetic, non- hypertensive) admitted in Medicine wards, Out of total admissions; which is 2% on the basis of last 6 months Data record. Q= 1-p L= allowable error = 4%]

Sample size= 50

Data Collection & Analysis

The data collected was subjected to analysis using the Chi-square test, which is a statistical method utilized to evaluate the significance of proportions among different groups. In this study, the Chi-square test was applied to examine the relationship between various predisposing factors and the occurrence of microalbuminuria. Additionally, similar analyses were conducted to assess the significance of presenting factors and the mean patterns of parameters in patients, as well as to compare the differences between those who tested positive and negative for microalbuminuria.

Table 1. Age and Gender wise distribution

The mean age of study participants was 56.28 ± 17.2 years and the median age was 59.5 years. Majority 21(42%) cases were belonged aged more than 60 years followed by 11(22%) cases were belonged to 51-60 years. Total 9 cases were from 41-50 years, 3 cases were from 31-40 years and 2 cases were from 21-30 years age group. Only 3 cases were aged less than 20 years. Among the study participants, 33(66%) cases were males and 17(34%) cases were females.

Table 2: Microalbuminuria wise distribution

Of total, 35(70%) cases had presence of Microalbuminuria, remaining 15(30%) cases had absence of Microalbuminuria.

 Table 3. Association between Microalbuminuria and Presenting complain

The loss of consciousness was more common in patients with microalbuminuria and reached statistically significant levels. (p value-0.032)

Table 4: Association between Microalbuminuria and Blood as well as vital parameters

On applying Z test, there was no statistically significant difference found between Systolic BP, Diastolic BP, S. cholesterol, RBS as well as creatinine level and presence of Microalbuminuria.

Table 5: Association between Microalbuminuria and NIHSS score

On applying chi square test, there was an association found between NIHSS score and presence of microalbuminemia. (p value-<0.001).

Table 6: Association between Microalbuminemia and MRS score

On applying chi square test, there was an association found between MRS score and presence of microalbuminemia. (p value-0. 004).

In present study, the mean age of study participants was 56.28 + 17.2 years and the median age was 59.5 years. Majority 21(42%) cases were belonged aged more than 60 years followed by 11(22%) cases were belonged to 51-60 years. Total 9 cases were from 41-50 years, 3 cases were from 31-40 years and 2 cases were from 21-30 years age group. Only 3 cases were aged less than 20 years. In research of Pavuluri KS et al.^[10] and Sander D et al.^[11] the mean age of study participants was 61.87 years and 64.2 years respectively. Among the study participants, 33(66%) cases were males and 17(34%) cases were females. While in studies of Pavuluri KS et al.^[10] and Sander D et al.^[11] similar to our study findings, males were more affected in compared to females.

In present study, the mean Systolic BP level was 118.6 ±14.7 mmHg and the mean Diastolic BP level was 74.3 ±8.2 mmHg. The mean S. Cholesterol level was 162.03 mg/dl. The mean RBS level was 121.7 mg/dl. The mean Creatinine level was 1.046 mg/dL. In research of Pavuluri KS et al.^[10] observed that mean Systolic and Diastolic BP readings were 142.16±26.88 mmHg and 89.93 ± 14.30 mmHg, respectively. Microalbuminuria was present in a significant 61.4% (70) of the cohort, with a mean of 97.72 ± 49.1 mg/g of creatinine. In research of Sander D et al.^[11]. observed that the mean SBP level was 134 mmhg and the mean DBP level was 77 mmhg. The mean S. Cholesterol level was 182 mg/dL. So, a majority of the patients had normal range serum cholesterol level.

This finding is not similar to previous studies that had a positive correlation between higher level of serum cholesterol and stroke. This may be due to the fact that most of our study population belonged to the relatively economically low class. In a developing country like India, the prevalence of hypercholesterolemia may be overall lower than the west. Also, this indicates that many patients of ischemic cerebrovascular stroke may have normal to low serum cholesterol levels, and in spite of this, they should be treated with statins. Addition of statins has lowered the risk of stroke even in patients without elevated LDL or low HDL.

In this study,of total, 35(70%) cases had presence of Microalbuminuria, remaining 15(30%) cases had absence of Microalbuminuria. In research of Vadher et al.^[12] found that in 34 cases had presence of Microalbuminuria.

Among the study participants, 26(52%) cases had less than or equal to 10 NIHSS score, while remaining 24(48%) cases had more than 10 NIHSS score. The mean NIHSS score was 11.1 + 5.1. Research done by Pavuluri KS et al.^[10] and Vadher et al.^[12] found that majority of patients had less than or equal to 10 NIHSS score. The presence of microalbuminuria is associated with higher NIHSS score, indicating a more severe infarct as compared to absence of microalbuminuria. p-value was <0.001, so there is a significant correlation between microalbuminuria and higher NIHSS score on admission, so indicating a severe infarct.

In current research, the mean MRS score was 3.14 + 1.5. of total, only 22(44%) cases had more than 3 MRS score which indicates severe disability. Research done by Pavuluri KS et al.^[10] and Vadher et al.^[12] found that 67 and 22 cases respectively had MRS score more than 3. The presence of microalbuminuria is associated with higher MRS score, indicating a poor prognosis as compared to absence of microalbuminuria p-value was 0.004 (<0.05), so there is a significant correlation between microalbuminuria and higher MRS score, so indicating poor outcome. Other studies including Pavuluri KS et al.^[10] and Vadher et al.^[12] had similar findings. Thus, our findings are consistent with other studies.

Our study has few limitations-

Ideally, a large study sample is required for the statistical significance of the results, their implications, and their validity to extrapolate result and to suggest recommendations on the basis of it. The study involved only a short term follow up. So results can be used for prognostication more confidently only after long term prospective trials.

Long term prognosis was not analysed in the study, the assessment of prognosis was on admission. All patients in the study had presented at a tertiary care hospital. However, the study has not included those patients whose prognosis might have been too poor to reach the hospital in time, or impairment too minimal to seek medical advice at a tertiary care centre or a prognosis good enough.

Our findings suggest that a higher severity and worse short-term prognosis are linked to the occurrence of microalbuminuria. Therefore, in individuals suffering from an acute ischaemic cerebrovascular stroke, they might serve as markers of the severity and short-term prognosis. These findings support the existing literature and suggest that microalbuminuria may be used as a surrogate for stroke risk and outcome in the non-diabetic non- hypertensive population. Nevertheless, larger-scale research and a longer follow-up period are required to validate these results.

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