Favorable outcome of blood urea nitrogen/creatinine–based hydration therapy 3 months after acute ischemic stroke

2016 ◽  
Vol 34 (12) ◽  
pp. 2414-2418 ◽  
Author(s):  
Chung Jen Lin ◽  
Jen Tsung Yang ◽  
Yen Chu Huang ◽  
Yuan Hsiung Tsai ◽  
Ming Hsueh Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Urea Nitrogen ◽  
Favorable Outcome ◽  
Urea Nitrogen ◽  
Hydration Therapy

Association between Blood Urea Nitrogen-to-creatinine Ratio and Three-Month Outcome in Patients with Acute Ischemic Stroke

2019 ◽  
Vol 16 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Linghui Deng ◽  
Changyi Wang ◽  
Shi Qiu ◽  
Haiyang Bian ◽  
Lu Wang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Blood Urea Nitrogen ◽  
Univariate Analysis ◽  
Density Lipoprotein ◽  
Hydration Status ◽  
Creatinine Ratio ◽  
Urea Nitrogen

Background: Hydration status significantly affects the clinical outcome of acute ischemic stroke (AIS) patients. Blood urea nitrogen-to-creatinine ratio (BUN/Cr) is a biomarker of hydration status. However, it is not known whether there is a relationship between BUN/Cr and three-month outcome as assessed by the modified Rankin Scale (mRS) score in AIS patients. Methods: AIS patients admitted to West China Hospital from 2012 to 2016 were prospectively and consecutively enrolled and baseline data were collected. Poor clinical outcome was defined as three-month mRS > 2. Univariate and multivariate logistic regression analyses were performed to determine the relationship between BUN/Cr and three-month outcome. Confounding factors were identified by univariate analysis. Stratified logistic regression analysis was performed to identify effect modifiers. Results: A total of 1738 patients were included in the study. BUN/Cr showed a positive correlation with the three-month outcome (OR 1.02, 95% CI 1.00-1.03, p=0.04). However, after adjusting for potential confounders, the correlation was no longer significant (p=0.95). An interaction between BUN/Cr and high-density lipoprotein (HDL) was discovered (p=0.03), with a significant correlation between BUN/Cr and three-month outcome in patients with higher HDL (OR 1.03, 95% CI 1.00-1.07, p=0.04). Conclusion: Elevated BUN/Cr is associated with poor three-month outcome in AIS patients with high HDL levels.

scholarly journals Usefulness of the blood urea nitrogen-to-serum albumin ratio as a prognostic indicator of severity in acute ischemic stroke

2021 ◽  
Keyword(s):  
Ischemic Stroke ◽  
Serum Albumin ◽  
Acute Ischemic Stroke ◽  
Blood Urea Nitrogen ◽  
Area Under The Curve ◽  
Neuroprotective Effects ◽  
Urea Nitrogen ◽  
Albumin Ratio ◽  
Icu Admission ◽  
Significant Difference

Objectives: Acute ischemic stroke (AIS) is one of the most important and major causes of mortality worldwide. In AIS patients, the blood urea nitrogen to creatinine ratio (B/C ratio) was investigated as a dehydrated biomarker in previous studies. However, the B/C ratio can be affected by medications and past medical history. We hypothesized addition of serum albumin, which has been shown to have beneficial neuroprotective effects, could compensate for the disadvantages. In the present study, the BUN to serum albumin ratio (B/A ratio) was evaluated association with AIS patient’s prognosis. Methods: This retrospective cohort study of AIS in our hospital was conducted from February 2018 through June 2020. First, demographic and clinical data were collected and compared with the prevalence of mortality and ICU admission. Then, the B/C ratio and the B/A ratio were calculated. Differences in the performance between the B/C ratio and the B/A ratio for outcome prediction were evaluated based on the area under the curve of the receiver operating characteristic (AUROC). Results: Among the 1,164 patients enrolled in this study, 77 (6.6%) died during hospitalization and 467 (40.1%) were admitted to ICU. Multivariate logistic regression had shown that the B/A ratio was a significant predictor of mortality and admission to ICU. In addition, the B/A ratio was significantly higher in ICU-admitted patients and non-survivors. The AUROC of the B/A ratio was 0.687 and the B/C ratio was 0.533 for predicting mortality; the B/A ratio was statistically superior to the B/C ratio. For predicting ICU admission, the AUROC values of the B/A ratio and the B/C ratio were 0.567 and 0.556, respectively, and a statistically significant difference was not observed. Conclusion: The B/A ratio is a simple and useful tool for predicting the outcomes of ischemic stroke patients.

scholarly journals Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke

2018 ◽  
Vol 82 (2) ◽  
pp. 572-578 ◽  
Author(s):  
Shoujiang You ◽  
Danni Zheng ◽  
Chongke Zhong ◽  
Xianhui Wang ◽  
Weiting Tang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Urea Nitrogen ◽  
Prognostic Significance ◽  
Urea Nitrogen

Abstract 268: Is There a Weekend Effect on Telestroke Code Time Metrics?

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Emily H Marino ◽  
Bridget M Ho ◽  
Sandra K Hanson
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Mortality Rates ◽  
Weekend Effect ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Code Process

Background: It has been suggested that there is a “weekend effect” resulting in higher mortality rates for stroke patients admitted on weekends. We examine this phenomenon for acute ischemic stroke (AIS) patients presenting to telestroke (TS) sites to determine its effect on stroke code process times and outcomes. Methods: From October 2015-June 2017, we reviewed consecutive AIS patients receiving IV alteplase within our TS network who then were transferred to our CSC. We compared patients presenting to TS sites on weekdays (Monday 0700 to Friday 1859) to patients presenting on weekends (Friday 1900 to Monday 0659). We analyzed door to code activation, code activation to TS evaluation, door to imaging, and door to needle times. Rates of favorable outcome (modified Rankin Scale score ≤2) and death at 90 days were compared. Results: We identified 89 (54 weekday, 35 weekend) patients (mean age 71.8±13.3 years, 47.2% women) during the study period. Median door to code activation (15 [5, 27] vs 8 [1, 17] mins, p=0.01) and door to needle (61 [49, 73] vs 47 [35, 59] mins, p=0.003) times were significantly longer for patients presenting on weekends compared to weekdays. There were no significant differences in median door to imaging (weekend 17 [7, 30] vs weekday 11 [6, 21], p=0.1) and code activation to TS evaluation (weekend 7 [6, 10] vs weekday 5 [4, 9], p=0.14) times. The rates of favorable outcome (weekend 50% vs weekday 66.7%, p=0.18) and death (weekend 8.3% vs weekday 4.8%, p=0.56) at 90 days were not significantly different. Conclusion: While there were no significant differences in outcomes, the “weekend effect” results in slower door to code activation and door to needle times. Efforts to improve methods in increasing efficiency of care on weekends should be considered.

scholarly journals Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase)

2018 ◽  
Vol 5 (1) ◽  
pp. 164
Author(s):  
Shiva Prasad Jagini ◽  
Suresh I.
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Intravenous Thrombolysis ◽  
Clinical Profile ◽  
Favorable Outcome ◽  
Nihss Score ◽  
The Mean ◽  
Centre Hospital

Background: Stroke patients are at highest risk death in the first few weeks after the event, and between 20-50% die within first month depending on type, severity, age, co-morbidities and effectiveness of treatment of complications. Objective of this study was to clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase).Methods: Prospective Observational study of 26 cases of acute ischemic stroke receiving IV thrombolysis using rtPA-alteplase at Kovai Medical Centre Hospital, Coimbatore over a period of 1 year 9 months.Results: 21 cases had NIHSS score of range 10 to 22. The mean NIHSS score at admission is 13.5. 15 subjects (57.7%) had achieved primary outcome in this study. MRS Score of 0 to 2 is considered as favorable outcome. In this study 20 subjects (76.92 %) had favorable outcome at the end of 3 months.Conclusions: Majority of the patients receiving rtPA-alteplase had favorable outcome.

Abstract T P66: Safety and Effectiveness of Intravenous Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients on Aspirin and Clopidogrel

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mushtaq H Qureshi ◽  
Shayaan M Khan ◽  
Nauman Jahangir ◽  
Ahmed A Malik ◽  
Melissa Freese ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Combination Therapy ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Neurological Improvement ◽  
Tissue Plasminogen

Background: The number of acute ischemic stroke patients who are on both aspirin and clopidogrel treatment at time of acute ischemic event is increasing. There is limited data regarding the safety and efficacy of intravenous recombinant tissue plasminogen activator (rt-PA) treatment in such patients. Methods: We reviewed the medical records and imaging data of consecutive patients with acute ischemic stroke who received IV rt-PA within 4.5 hours of symptom onset. We stratified the patients based on active regular use of antiplatelet medications: monotherapy (aspirin or clopidogrel), combination therapy (aspirin and clopidogrel), and no therapy and compared the rates of symptomatic intracerebral hemorrhage (ICH), neurological improvement (≥4 points in National Institutes of Health Stroke Scale [NIHSS], and favorable outcome (modified Rankin scale [mRS] 0-1) at discharge between the three groups. Results: A total of 88 acute ischemic stroke patients (mean age±SD; 69.88 ±15) were treated with IV rt-PA within the study duration. Of the 88 patients 45 (50.6%), 37 (41.6%), and 52 (58.4) were on monotherapy, combination therapy, or no therapy at time of presentation. The proportion of patients who developed symptomatic ICHs were similar (p=0.8) in monotherapy, combination therapy, and no therapy groups (3.3%, 0.0%, and 4.1%, respectively). The rates of neurological improvement were greater in patients on monotherapy (20%) (p=0.03) followed by combination therapy (11.1%), and no therapy groups (2.0%). There was no significant reduction in the rate of favorable outcome at discharge among patients on combination treatment compared with no treatment (odds ratio 0.8 , 95% confidence interval 0.4-1.8 ) after adjusting for age and initial NIHSS score strata (<10, 10-19, and ≥20). Conclusions: Compared with patients on no antiplatelet treatment, acute ischemic stroke patients who are actively using aspirin and clopidogrel appear to have similar risks and benefits with IV rt-PA treatment.

Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Jeffrey L Saver ◽  
Mayank Goyal ◽  
David S Liebeskind ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Nihss Score ◽  
Post Procedure ◽  
Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

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