Recanalization between 1 and 24 hours after t-PA therapy is a strong predictor of cerebral hemorrhage in acute ischemic stroke patients

2008 ◽  
Vol 270 (1-2) ◽  
pp. 48-52 ◽  
Author(s):  
Kazumi Kimura ◽  
Yasuyuki Iguchi ◽  
Kensaku Shibazaki ◽  
Kazuto Kobayashi ◽  
Junichi Uemura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Hemorrhage ◽  
Strong Predictor ◽  
Stroke Patients

A COACHS Nomogram to Predict the Probability of Three-Month Unfavorable Outcome after Acute Ischemic Stroke in Chinese Patients

2019 ◽  
Vol 47 (1-2) ◽  
pp. 80-87 ◽  
Author(s):  
BaiLi Song ◽  
YuKai Liu ◽  
Linda Nyame ◽  
XiangLiang Chen ◽  
Teng Jiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Ischemic Stroke ◽  
Valvular Heart Disease ◽  
Cerebral Hemorrhage ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Lemeshow Test

Background: Accurate prognostication of unfavorable outcome made at the early onset of stroke is important to both the clinician and the patient management. This study was aimed to develop a nomogram based on the integration of parameters to predict the probability of 3-month unfavorable functional outcome in Chinese acute ischemic stroke patients. Methods: We retrospectively collected patients who underwent acute ischemic stroke at Stroke Center of the Nanjing First Hospital (China) between May 2013 and May 2018. After exclusion, the study population includes 1,025 patients for nomogram development. The main outcome measure was 3-month unfavorable outcome (modified Rankin Scale > 2). Multivariable logistic regression analysis was used to develop the predicting model, and stepwise logistic regression with the Akaike information criterion was utilized to find best-fit nomogram model. We incorporated the creatinine, fast blood glucose, age, previous cerebral hemorrhage, previous valvular heart disease, and NHISS score (COACHS), and these factors were presented with a nomogram. We assessed the discriminative performance by using the area under curve (AUC) of receiver-operating characteristic (ROC) and calibration of risk prediction model by using the Hosmer-Lemeshow test. Results: Multivariate analysis of the 1,025 patients for logistic regression helped identify the independent factors as National Institutes of Health Stroke Scale score on admission, age, previous valvular heart disease, fasting blood glucose, creatinine, and previous cerebral hemorrhage, which were included in the COACHS nomogram. The AUC-ROC of nomogram was 0.799. Calibration was good (p = 0.1376 for the Hosmer-Lemeshow test). Conclusions: The COACHS nomogram may be used to predict unfavorable outcome at 3 months after acute ischemic stroke in Chinese population. It may be also a reliable tool that is effective in its clinical utilization to risk-stratify acute stroke patients.

Abstract TP181: Albuminuria Should Be A Strong Predictor Of Acute Kidney Injury in Acute Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Takashi Shimoyama ◽  
Satoshi Suda ◽  
Yohei Takayama ◽  
Takahiro Ouchi ◽  
Masafumi Arakawa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Acute Ischemic Stroke ◽  
Creatinine Level ◽  
Strong Predictor ◽  
Kidney Injury ◽  
Albumin Level ◽  
Stroke Patients ◽  
Urine Albumin

Background: Acute kidney injury (AKI) in the setting of cardiovascular events is recognized as a high risk of poor clinical outcome. Although estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes, solid evidence has not yet to be presented regarding the relationship among the two markers and AKI. The present study aimed to clarify this issue in patients with acute ischemic stroke. Methods: From a prospectively gathered registry, we examined acute ischemic stroke patients who were hospitalized within 48 hours after symptom from September 2014 to June 2016. Admission serum creatinine level was considered to be the baseline. AKI is defined by an increase in the serum creatinine level of ≥0.3 mg/dl within 48 hours; or percentage increase of 50% or more from the baseline value within 7 days after admission. We divided all patients into the AKI group and the non-AKI group, and compared clinical characteristics between the two groups. The factors associated with AKI were investigated by multivariate logistic regression analysis. Results: Three hundred and eighty-nine patients (245 males, 74 [65-82] years old) were enrolled in the study. AKI occurred in 14 patients (3.6%) with acute ischemic stroke patients. Compared with patients without AKI, patients with AKI had increased serum creatinine level (1.20 mg/dl vs. 0.80 mg/dl, p=0.033) and urine albumin level (259.6 mg/g vs. 38.7mg/g, P<0.001). On the other hand, eGFR level was decreased in the AKI group than in the non-AKI group (45.5 ml/min/1.73 m 2 vs. 65.0 ml/min/1.73 m 2 , P=0.048). Poor clinical outcome at discharge (mRS ≥5) was frequently observed in the AKI group than the non-AKI group (42.9% vs. 16.5%, P=0.022). The optimal cut-off urine albumin value to distinguish the AKI from the non-AKI using receiver operating characteristics (ROC) curves was 170 mg/g, with 78.6% sensitivity and 79.2% specificity. Multivariate regression analysis showed that urine albumin level > 170mg/g was an independent factor of AKI (odds ratio [OR] 12.73; 95% confidence interval [CI], 3.10-52.30, P<0.001), but not eGFR <60 ml/min/1.73 m 2 (OR 0.96; 95% CI 0.26-3.54, P=0.944). Conclusion: Albuminuria should be a strong predictor for AKI in acute ischemic stroke patients.

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