scholarly journals In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Yu ◽  
Xiaolu Liu ◽  
Qiong Yang ◽  
Yu Fu ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Recurrent Events ◽  
Early Stage ◽  
High Rate ◽  
Large Artery ◽  
Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

Admission Hemoglobin Is Prognostic for In-Hospital Mortality in Oldest-Old Patients with Acute Ischemic Stroke

Gerontology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Mingquan Li ◽  
Xiaoyun Liu ◽  
Liumin Wang ◽  
Lei Shu ◽  
Liqin Luan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Oldest Old ◽  
Final Analysis ◽  
Short Term ◽  
Old Patients ◽  
Short Term Mortality ◽  
Tertiary Hospitals

<b><i>Introduction:</i></b> Anemia is a common condition encountered in acute ischemic stroke, and only a few pieces of evidence has been produced suggesting its possible association with short-term mortality have been produced. The study sought to assess whether admission anemia status had any impact on short-term clinical outcome among oldest-old patients with acute ischemic stroke. <b><i>Materials and Methods:</i></b> A retrospective review of Electronic Medical Recording System was performed in 2 tertiary hospitals. Data, from the oldest-old patients aged &#x3e; = 80 years consecutively admitted with a diagnosis of acute ischemic stroke between January 1, 2015, and December 31, 2019, were analyzed. Admission hemoglobin was used as indicator for anemia and severity. Univariate and multivariate regression analyses were used to compare in-hospital mortality and length of in-hospital stay in different anemia statuses and normal hemoglobin patients. <b><i>Results:</i></b> A total of 705 acute ischemic stroke patients were admitted, and 572 were included in the final analysis. Of included patients, 240 of them were anemic and 332 nonanemic patients. A statistical difference between the 2 groups was found in in-hospital mortality (<i>p</i> &#x3c; 0.001). After adjustment for baseline characteristics, the odds ratio value of anemia for mortality were 3.91 (95% confidence intervals (CI) 1.60–9.61, <i>p</i> = 0.003) and 7.15 (95% CI: 1.46–34.90, <i>p</i> = 0.015) in moderate and severely anemic patients, respectively. Similarly, length of in-hospital stay was longer in anemic patients (21.64 ± 6.17 days) than in nonanemic patients (19.08 ± 5.48 days, <i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Increased severity of anemia may be an independent risk factor for increased in-hospital mortality and longer length of stay in oldest-old patients with acute ischemic stroke.

scholarly journals Clinical profile, in-hospital outcome and associated factors of stroke after the start of a standard organized stroke care unit at university of Gondar hospital, northwest Ethiopia.

2019 ◽  
Author(s):  
Seid Getahun Abdella ◽  
Nebiyu Bekele Gebi ◽  
Ermias Shenkutie Gerffie ◽  
Koku Sisay Tamirat
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Regression Model ◽  
Hospital Stay ◽  
Functional Impairment ◽  
Associated Factors ◽  
Stroke Care ◽  
Post Stroke ◽  
Stroke Disability

Abstract Background: Epidemiological transitions and widespread risk factors made stroke common health problem in sub-Saharan countries in the early age. Stroke management largely depends on non-drug interventions. Stroke care units are facilities in hospitals which increased patient survival, return home, and regain independence in daily activities. This study was aimed to assess clinical profile, in-hospital outcome and its associated factors of stroke after the start of a standard organized stroke care unit in the study area. Method: An institution based cross-sectional study was employed from July 2015 to September 2017. A total of 151 stroke patients with computed tomography (CT) scan result were included in the study. Data were collected using structured questionnaire from secondary sources of patient medical records. In-hospital mortality and poor post-stroke disability (greater functional impairment, when Modified Rankin Scale score (mRS) ≥3) were outcome variables. Binary logistic regression model was fitted to identify predictor variables. Adjusted Odds Ratio (OR) with a 95% confidence interval (CI) used to assess the strength of association. Variables with p-value less than 0.05 in the multi-variable regression model was considered as significantly associated with the dependent variables. Result: Ischemic stroke (60.3%) subtype was the most common. The median age at presentation was 65 (IQR: 55-75) years. Hypertension (49.7%) and carotid atherosclerosis (54.7%) were the most commonly identified risk factors. Overall in-hospital mortality was 9.3% (95% CI: 5.2%-15.1%), poor post-stroke disability was 55.6% (95%CI: 47.3%-63.7%), and median length of hospital stay was 10 (IQR: 7-14) days. Being male (AOR=0.19, 95%CI: 0.038 0.97), longer in-hospital stays (AOR=0.21, 95%CI: 0.048 0.93) were significant predictors of in-hospital mortality. Furthermore increased ICP (AOR=2.81, 95%CI: 1.22 6.92) was also the predictor of poor post-stroke disability at discharge. Conclusion: Ischemic stroke was the most common stroke subtype. In-hospital mortality was relatively lower. However, greater functional impairment was high at discharge. Stroke morality was observed lower among male and longer in-hospital stay patients, while evidence of increased intracranial pressure was associated with poor post-stroke disability at discharge.

Abstract W P47: Recanalization After IV TPA Alone Among Acute Ischemic Stroke Patients Treated With Combined IV-Endovascular Recanalization: Impact of Arterial Occlusion Site

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Seo Hyun Kim ◽  
David Liebeskind ◽  
Reza Jahan ◽  
Sidney Starkman ◽  
Latisha Ali ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Multivariate Logistic Regression Analysis ◽  
Arterial Occlusion ◽  
High Rate ◽  
Large Artery ◽  
Diagnostic Catheter ◽  
Iv Tpa

Background: Combined IV TPA and catheter-based reperfusion is an emerging treatment strategy for acute ischemic stroke. Both patient care and clinical trial design would be enhanced by delineation of which patients rapidly respond to IV TPA alone, before endovascular therapy can be initiated. Methods: In a prospectively maintained registry of patients treated under a general policy of combined IV TPA and endovascular therapy, we analyzed subjects with MRA/CTA-confirmed anterior circulation occlusions prior to IV TPA start. Results: Among 118 patients meeting study entry criteria, age was mean 71.5 (SD 14.5), 53.0% were female, and baseline NIHSS was 14.4 (SD 7.1). Confirmed sites of occlusion prior to IV TPA were internal cerebral artery (ICA) in 22.9%, M1 segment of middle cerebral artery (MCA) in 50.0%, and M2-3 in 27.1%. Among patients undergoing catheter cerebral angiography, median time from start of IV TPA to diagnostic catheter angiogram was 75 mins (IQR 50-113). A total of 48 (40.7%) patients achieved partial or complete recanalization (AOL 2-3) of the initial target artery with IV TPA alone (partial in 22 (18.6%) and complete in 26 (22.2%)); an additional 44 (37.3%) achieved partial or complete recanalization after endovascular therapy. Recanalization rates after IV TPA alone varied by target occlusion site: ICA - 22.2%, M1 - 40.7%, and M2-3 - 56.2%. In multivariate logistic regression analysis, independent predictors of recanalization with IV TPA alone were: M2-3 clot location, OR 3.04 (95% CI 1.20-7.73, p=0.019) and TOAST etiology large-artery atherosclerosis, OR 0.14 (CI 0.04-0.50, p = 0.003). Good outcome (mRS ≤ 3) rates at 3 months were 76.6% among recanalizers with IV TPA alone and 47.5% among recanalizers after both IV TPA and catheter therapy. Conclusions: When combined IV-endovascular treatment is pursued, recanalization with IV TPA alone occurs in 4 out of 10 patients before catheter therapy is started, is more common with more distal clot location, and is associated with a high rate of excellent clinical outcomes.

scholarly journals ENDOVASCULARAPPROACHES TOACUTE ISCHEMIC STROKE- INDIAN PERSPECTIVE

2020 ◽  
Vol 7 (3) ◽  
pp. 7-14
Author(s):  
Pramod Dhonde ◽  
N. Kadam
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Review Literature ◽  
Large Artery ◽  
Stroke Event ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Indian Perspective

Aim: To review literature about endovascular approaches to acute ischemic stroke and provide Indian perspective about managing these cases. Brief Summary: In acute ischemic stroke cases, intravenous thrombolysis (IVT) with altepase within 4.5 hours has been the standard of care. Due to certain limitations of IVT, in pooled patientlevel data from 5 trials (HERMES [Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials], which included the 5 trials MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND-IA), mechanical thrombectomy (MT) is indicated for patients with acute ischemic stroke due to a large artery occlusion (LVO) in the anterior circulation who can be treated within 24 hours of the time last known to be well (ie, at neurologic baseline), regardless of whether they received intravenous alteplase for the same ischemic stroke event. The maximum benefit can be achieved within 6 hours of onset of symptoms. There are studies suggesting the benefit of MT in posterior circulation stroke as well as in distal arteries. We are going to review the methodology of endovascular techniques in brief alongwith Indian perspective on feasibility of this treatment approach in AIS. Conclusion: Mechnicalthrombectomy is certainly an effective modality of treatment in large vessel occlusion in anterior circulation within 24 hours. More awareness regarding the approach in India, can reduce the stroke morbidity and mortality in many of the cases in future

Abstract WP348: Difference Risk Factors in Sex Difference Between Patients With First-Ever and Recurrent Strokes in Shanghai

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yi Dong ◽  
Kun Fang ◽  
Xin Wang ◽  
Jianhua Zhuang ◽  
Xueyuan Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Chinese Population ◽  
Service System ◽  
Recurrent Stroke ◽  
Vascular Risk ◽  
Stroke Population

Objective: The underlying mechanisms of high recurrence of ischemic stroke in Chinese population are unclear. Our study is to determine sex differences in recurrent stroke and hospital mortality after a recurrent stroke in Chinese population. Methods: Shanghai Stroke Service System is a quality improvement project based on the EHR system. All stroke population who were hospitalized in 2018 for acute ischemic stroke within 7 days were prospectively extracted. The ORs for recurrent ischemic stroke were calculated with adjustment for demographics and risk factors. Results: Among 21,805 acute ischemic stroke patients in Shanghai Stroke Service System, having an ischemic stroke (mean age 69 years [SD 12 years], 63.7% male). About 21.8% of patients had a recurrent stroke (95%CI 21.3-22.4%). The multivariable logistic regression suggested that recurrent stroke population have more vascular risk factors, compared to first-ever stroke population. Furthermore, the sex differences in risk factors were gradually increasing, but reduction in smoking (35% vs. 28% in male; 2% vs 1.8% in female) and alcoholic status (22% vs. 18% in male; 1.9% vs 1.4% in female). The ORs of recurrent rate in male stroke population compared with in female was 0.74 (95% CI 0.62-0.79) after multivariable adjusted. The hospital mortality after recurrent stroke for male and female was 2.1% (95% CI 1.6%-2.6%) and 3.1% (95% CI 2.3%-4.1%), respectively. The multivariable-adjusted relative risk for hospitalization mortality of a recurrent stroke was 1.19 (95% CI 0.94-1.50). There is no significant difference impact on mortality between sex (aOR 1.08, 95% 0.72-1.63). Conclusion: The vascular risk factors in recurrent stroke population were mostly increasing, compared to those with first-ever stroke. However, the rates of smoking and alcoholism were reduced in male but not in female. The hospitalization mortality rate in recurrent stroke was similar to those with first-ever stroke population.

scholarly journals Clinical Characteristics and Outcomes of Acute Ischemic Stroke in Patients with Type 2 Diabetes: A Single-Center, Retrospective Study in Southern China

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Minrui Chen ◽  
Weiliang Luo ◽  
Jiming Li ◽  
Kaiyi Cao ◽  
Xiaohui Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Large Artery ◽  
Nihss Score ◽  
Type 2 Dm ◽  
Significant Difference

Objective. To explore the associations between type 2 diabetes mellitus (DM) and stroke by evaluating the clinical risk factors, characteristics, and outcomes of acute ischemic stroke (AIS) patients with and without type 2 DM. Methods. A total of 1,156 AIS patients (including 410 with type 2 DM (AIS-DM group)) and 746 without type 2 DM (AIS-NDM group)) were included. Patients’ demographics, auxiliary examinations, clinical manifestations, and treatment outcomes were recorded and analyzed. Results. Among the included AIS patients, 35.46% had type 2 DM. The AIS-DM group had less males (59.76% versus 70.64%), less smokers (33.90% versus 41.96%), more patients with hypertension (72.93% versus 63.94%; p = 0.002 ), higher triglyceride levels (42.93% versus 25.08%; p ≤ 0.01 ), and lower total cholesterol (147.06 mg/dl versus 175.31 mg/dl) than the AIS-NDM group. The proportion of patients with large artery atherosclerosis (LAA) in the AIS-DM group was lower (77.56% versus 85.92%; p < 0.05 ) than that in the AIS-NDM group, and the proportion of patients with small arterial occlusions (SAO) in the AIS-DM group was higher (27.07% versus 13.67%; p < 0.05 ) than that in the AIS-NDM group. The mean National Institutes of Health Stroke Scale (NIHSS) score at admission in the AIS-DM group was lower than that in the AIS-NDM group (4.39 versus 5.00; p = 0.008 ), but there was no significant difference in the NIHSS score or the modified Rankin Scale score between the two groups at discharge. A total of 85 AIS patients underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator (rtPA). The door-to-needle time (DNT) did not differ significantly between the groups (49.39 ± 30.40 min versus 44.25 ± 15.24 min; p = 0.433 ). In addition, there were no significant differences in the baseline NIHSS score, 7-day NIHSS score, and mRS score at discharge between the groups. After intravenous thrombolysis with rtPA, the AIS-NDM group had better recovery (44.30% versus 29.20%; p = 0.017 ) and a higher ratio of good treatment outcome at discharge (65.60% versus 54.20%; p = 0.762 ). Conclusions. Type 2 DM is associated with AIS and its risk factors, such as dyslipidemia and hypertension. Patients in the AIS-DM group had less LAA and smaller arterial occlusions, and DM could exacerbate the short-term clinical outcomes in AIS patients.

scholarly journals Risk, clinical course and outcome of ischemic stroke in patients hospitalized with COVID-19: a multicenter cohort study

2021 ◽  
Author(s):  
Wouter M. Sluis ◽  
Marijke Linschoten ◽  
Julie E. Buijs ◽  
J. Matthijs Biesbroek ◽  
Heleen M. den Hertog ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Cumulative Incidence ◽  
Stroke Patients ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

AbstractBackground and purposeThe frequency of ischemic stroke in patients with COVID-19 varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19.MethodsWe included patients with a laboratory confirmed SARS-CoV-2 infection admitted in 16 hospitals participating in the international CAPACITY-COVID registry between March 1st and August 1st, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke.ResultsWe included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit (ICU). Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older, but did not differ in sex or cardiovascular risk factors. Median time between onset of COVID-19 symptoms and diagnosis of stroke was two weeks. The incidence of ischemic stroke was higher among patients who were treated at an ICU (16/586; 2.7% versus 22/1561; 1.4%; p=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted RR: 2.08; 95%CI:1.52-2.84). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functional dependent at discharge and in-hospital mortality. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted RR 1.56; 95%CI:1.13-2.15) than patients without stroke.ConclusionsIn this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was approximately 2%, with a higher risk in patients treated at an ICU. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.

Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios Giampatzis ◽  
Stella Bouziana ◽  
Athinodoros Pavlidis ◽  
Marianna Spanou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
National Institutes Of Health ◽  
Limited Data ◽  
Severe Stroke ◽  
Hospital Outcome ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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