scholarly journals Association of pre- and post-stroke glycemic status with clinical outcome in spontaneous intracerebral hemorrhage

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kaijiang Kang ◽  
Jingjing Lu ◽  
Yi Ju ◽  
Wenjuan Wang ◽  
Yuan Shen ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Fasting Blood Glucose ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Glycemic Status ◽  
Hematoma Volume ◽  
Post Stroke ◽  
Risk Of Death ◽  
Poor Outcome

AbstractIn this study, we aimed to disclose the association of pre- and post-stroke glycemic status with clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH). It was a multicenter, prospective, observational cohort study, conducted in 13 hospitals in Beijing from January 2014 to September 2016. The association of admission random blood glucose (RBG), fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with clinical outcome at 90 days after sICH onset were analyzed comprehensively. Poor outcome was defined as death or modified Rankin Scale (mRS) score >2. The results showed that elevated RBG and FBG were associated with larger hematoma volume, lower GCS, higher NIHSS (P < 0.001), and poor outcome, but HbA1c was not (P > 0.05). In stratified analysis, the association of poor outcome with elevated FBG or RBG retained statistical significance just in patients without diabetes. Kaplan-Meier curve and Cox regression showed that patients with elevated FBG or RBG had significantly higher risk of death within 90 days (P < 0.05). So we conclude that poststroke hyperglycemia was associated with larger hematoma volume, severe neurological damage and poor clinical outcome, but HbA1c was not relevant to hematoma volume or clinical outcome in patients with sICH.

scholarly journals Perihematomal edema as predictor of outcome in spontaneous intracerebral hemorrhage

2014 ◽  
Vol 5 (01) ◽  
pp. 48-54 ◽  
Author(s):  
Mani Gupta ◽  
Rajesh Verma ◽  
Anit Parihar ◽  
Ravindra K. Garg ◽  
Maneesh K. Singh ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Clinical Laboratory ◽  
Negative Impact ◽  
Univariate Analysis ◽  
High Rate ◽  
Controlled Study ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Poor Outcome ◽  
Perihematomal Edema

ABSTRACT Background: Spontaneous intracerebral hemorrhage (SICH) is a form of cerebrovascular accident with a very high rate of morbidity and mortality. The determinants of prognosis include the demographic, clinical, laboratory, and radiologic factors. It is long known that the hematoma size has a negative impact on the outcome in SICH. The influence of perihematomal edema (PHE) is not established to the extent same as that of hematoma volume. Hence, we planned this study to determine as to what role does PHE plays in the outcome in SICH. Aim of the Study: To evaluate the prognostic influence of absolute and relative edema (ratio of absolute edema to hematoma volume) in the patients of SICH. Materials and Methods: This is a prospective case-controlled study. A total of 44 patients were enrolled after excluding the confounding factors. The patients were evaluated and their disability was assessed using modified Rankin scale (MRS). The imaging was done in the interval between 24 and 72 h and the hematoma volume, absolute edema volume, and the relative edema were calculated. The outcome was reassessed at 12 weeks and defined as favorable if MRS < 3. Results: A total of 69 patients were found to be having SICH on imaging; however, 25 patients were excluded as they had one of the criterion for exclusion. Hence, only 44 patients were included in the study. On univariate analysis, none of the demographic characteristics of the patients, vascular risk factors, presenting complaints, blood pressure, Glasgow coma scale, and MRS at admission, laboratory parameters were not significantly different in the two outcome groups. The hematoma volume was significantly higher in the poor outcome group (P < 0.0001) and the relative edema was associated with a favorable outcome at 12 weeks (P < 0.0001). On multivariate logistic regression, the hematoma volume and relative edema were found to have effect on the outcome similar to that seen on univariate analysis. Conclusion: In SICH, a larger hematoma volume is a predictor of poor outcome and a relative edema is associated with a better functional status.

scholarly journals Anti-inflammatory genes in PBMCs post-spontaneous intracerebral hemorrhage

2021 ◽  
Vol 12 (1) ◽  
pp. 58-66
Author(s):  
Doan Nguyen ◽  
Vi Tran ◽  
Alireza Shirazian ◽  
Cruz Velasco-Gonzalez ◽  
Ifeanyi Iwuchukwu
Keyword(s):  
Intracerebral Hemorrhage ◽  
Negative Correlation ◽  
Mononuclear Cells ◽  
Inflammatory Cells ◽  
Favorable Outcome ◽  
Hospital Length Of Stay ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Peripheral Blood Mononuclear ◽  
Anti Inflammatory

Abstract Background Neuroinflammation is important in the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and peripheral inflammatory cells play a role in the clinical evolution and outcome. Methodology Blood samples from ICH patients (n = 20) were collected at admission for 5 consecutive days for peripheral blood mononuclear cells (PBMCs). Frozen PBMCs were used for real-time PCR using Taqman probes (NFKB1, SOD1, PPARG, IL10, NFE2L2, and REL) and normalized to GAPDH. Data on hospital length of stay and modified Rankin score (MRS) were collected with 90-day MRS ≤ 3 as favorable outcome. Statistical analysis of clinical characteristics to temporal gene expression from early to delayed timepoints was compared for MRS groups (favorable vs unfavorable) and hematoma volume. Principle findings and results IL10, SOD1, and REL expression were significantly higher at delayed timepoints in PBMCs of ICH patients with favorable outcome. PPARG and REL increased between timepoints in patients with favorable outcome. NFKB1 expression was not sustained, but significantly decreased from higher levels at early onset in patients with unfavorable outcome. IL10 expression showed a negative correlation in patients with high hematoma volume (>30 mL). Conclusions and significance Anti-inflammatory, pro-survival regulators were highly expressed at delayed time points in ICH patients with a favorable outcome, and IL10 expression showed a negative correlation to high hematoma volume.

scholarly journals 17p12 Influences Hematoma Volume and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2018 ◽  
Vol 49 (7) ◽  
pp. 1618-1625 ◽  
Author(s):  
Sandro Marini ◽  
William J. Devan ◽  
Farid Radmanesh ◽  
Laura Miyares ◽  
Timothy Poterba ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume

Abstract T P362: Blood Pressure, Blood Glucose, Temperature and Outcome after Childhood Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kimberly N Grelli ◽  
Melissa Gindville ◽  
C H Walker ◽  
Lori C Jordan
Keyword(s):  
Blood Pressure ◽  
Blood Glucose ◽  
Infarct Size ◽  
Outcome Measure ◽  
Multivariable Analysis ◽  
Tertiary Hospital ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Post Stroke ◽  
Poor Outcome

Objective: To determine the prevalence of abnormal blood pressure (BP), blood glucose and temperature in the acute phase after ischemic stroke (IS) and explore any relationship to outcome. We hypothesized that high and low BP, hyperglycemia, and fever after pediatric IS were all associated with poor outcome. Methods: We performed a retrospective review of children aged 1 month to 18 years with first IS admitted to a tertiary hospital between 2009 and 2013. Blood pressure, glucose and temperature readings recorded over the first 5 days after diagnosis. Morbidity or mortality and BP at 3 months post-stroke were documented. Hypertension (HTN) was defined as systolic or diastolic BP ≥95th% percentile for age, sex, and height for two consecutive recordings and two consecutive days. Results: Ninety-eight children were identified (median age 6 years). Prevalence of hypertension, hypotension, hyperglycemia and fever was 65%, 68%, 18%, and 41%, respectively. In multivariable analysis, the strongest association with poor outcome (defined as pediatric stroke outcome measure ≥1) was infarct size >4% of brain volume [odds ratio (OR) 5.3, CI 1.8-15.3, p=0.002]. Blood glucose ≥200mg/dL was also independently associated with poor outcome (OR 4.6, CI 1.3-16.3, p=0.015). Hypotension requiring treatment (p=0.02, Fisher Exact Test) and fever ≥37.8°C (p=0.03, X2=4.6) were associated with poor outcome in univariable testing only. Hypertension was not significantly associated with stroke size, poor outcome, or death. During the acute post-stroke period 18% were treated with anti-hypertensive medication. At 3-months post-stroke, 11 children had died; 90% of the survivors followed up. Of these, 15 of 78 (19%) were receiving anti-hypertensive medication, an additional 9 children were hypertensive but untreated. Conclusions: Abnormalities of BP, blood glucose and temperature are prevalent in children with IS during the first 5 days after diagnosis. Infarct size and hyperglycemia were associated with poor outcome, hypertension was not. Prospective studies involving systematic recording of BP, blood glucose and temperature are required to better assess whether these factors impact outcome and are amenable to intervention to reduce morbidity after stroke in children.

Abstract T P307: Similar Rates of Early Cognitive Dysfunction after Intracerebral Hemorrhage and Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
M. Carter Denny ◽  
Suhas S Bajgur ◽  
Kim Y Vu ◽  
Rahul R Karamchandani ◽  
Amrou Sarraj ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Cognitive Dysfunction ◽  
Hospital Setting ◽  
Stroke Severity ◽  
Regression Analyses ◽  
Post Stroke ◽  
Poor Outcome

Introduction: Post-stroke cognitive dysfunction (CD) affects at least 1/3 of acute ischemic stroke (AIS) patients when assessed at 3 months. Limited data exists on CD in intracerebral hemorrhage (ICH). The role of early, in-hospital cognitive screening using the brief Montreal Cognitive Assessment (mini MoCA) is being investigated at our center. Hypothesis: We assessed the rates of early CD in ICH and AIS and hypothesized that even minor deficits from these disorders causes significant CD. Methods: 1218 consecutive stroke patients admitted from 2/13 to 12/13 were reviewed; 610, 442 with AIS and 168 with ICH, with admission NIHSS and mini MoCAs were included in the final analyses. CD was defined as mini MoCA <9 (max 12). Poor outcome was defined as discharge mRS 4-6. Stroke severity was stratified by NIHSS score of 0-5, 6-10, 11-15, 16-20, 21-42 as in ECASS-I . Chi-squared tests and univariate logistic regression analyses were performed. Results: Baseline characteristics are shown in table 1. AIS and ICH groups were similar with regard to race, gender and stroke severity. ICH patients were younger, had longer stroke service lengths of stay and poorer outcomes than AIS patients (p=0.03, p<0.001, p<0.001). No difference was seen in rates of CD between AIS and ICH patients (60% vs. 57%, p=0.36, OR 1.2 (CI 0.8-1.7)). CD rates ranged from 36% for NIHSS 0-5 to 96% for 21-42 (figure 1). Older patients were twice as likely to have CD (p<0.001, OR 2.2 (CI 1.6 - 3.0)). Patients with CD had five times the odds of having a poor outcome compared to the cognitively intact (p<0.001, OR 5.2 (CI 3.4-7.7)). In univariate logistic regression analyses, age was a significant predictor of CD in AIS, but not in ICH (p= <0.001, p=0.06). Conclusion: Post-stroke CD is common across all severities and occurs at similar rates in AIS and ICH. More than 1/3 of patients with minor deficits (NIHSS 0-5) had CD in the acute hospital setting. Whether early CD is predictive of long term cognitive outcomes deserves further study.

Abstract TP326: Lymphopenia, Infectious Complications and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andrea Morotti ◽  
Sandro Marini ◽  
Michael J Jessel ◽  
Kristin Schwab ◽  
Alison M Ayres ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Lymphocyte Count ◽  
Cox Regression ◽  
Case Fatality ◽  
Retrospective Chart Review ◽  
Infectious Complications ◽  
Multiple Infections ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Poor Outcome ◽  
Increased Risk

Background and Purpose: lymphopenia is increasingly recognized as a consequence of acute illness and may predispose to infections. We investigated whether admission lymphopenia (AL) is associated with increased risk of infectious complications and poor outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods: we analyzed a prospectively collected cohort of ICH patients ascertained between 1994 and 2015. Subjects were included if they had a lymphocyte count obtained within 24 h from onset and AL was defined as lymphocyte count<1000/uL. Infectious complications were assessed through retrospective chart review and the association between AL, infectious complications and mortality was investigated with a multivariable Cox regression and logistic regression respectively. Results: 2014 patients met the inclusion criteria (median age 75, males 54.0%) of whom 548 (27.2%) had AL and 605 (30.0%) experienced an infectious complication. Overall case fatality at 90 days was 36.9%. Patients with AL were more severely affected, as highlighted by larger hematoma volume, higher frequency of intraventricular hemorrhage and lower Glasgow Coma Scale score (all p<0.001). AL was independently associated with increased risk of pneumonia (Hazard Ratio [HR] 1.65, 95% confidence interval [CI] 1.32-2.05, p<0.001) and multiple infections (HR 1.75, 95% CI 1.22-2.51, p=0.002). The association with urinary tract infection, sepsis or other infections was not significant. AL was also an independent predictor of 90-day mortality (odds ratio 1.55, 95% CI 1.18-2.04, p=0.002) after adjusting for confounders. Conclusions: AL is common in ICH and associated with increased risk of infectious complications and poor outcome. Further studies will be needed to determine whether prophylactic antibiotics in ICH patients with AL can improve outcome.

scholarly journals HEMATOMA VOLUME AND OTHER PROGNOSTIC FACTORS WITH MORTALITY IN SPONTANEOUS INTRACEREBRAL HEMORRHAGE

2015 ◽  
Vol 3 (Suppl 1) ◽  
pp. A981
Author(s):  
HB Rotzel ◽  
A Serrano Lázaro ◽  
D Aguillón Prada ◽  
A Mesejo Arizmendi ◽  
C Sanchís Piqueras ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume

scholarly journals Association between fasting blood glucose and outcomes and mortality in acute ischaemic stroke patients with diabetes mellitus: a retrospective observational study in Wuhan, China

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037291
Author(s):  
Tao Yao ◽  
Yanqiang Zhan ◽  
Jing Shen ◽  
Lu Xu ◽  
Bo Peng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Fasting Blood Glucose ◽  
Chinese Patients ◽  
Stroke Severity ◽  
Unfavourable Outcome ◽  
Cox Regression Analysis ◽  
Risk Of Death

ObjectiveTo evaluate the predictive value of fasting blood glucose (FBG) on unfavourable outcomes and mortality in diabetes mellitus (DM) patients after acute ischaemic stroke (AIS).Study designA hospital-based observational cohort study was conducted. Clinical data, including sex, age, body mass index, vascular risk factors and systolic/diastolic blood pressure, were routinely collected. National Institutes of Health Stroke Scale score was used to assess stroke severity on admission. FBG was determined on the first day after fasting for at least 8 hours. The modified Rankin Scale was used to assess functional outcome at 90 days: 3–6, unfavourable outcome and 6, death.SettingRenmin Hospital of Wuhan University, Wuhan, China.ParticipantsPatients who had AIS with DM, who were consecutively admitted within 24 hours of onset from January 2018 to June 2019.ResultsFor the 568 patients, the median age was 65 years (IQR, 55–74 years). There were 377 (66.4%) men. The median FBG values were 7.37 mmol/L (IQR, 5.99–10.10 mmol/L), and the median glycated haemoglobin (HbA1c) values were 6.6 (IQR, 5.8–8.3). Multivariable logistic and Cox regression analysis of confounding factors showed that FBG at the time of admission was an independent predictor of unfavourable outcome (OR, 1.25 (1.14–1.37); p<0.0001) and mortality (HR, 1.10 (1.03–1.15); p<0.05) at 90 days after onset. Time to death was analysed by Kaplan-Meier curves based on FBG quartiles. The risk of death in the two highest quartile groups (FBG, 7.38–10.10 mmol/L; FBG, ≥10.11 mmol/L) was significantly higher than that in the two lowest quartile groups (FBG, ≤6.00 mmol/L; FBG, 6.01–7.37 mmol/L; p<0.0001).ConclusionsHigher FBG levels are associated with unfavourable outcomes and mortality in Chinese patients who had AIS with DM. Our data contribute to the knowledge regarding the relationship between FBG and prognosis in patients with DM who had AIS.

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