Comparative Analysis of Laboratory Parameters in Acute Ischemic and Hemorrhagic Stroke
Süleyman Nogay, Turgut Dolanbay, Levent Şahin, Bilgehan Demir, Asiye ÖzkanIntroduction:
Acute stroke, encompassing ischemic and hemorrhagic subtypes, remains a leading cause of morbidity and mortality worldwide. Early and accurate differentiation of stroke subtypes is essential for guiding appropriate therapeutic decisions. Although numerous hematological and biochemical parameters have been explored for differential diagnosis, their diagnostic relevance remains uncertain. This study aimed to compare the performance of laboratory parameters and indices in acute stroke.
Methods:
Adult patients presenting to the emergency department between January and December 2024 with a diagnosis of ischemic or hemorrhagic stroke were retrospectively evaluated. Hemogram and biochemistry parameters, CRP-based ratios (CAR, CrAR), GAR, SII, SIRI, and HALP scores were examined. Intergroup comparisons were performed using appropriate statistical tests, and ROC analysis was applied for CRP and CAR.
Results:
Of the total 119 patients, 88.2% were in the ischemic stroke group, and 11.8% were in the hemorrhagic stroke group. Among the evaluated parameters, CRP and CAR values were significantly higher in the ischemic stroke group (p=0.035 and p=0.024, respectively), whereas glucose levels were significantly higher in the hemorrhagic stroke group (p=0.035). Other biomarkers and inflammatory scores did not show significant differences between subtypes. In the ROC analysis, CAR (AUC=0.686) showed higher discriminatory performance than CRP (AUC=0.673).
Discussion:
The findings suggest that inflammatory biomarkers, particularly CRP and CAR, may reflect differences in inflammatory and metabolic responses between ischemic and hemorrhagic stroke during the acute phase. Higher glucose levels observed in hemorrhagic stroke patients may also reflect acute metabolic stress responses associated with cerebrovascular injury. However, the relatively modest ROC performance and the absence of significant differences in several other inflammatory indices indicate that these parameters should be interpreted as supportive rather than definitive diagnostic tools. Larger prospective multicenter studies are needed to validate their potential clinical utility.
Conclusion:
Significantly higher CRP and CAR levels were observed in ischemic stroke patients; however, the modest discriminatory performance observed in ROC analysis suggests that these markers may serve only as supportive adjunctive parameters rather than definitive tools for stroke subtype differentiation. Conversely, indices including SII, SIRI, and HALP appear more informative for prognostic assessment than for subtype discrimination. Overall, CRP, CAR, and related biomarkers should support clinical evaluation and decision-making rather than serve as independent diagnostic tools in acute stroke.