scholarly journals Association of lipid profiles with severity and outcome of acute ischemic stroke in patients with and without chronic kidney disease

2020 ◽  
Author(s):  
Ailing Zhang ◽  
Wenjing Deng ◽  
Bin Zhang ◽  
Mengyang Ren ◽  
Long Tian ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Lipid Profiles ◽  
Stepwise Logistic Regression ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Adjusted Risk ◽  
Lipid Components

Abstract Background Contribution of lipid profiles to stroke severity and outcome was inconclusive, whether chronic kidney disease (CKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m2) affects the association has not been investigated. We aim to evaluate this relationship. Methods A retrospective study of consecutive acute ischemic stroke patients was performed. We assessed the risk of severe stroke with the National Institutes of Health Stroke Scale (NIHSS) ≥ 5 at admission and poor outcome with the modified Rankin Scale (mRS) ≥ 3 at discharge. Multivariate stepwise logistic regression models were adopted to study interaction and independent association of lipid components with stroke severity and outcome according to lipid level quartiles by CKD stratification. Results Among the 875 included patients (mean age 64.9 years, 67.8% males), 213 (24.3%) presented with CKD. Elevated low-density lipoprotein cholesterol (LDL-C) was independently associated with severe stroke in patients with CKD (P for trend = 0.033) than in those without CKD (P for trend = 0.121). The association between the level of LDL-C and stroke severity was appreciably modified by CKD (Pinteraction = 0.013). Compared with without CKD patients in the lowest LDL-C quartile, the multivariable-adjusted risk of severe stroke increased significantly by 2.9-fold (95% CI 1.48–5.74) in patients with CKD in the highest LDL-C quartile. No significant association was observed between lipid components and early outcome in patients with and without CKD. Conclusion LDL-C levels are positively associated with stroke severity in only patients with CKD, with an interactive impact of LDL-C and CKD on ischemic stroke in the acute phase.

scholarly journals Cellular and molecular mechanisms associated with ischemic stroke severity in female mice with chronic kidney disease

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Lucie Hénaut ◽  
Maria Grissi ◽  
François Brazier ◽  
Maryam Assem ◽  
Sabrina Poirot-Leclercq ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Molecular Mechanisms ◽  
Stroke Severity ◽  
Female Mice

Abstract TP199: Cerebral Microblees and Chronic Kidney Disease in Patients With First-ever Acute Ischemic Stroke or Transient Ischemic Attack

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Asako Nakamura ◽  
Masahiro Yasaka ◽  
Takahiro Kuwashiro ◽  
Seiji Gotoh ◽  
Yasuyuki Nakanishi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Ischemic Attack

scholarly journals Metformin prevents stroke damage in non-diabetic female mice with chronic kidney disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maria Grissi ◽  
Cédric Boudot ◽  
Maryam Assem ◽  
Alexandre Candellier ◽  
Mathilde Lando ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Brain Activity ◽  
Artery Occlusion ◽  
Diabetic Patients ◽  
Stroke Severity ◽  
Neurological Score ◽  
Amp Activated Protein Kinase ◽  
Cerebral Artery Occlusion

AbstractChronic kidney disease (CKD) worsens ischemic stroke severity in both patients and animals. In mice, these poorer functional outcomes are associated with decreased brain activity of AMP-activated protein kinase (AMPK), a molecule that recently emerged as a potential therapeutic target for ischemic stroke. The antidiabetic drug metformin, a well-known activator of AMPK, has improved stroke outcomes in diabetic patients with normal renal function. We investigated whether chronic metformin pre-conditioning can rescue AMPK activity and prevent stroke damage in non-diabetic mice with CKD. Eight-week-old female C57BL/6J mice were assigned to CKD or SHAM groups. CKD was induced through right kidney cortical electrocautery, followed by left total nephrectomy. Mice were then allocated to receive metformin (200 mg/kg/day) or vehicle for 5 weeks until stroke induction by transient middle cerebral artery occlusion (tMCAO). The infarct volumes were lower in CKD mice exposed to metformin than in vehicle-treated CKD mice 24 h after tMCAO. Metformin pre-conditioning of CKD mice improved their neurological score, grip strength, and prehensile abilities. It also enhanced AMPK activation, reduced apoptosis, increased neuron survival and decreased microglia/macrophage M1 signature gene expression as well as CKD-induced activation of the canonical NF-κB pathway in the ischemic lesions of CKD mice.

scholarly journals Association between chronic kidney disease and outcomes among admissions for acute ischemic stroke receiving thrombolysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Weeda
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Funding Source ◽  
National Inpatient Sample ◽  
Risk Of Bleeding ◽  
Diagnostic Coding

Abstract Background Patients with chronic kidney disease may have hemostatic defects that increase the risk of bleeding following the administration of thrombolysis. Purpose We assessed the association between chronic kidney disease and intracerebral hemorrhage in acute ischemic stroke admissions receiving thrombolysis. Methods Using administrative data from the 2013 and 2014 National Inpatient Sample, adult acute ischemic stroke admissions treated with thrombolysis were identified. Patients with chronic kidney disease were identified via diagnostic coding. We used multivariable logistic regression to estimate the odds of intracerebral hemorrhage in patients with chronic kidney disease after adjustment for age and comorbidities. The association between chronic kidney disease and in-hospital mortality was also evaluated. Results Of 13,993 admissions treated with thrombolysis for acute ischemic stroke, 12.4% (n=1,739) had chronic kidney disease. Intracerebral hemorrhage occurred in 7.6% of patients and 7.0% experienced in hospital mortality. Chronic kidney disease did not increase the odds of intracerebral hemorrhage (odds ratio [OR]=1.00; 95% confidence interval [CI]=0.83–1.20). The adjusted odds of in-hospital mortality were also no different in those with versus without chronic kidney disease (OR=1.19; 95% CI=0.99–1.42). Conclusions Among admissions treated with thrombolysis for acute ischemic stroke, chronic kidney disease was not associated with a higher adjusted odd of intracerebral hemorrhage. Chronic kidney disease did not increase the odds of in-hospital mortality. Funding Acknowledgement Type of funding source: Other. Main funding source(s): SmartState Medication Safety

scholarly journals Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Stroke Severity and Short-Term Prognosis in Acute Ischemic Stroke With Intracranial Atherosclerotic Stenosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yuanlin Ying ◽  
Fang Yu ◽  
Yunfang Luo ◽  
Xianjing Feng ◽  
Di Liao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stroke Severity ◽  
Short Term ◽  
Severe Stroke ◽  
Lymphocyte Ratio ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis

Background: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of poor prognosis in acute ischemic stroke (AIS), but associations between NLR with stroke severity and prognosis of intracranial atherosclerotic stenosis (ICAS)-related ischemic events have not been well-elucidated; therefore, we aimed to evaluate whether admission NLR levels correlate with the early stroke severity and short-term functional prognosis in patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods: This retrospective study enrolled 899 consecutive patients with AIS attributed to ICAS at Xiangya Hospital stroke center between May 2016 and September 2020. The initial stroke severity was rated by the admission National Institutes of Health Stroke Scale (NIHSS) scores, and the short-term prognosis was evaluated using the 14-day modified Rankin Scale (mRS) scores after stroke onset. A severe stroke was defined as NIHSS &gt;8; an unfavorable functional outcome was defined as mRS scores of 3–6. Admission NLR was determined based on circulating neutrophil and lymphocyte counts.Results: The median admission NLR of all patients was 2.80 [interquartile range (IQR), 2.00–4.00]. In univariate analysis, admission NLR was significantly elevated in patients with severe stroke and poor short-term prognosis. After multivariate adjustment, admission NLR levels were significantly correlated with severe stroke [odds ratio (OR), 1.132; 95% confidence interval (95% CI), 1.038–1.234; P = 0.005] and unfavorable short-term prognosis (OR, 1.102; 95% CI, 1.017–1.195; P = 0.018) in Model 1. In Model 2, the highest NLR tertile (≥3.533) remained an independent predictor of severe stroke (OR, 2.736; 95% CI, 1.590–4.708; P &lt; 0.001) and unfavorable functional outcome (OR, 2.165; 95% CI, 1.416–3.311; P &lt; 0.001) compared with the lowest NLR tertile (&lt;2.231). The receiver operating characteristic (ROC) curves showed the predictability of NLR regarding the stroke severity [area under the curve (AUC), 0.659; 95% CI, 0.615–0.703; P &lt; 0.001] and short-term prognosis (AUC, 0.613; 95% CI, 0.575–0.650; P &lt; 0.001). The nomograms were constructed to create the predictive models of the severity and short-term outcome of sICAS.Conclusions: Elevated admission NLR levels were independently associated with the initial stroke severity and could be an early predictor of severity and poor short-term prognosis in AIS patients with ICAS, which might help us identify a target group timely for preventive therapies.

Abstract P532: Hypertension and Gender Differences in Acute Ischemic Stroke Patients Treated With Rtpa

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Thomas I Nathaniel ◽  
Jordan Gainey ◽  
Leah Wormack ◽  
Chibueze Ubah ◽  
Leanne Brechtel ◽  
...  
Keyword(s):  
Gender Differences ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Hypertensive Patients ◽  
Ischemic Cerebrovascular Disease ◽  
And Gender ◽  
Similar Incidence

Background: Women and men have a similar incidence for ischemic cerebrovascular disease but women are more frequently hit by stroke later in life than men. It has been shown that women presented with severe stroke symptoms during admission, a poorer prognosis, are likely to have an overall poorer outcome after ischemic stroke when compared with men. However, some studies indicate similarities in outcome for men and women after stroke. Moreover, there is evidence that women treated with tPA benefit at least as much as men. Since a higher diastolic blood pressure increases the risk for a worse prospective functional status in men, but less significance in women, it is not clear whether hypertensive patients with acute ischemic stroke treated will reveal similarity or difference in functional outcome. We investigated this issue in the current study. Method: We performed a retrospective analysis of 4500 acute ischemic stroke patients who presented to a health care system between January 2010 and June 2016 and received rt-PA. We develop a new tool to determine the possibility of erasing any gender difference, and identify the most important factor for the poorer outcomes in women or men and whether thrombolysis may counteract this effect. Results: Our results reveal that poorer outcomes after stroke and the observed gender differences is due to age, at stroke onset, and that thrombolysis may neutralize this effect. Conclusion: The important factor for the poorer outcome and gender differences in hypertensive patients with acute ischemic stroke is mainly due to stroke severity and thrombolysis may play a major role in neutralizing this effect.

scholarly journals Impaired kidney function evaluated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is associated with more severe acute ischemic stroke

2017 ◽  
Vol 22 (5) ◽  
pp. 432-434 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Marina Georgaraki ◽  
Stella D Bouziana ◽  
Marianna Spanou ◽  
Stavroula Kostaki ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Kidney Function ◽  
Disease Epidemiology
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