scholarly journals Proteomic analysis of extracellular vesicles enriched serum associated with future ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shingo Mitaki ◽  
Yasuko Wada ◽  
Abdullah Md. Sheikh ◽  
Shuhei Yamaguchi ◽  
Atsushi Nagai
Keyword(s):  
Ischemic Stroke ◽  
Extracellular Vesicles ◽  
Proteomic Analysis ◽  
Protein Quantification ◽  
Isobaric Tagging ◽  
New Biomarkers ◽  
Complement C1q ◽  
Subunit B ◽  
New Onset

AbstractIdentifying new biomarkers beyond the established risk factors that make it possible to predict and prevent ischemic stroke has great significance. Extracellular vesicles are powerful cell‒cell messengers, containing disease-specific biomolecules, which makes them powerful diagnostic candidates. Therefore, this study aimed to identify proteins derived from extracellular vesicles enriched serum related to future ischemic stroke events, using a proteomic method. Of Japanese subjects who voluntarily participated in health checkups at our institute a number of times, 10 subjects (6 males and 4 females, age: 64.2 ± 3.9 years) who developed symptomatic ischemic stroke (7.3 ± 4.4 years’ follow-up) and 10 age‒sex matched controls without brain lesions (6.7 ± 2.8 years’ follow-up) were investigated. Extracellular vesicles enriched fractions were derived from serum collected at the baseline visit. Differentially expressed proteins were evaluated using isobaric tagging for relative and absolute protein quantification (iTRAQ)-based proteomic analysis. Of the 29 proteins identified, alpha-2-macroglobulin, complement C1q subcomponent subunit B, complement C1r subcomponent, and histidine-rich glycoprotein were significantly upregulated (2.21-, 2.15-, 2.24-, and 2.16-fold, respectively) in subjects with future ischemic stroke, as compared with controls. Our study supports the concept of serum-derived extracellular vesicles enriched fractions as biomarkers for new-onset stroke. These proteins may be useful for prediction or for targeted therapy.

Abstract 15360: Prolonged P Wave Duration is Not Associated With New Onset Atrial Fibrillation During 10-year Follow-up After First-ever Ischemic Stroke in Lund Stroke Register

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Maria A Baturova ◽  
Arne Lindgren ◽  
Jonas Carlson ◽  
Yuri V Shubik ◽  
Bertil Olsson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
P Wave ◽  
Stroke Patients ◽  
Wave Duration ◽  
Control Subjects ◽  
P Wave Duration ◽  
Stroke Register ◽  
New Onset

Introduction: Prolonged P-wave duration (PWD) is associated with paroxysmal atrial fibrillation (AF), which might be underdiagnosed in ischemic stroke patients, in whom it might be pivotal for initiation of secondary prevention oral anticoagulation therapy. We aimed to assess whether PWD predicts new-onset AF during 10-year follow-up in ischemic stroke patients compared to control subjects enrolled in the Lund Stroke Register (LSR). Methods: Study sample comprised of 227 first-ever ischemic stroke patients without AF (mean age 72±12 y, 92 female) and 1:1 age- and gender- matched control subjects without stroke and AF enrolled in LSR from Mar 2001 to Feb 2002. The date of new-onset AF during follow-up was assessed by the date of first AF ECG in the regional ECG database and by record linkage with the Swedish National Patient Register. The available standard snapshot 12-lead sinus rhythm ECGs at baseline were retrieved from electronic database and digitally processed. Results: Patients with ischemic stroke compared to controls more often had hypertension (57% vs 31%), diabetes (15% vs 7%) and vascular diseases (42% vs 13%, all p < 0.005). New-onset AF was detected in 39 (17%) stroke patients and in 30 (13%) controls, p=0.296. In the multivariate Cox regression analysis, new onset AF in the stroke group was associated with age>65 years (HR=3.78, 95%CI 1.32-10.85, p=0.013) and hypertension (HR=2.42, 95%CI 1.09-5.40, p=0.030), but not with PWD. On the contrary, PWD>120 ms was the only independent predictor of new onset AF in the control group after adjustment for age and cardiovascular risk factors (HR=3.36, 95%CI 1.41-8.01, p=0.006, Figure 1). Conclusions: Prolonged P-wave duration is the strongest predictor of AF incidence during 10-year follow-up in stroke-free population. However, in ischemic stroke patients the developing of AF is more likely associated with more advanced cardiovascular comorbidities than with electrical abnormalities in the heart.

Predictors of new onset atrial fibrillation during 10-year follow-up after first-ever ischemic stroke

2015 ◽  
Vol 199 ◽  
pp. 248-252 ◽  
Author(s):  
Maria A. Baturova ◽  
Arne Lindgren ◽  
Jonas Carlson ◽  
Yuri V. Shubik ◽  
S. Bertil Olsson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract 2587: Standard Medical Management Is Associated With Improved Quality And Outcome Of Secondary Stroke Prevention In China

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Liying Cui ◽  
Bin Peng ◽  
Jun Ni ◽  
Lixin Zhou ◽  
Yicheng Zhu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Medical Management ◽  
Stroke Prevention ◽  
Cardiovascular Events ◽  
Care Group ◽  
Treatment Target ◽  
Composite Measures ◽  
New Onset

Background and objective: Although guidelines for secondary ischemic stroke have been developed, there is a gap between guidelines and real world. To investigate the current status of secondary ischemic stroke in China and improve the quality of stroke prevention, We design a recommended guideline based program (SMART trial) and implement it in clinic practice to evaluate the feasibility and efficacy of the program. Methods: We conducted a multicenter (47 centers), paralleled, randomized, open label, controlled trial. Patients were randomized to two groups: standard medical management group (SMART group) and usual care group. In SMART group, measures of intervention were chosen based on the stroke sub-type according to the TOAST classification. Advice were given to the patients on stroke prevention . In usual treatment group, measures of intervention were chosen by the physician according to his/her personal knowledge. The main outcomes were the proportion of the patient’s adherence to 5 recommended measures and proportion of patients achieving the treatment target over time, a composite measures (total number of measure performed divided by the total number of eligible patients) was calculated. Secondary outcome was the composite cardiovascular events including new onset ischemic stroke, acute coronary syndrome, new onset hemorrhage stroke, and all causes of deaths. Results: Three thousand eight hundred and twenty-one patientswere enrolled into the trial. 1795 patients in standard medical treatment group, 2026 patients in usual care group. Participation in SMART group was associated with improvements in 3 measures and 1 composite measures (one year follow up): antiplatelet agents use (81.1% versus 74.9% ), statins use (55.8% versus 32.9%), antihyperglycemic agents use ( 72.6% versus 66.9% )and composite measures (68.36% versus 58.33%).Increased proportion of patients achieving treatment target were noticed (18 months follow up): blood pressure <140/90mmHg(60.6% versus 42.9%), LDL-C <2.6mmol/L (11.4% versus 9%)and HbA1c≤ 7% ( 6% versus 4.8%). The composite cardiovascular events rate decreased (4.18% versus 4.84%). The cost in hospital reduced 4.66%. Conclusions: Standard medical management program was feasible and associated with improved quality and outcome in secondary ischemic stroke prevention. Large scale promotion of this program across China was warranted.

scholarly journals Cardiovascular events in metabolically healthy obese. A nationwide cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Fauchier ◽  
A Bisson ◽  
C Semaan ◽  
J Herbert ◽  
A Bodin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
Metabolic Abnormalities ◽  
Metabolically Healthy Obese ◽  
Healthy Obese ◽  
Metabolically Healthy ◽  
New Onset

Abstract Background Obesity is a risk factor for cardiovascular disease (CVD) and has been increasing globally over the past 40 years in many countries worldwide. Metabolic abnormalities such as hypertension, dyslipidemia and diabetes mellitus are commonly associated and may mediate some of the deleterious effects of obesity. A subset of obese individuals without obesity-related metabolic abnormalities may be classified as being “metabolically healthy obese” (MHO). We aimed to evaluate the associations among MHO individuals and different types of incident cardiovascular events in a contemporary population at a nationwide level. Methods From the national hospitalization discharge database, all patients discharged from French hospitals in 2013 with at least 5 years or follow-up and without a history of major adverse cardiovascular event (myocardial infarction, heart failure [HF], ischemic stroke or cardiovascular death, MACE-HF) or underweight/ malnutrition were identified. They were categorized by phenotypes defined by obesity and 3 metabolic abnormalities (diabetes mellitus, hypertension, and hyperlipidemia). In total, 2,953,816 individuals were included in the analysis, among whom 272,838 (9.5%) were obese. We evaluated incidence rates and hazard ratios for MACE-HF, cardiovascular death, myocardial infarction, ischemic stroke, new-onset HF and new-onset atrial fibrillation (AF). Adjustments were made on age, sex and smoking status at baseline. Results During a mean follow-up of 4.9 years, obese individuals with no metabolic abnormalities had a higher risk of MACE-HF (multivariate-adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI]: 1.19–1.24), new-onset HF (HR 1.34, 95% CI 1.31–1.37), and AF (HR 1.33, 95% CI 1.30–1.37) compared with non-obese individuals with 0 metabolic abnormalities. By contrast, risks were not higher for myocardial infarction (HR 0.92, 95% CI 0.87–0.98), ischemic stroke (HR 0.93, 95% CI 0.88–0.98) and cardiovascular death (HR 0.99, 95% CI 0.93–1.04). In the models fully adjusted on all baseline characteristics, obesity was independently associated with a higher risk of MACE-HF events (HR 1.13, 95% CI 1.12–1.14), of new-onset HF (HR 1.19, 95% CI 1.18–1.20) and new-onset AF (HR 1.29, 95% CI 1.28–1.31). This was not the case for the association of obesity with cardiovascular death (HR 0.96, 95% CI 0.94–0.98), myocardial infarction (HR 0.93, 95% CI 0.91–0.95) and ischemic stroke (HR 0.93, 95% CI 0.91–0.96). Conclusions Metabolically healthy obese individuals do not have a higher risk of myocardial infarction, ischemic stroke or cardiovascular death than metabolically healthy non-obese individuals. By contrast they have a higher risk of new-onset HF and new onset AF. Even individuals who are non-obese can have metabolic abnormalities and be at high risk of cardiovascular disease events. Our observations suggest that specific studies investigating different aggressive preventive measures in specific subgroups of patients are warranted. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Admission blood glucose level as an ischemic stroke risk modifier in patients with new-onset non-valvular atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Bergamaschi ◽  
F Donati ◽  
P Paolisso ◽  
L Bartoli ◽  
F Angeli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Stroke Risk ◽  
Cox Regression ◽  
Independent Predictor ◽  
Risk Modifier ◽  
New Onset

Abstract Background Several scores have been proposed to assess the stroke risk in patients with non-valvular atrial fibrillation (NVAF). However, type 2 diabetes mellitus (T2DM) is considered a major stroke risk factor regardless of glycemic control. Whether basal blood glucose level modifies the risk of stroke in NVAF is still unclear. Purpose To evaluate the risk of ischemic stroke according to the presence of T2DM and admission blood glucose (ABG) level in patients with new-onset NVAF starting direct oral anticoagulants (DOACs). Methods We analyzed all consecutive patients with NVAF at our outpatient clinic from January to December 2018. The study population was constituted by 1014 patients with new-onset NVAF starting DOACs. Baseline characteristics were evaluated in the overall cohort whereas outcomes were assessed for 915 patients. The median follow-up time was 19.6±12.9 months. Results Overall, 50.3% were male with a mean age of 73.9±12.5 years. Diabetic NVAF patients were more frequently male (p=0.04) with higher prevalence of dyslipidemia (p&lt;0.001), hypertension (p&lt;0.001), severe renal impairment (p=0.02), peripheral vasculopathy (p=0.007) and history of myocardial infarction (p&lt;0.001) compared to non-diabetic NVAF. Conversely, no differences were observed between subgroups in terms of age (p=0.8). Baseline blood glucose level was significantly higher in the diabetic NVAF population (160±67 mg/dL vs 119±39 mg/dL; p&lt;0.001). As expected, the mean CHA2DS2-VASc score was significantly higher in diabetic NVAF compared to non-diabetic group (4.7±1.4 vs 3.2±1.5; p&lt;0.001). During a 2 year-follow up period, we collected 27 (3.0%) ischemic stroke. As expected, the rates of stroke were significantly higher in diabetic NVAF (7.6% vs 2.3%, p&lt;0.001). Also, the ABG was significantly greater in NVAF who had an ischemic stroke compared to others (160±68 mg/dL vs 119±39 mg/dL, p=0.005). The incidence of stroke was almost five-time greater in NVAF with ABG level major than 150 mg/dl (9.8% vs 1.9%, p&lt;0.001). At multivariate Cox-regression model adjusted for age, sex and presence of T2DM, blood glucose level at admission was the only independent predictor of ischemic stroke at follow up (HR 1.01, 95% CI 1.001–1.02; p=0.03). Finally, another multivariate Cox-regression model, adjusted for the mean CHA2DS2-VASc score, showed that the ABG level still remained a strong independent predictor of ischemic stroke at follow up (HR 1.012, 95% CI 1.003–1.02; p=0.01). Conclusions Diabetic NVAF had a worse baseline profile and higher stroke risk compared to non-diabetic NVAF. Baseline blood glucose level was an independent predictor of stroke regardless of the presence of T2DM or stroke risk profile. These findings underline the role of basal blood glucose level as a potential stroke risk modifier and therefore emphasize the importance of its routine determination to better stratify the stroke risk in NVAF starting DOACs. Funding Acknowledgement Type of funding source: None

scholarly journals Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: A retrospective study

2020 ◽  
Author(s):  
Yi-Chih Hung ◽  
Lu-Ting Chiu ◽  
Hung-Yu Huang ◽  
Da-Tian Bau
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Ischemic Stroke ◽  
Stroke Prevention ◽  
Asian Patients ◽  
Type 2 Dm ◽  
Subgroup Analyses ◽  
New Onset

Abstract Background: Studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian patients with type 2 DM without established CV diseases but with risk factors for CV diseases. Methods: Between 2000 and 2012, we enrolled patients aged ≥18 years, who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension and hyperlipidemia. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone and non-pioglitazone groups based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. The subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. Chi-square test, Student’s t-test, competing risk regression models, Kaplan–Meier method, and log-rank test were some of the statistical tests conducted.Results: A total of 13 078 patients were included in the pioglitazone and non-pioglitazone groups. Compared with patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.78; 95% confidence interval: 0.62–0.95). The subgroup analyses defined by different baseline features did not reveal significant alterations in the observed effect of pioglitazone. Moreover, a significant decreasing trend in ischemic stroke risk with an increase in pioglitazone dose (p-value for trend = 0.04) was observed.Conclusion: Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors.Trial registration number: CMUH104-REC2-115-CR4

scholarly journals Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: A retrospective study

2020 ◽  
Author(s):  
Yi-Chih Hung ◽  
Lu-Ting Chiu ◽  
Hung-Yu Huang ◽  
Da-Tian Bau
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Ischemic Stroke ◽  
Stroke Prevention ◽  
User Group ◽  
Asian Patients ◽  
Type 2 Dm ◽  
New Onset

Abstract Background: To date, studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian type 2 DM patients without established CV diseases but with risk factors for CV diseases. Methods: Between 2000 and 2012, we enrolled patients aged ≥18 years who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension, hyperlipidemia, proteinuria, and obesity. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone user group and non-pioglitazone user group based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. Subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of the pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. The chi-square test, Student’s t-test, Kaplan–Meier method, and log-rank test were some of the statistical tests conducted herein.Results: A total of 6,637 patients were included in the pioglitazone and non-pioglitazone group. Compared to patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.72; 95% confidence interval: 0.57–0.9). Subgroup analyses defined by different baseline features did not reveal significant alterations to the observed effect of pioglitazone. Moreover, a significant trend regarding the decrease in ischemic stroke risk and the increase in pioglitazone dose (p-value for trend=0.03) was observed.Conclusion: Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors.

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Red Blood Cell Indices in Relation to Post-stroke Psychiatric Disorders: A Longitudinal Study in a Follow-up Stroke Clinic

2020 ◽  
Vol 17 (3) ◽  
pp. 218-223
Author(s):  
Haichao Wang ◽  
Li Gong ◽  
Xiaomei Xia ◽  
Qiong Dong ◽  
Aiping Jin ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Blood Cell ◽  
Cox Regression ◽  
Depression And Anxiety ◽  
Cox Regression Analysis ◽  
Post Stroke ◽  
Rbc Indices ◽  
Post Stroke Depression

Background: Depression and anxiety after stroke are common conditions that are likely to be neglected. Abnormal red blood cell (RBC) indices may be associated with neuropsychiatric disorders. However, the association of RBC indices with post-stroke depression (PSD) and poststroke anxiety (PSA) has not been sufficiently investigated. Methods: We aimed to investigate the trajectory of post-stroke depression and anxiety in our follow- up stroke clinic at 1, 3, and 6 months, and the association of RBC indices with these. One hundred and sixty-two patients with a new diagnosis of ischemic stroke were followed up at 1, 3, and 6 months, and underwent Patient Health Questionnaire-9 (PHQ-9) and the general anxiety disorder 7-item (GAD-7) questionnaire for evaluation of depression and anxiety, respectively. First, we used Kaplan-Meier analysis to investigate the accumulated incidences of post-stroke depression and post-stroke anxiety. Next, to explore the association of RBC indices with psychiatric disorders after an ischemic stroke attack, we adjusted for demographic and vascular risk factors using multivariate Cox regression analysis. Results: Of the 162 patients with new-onset of ischemic stroke, we found the accumulated incidence rates of PSD (1.2%, 17.9%, and 35.8%) and PSA (1.2%, 13.6%, and 15.4%) at 1, 3, and 6 months, respectively. The incident PSD and PSA increased 3 months after a stroke attack. Multivariate Cox regression analysis indicated independent positive associations between PSD risk and higher mean corpuscular volume (MCV) (OR=1.42, 95% CI=1.16-1.76), older age (OR=2.63, 95% CI=1.16-5.93), and a negative relationship between male sex (OR=0.95, 95% CI=0.91-0.99) and PSA. Conclusion: The risks of PSD and PSA increased substantially 3 months beyond stroke onset. Of the RBC indices, higher MCV, showed an independent positive association with PSD.

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