A001 Free Fatty Acids Level in Cerebrospinal Fluid, Stroke Severity, and Comorbidity Indices as Independent Short-Term Prognostic Factors in Acute Ischemic Stroke in Intensive Care Unit

Background Temporal trends in life‐sustaining care after acute stroke are not well characterized. We sought to determine contemporary trends by age and sex in the use of life‐sustaining care after acute ischemic stroke and intracerebral hemorrhage in a large, population‐based cohort. Methods and Results We used linked administrative data to identify all hospitalizations for acute ischemic stroke or intracerebral hemorrhage in the province of Ontario, Canada, from 2003 to 2017. We calculated yearly proportions of intensive care unit admission, mechanical ventilation, percutaneous feeding tube placement, craniotomy/craniectomy, and tracheostomy. We used logistic regression models to evaluate the association of age and sex with life‐sustaining care and determined whether trends persisted after adjustment for baseline factors and estimated stroke severity. There were 137 358 people with acute ischemic stroke or intracerebral hemorrhage hospitalized during the study period. Between 2003 and 2017, there was an increase in the proportion receiving care in the intensive care unit (12.4% to 17.7%) and mechanical ventilation (4.4% to 6.6%). There was a small increase in craniotomy/craniectomy, a decrease in percutaneous feeding tube use, and no change in tracheostomy. Trends were generally consistent across stroke types and persisted after adjustment for comorbid conditions, stroke‐center type, and estimated stroke severity. After adjustment, women and those aged ≥80 years had lower odds of all life‐sustaining care, although the disparities in intensive care unit admission narrowed over time. Conclusions Use of life‐sustaining care after acute stroke increased between 2003 and 2017. Women and those at older ages had lower odds of intensive care, although the differences narrowed over time. Further research is needed to determine the reasons for these findings.

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Role of some inflammatory biomarkers in prediction of short-term outcome in acute ischemic stroke

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00294-4 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Yosria Abd Al Hameed AlTaweel ◽

Rania Sanad Nageeb ◽

Pakinam Mahmoud Metwally ◽

Ahmed Elsayed Badawy

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Severity ◽

Short Term ◽

Laboratory Assessment ◽

Term Outcome ◽

Neutrophil Lymphocyte Ratio ◽

Short Term Outcome ◽

Wbc Count

Abstract Background Several factors affect acute ischemic stroke (AIS) outcomes. Objective This study aimed to assess the role of the leukocyte count, neutrophil/lymphocyte ratio (NLR), and c reactive protein (CRP) as early predictors of outcome in AIS patients. Methods This study was conducted on 60 AIS patients. They were subjected to detailed history taking, clinical examination, brain imaging, and laboratory assessment including the CRP, white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and NLR which is calculated by dividing ANC by ALC. Neurological scales were used to assess the level of consciousness by the Glasgow Coma Scale (GCS) and stroke severity by the National Institute of Health Stroke Scale (NIHSS) at the first 48 h of stroke onset as well as 1 week and 2 weeks later for the assessment of short-term functional neurological outcome. Results Sixty percent of the patients had unfavorable outcomes assessed by the Modified Rankin Scale (mRS). Patients with unfavorable outcomes had higher NIHSS scores. NLR was positively correlated with WBC count, ANC, and CRP. The higher WBC, NLR, and NIHSS, the unfavorable the outcome was. Conclusion The higher WBC, the NLR, and the level of CRP at the onset of AIS, the more severe stroke and the poorer the short-term outcome are expected.

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Role of the Neurosurgeon in Acute Ischemic Stroke Treatment From Triage to Intensive Care Unit

Neurosurgery ◽

10.1093/neuros/nyz013 ◽

2019 ◽

Vol 85 (suppl_1) ◽

pp. S47-S51

Author(s):

Kimberly P Kicielinski ◽

Christopher S Ogilvy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Care ◽

Stroke Patients ◽

Acute Setting ◽

Stroke Treatment

Abstract As ischemic stroke care advances with more patients eligible for mechanical thrombectomy, so too does the role of the neurosurgeon in these patients. Neurosurgeons are an important member of the team from triage through the intensive care unit. This paper explores current research and insights on the contributions of neurosurgeons in care of acute ischemic stroke patients in the acute setting.

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The Impact of Hyperthermia and Infection on Acute Ischemic Stroke Patients in the Intensive Care Unit

Neurocritical Care ◽

10.1007/s12028-008-9056-0 ◽

2008 ◽

Vol 9 (2) ◽

pp. 183-188 ◽

Cited By ~ 10

Author(s):

Woo-Keun Seo ◽

Sung-Wook Yu ◽

Ji Hyun Kim ◽

Kun-Woo Park ◽

Seong-Beom Koh

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

The Impact

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Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

Medicina Intensiva (English Edition) ◽

10.1016/j.medine.2018.04.003 ◽

2018 ◽

Vol 42 (5) ◽

pp. 274-282

Author(s):

L. Viña Soria ◽

L. Martín Iglesias ◽

L. López Amor ◽

I. Astola Hidalgo ◽

R. Rodríguez García ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Stroke Patients

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Gambaran Pasien Stroke Iskemik Akut dengan COVID-19 yang Masuk Ruang Perawatan Intensif

e-CliniC ◽

10.35790/ecl.v9i1.32302 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Anastasia T. Thambas ◽

Diana Ch. Lalenoh ◽

Barry I. Kambey

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Literature Review ◽

Acute Ischemic Stroke ◽

Pulmonary Infiltrate ◽

Ground Glass ◽

Age Group ◽

D Dimer

Abstract: Acute ischemic stroke (AIS) has been reported in patients with coronavirus disease 2019 (COVID-19). The cause of AIS in COVID-19 patients has not been fully understood, but COVID-19 is known to cause hypercoagulation characterized by increased d-dimer levels, and cytokine storms. Some AIS patients with COVID-19 require intensive care. This study was aimed to determine the description of AIS patients with COVID-19 admitted to the intensive care unit. This was a literature review study using three databases, as follows: Pubmed, ClinicalKey, and Science Direct. The keywords used were acute ischemic stroke AND COVID-19 AND intensive care unit. The results showed that after being selected based on inclusion and exclusion criteria, 10 literatures were obtained. There were 20 subjects and most were female (55%) and age group of 60-69 years old (35%). The most common cardiovascular risk factor was hypertension (80%, n=10). There were some increases in the levels of LDH, CRP, d-dimer, ferritinin, and fibrinogen. On radiological examination performed, there were cases with bilateral pulmonary infiltrate (33%) and ground-glass opacities (67%) (n = 6). In conclusion, the characteristics of AIS patients with COVID-19 admitted to the intensive care room were mostly female, age group 60-69 years, had cardiovascular risk factors for hypertension, had elevated levels of LDH, CRP, d-dimer, ferritinin, and fibrinogen, and had ground-glass opacity on radiological imaging.Keywords: acute ischemic stroke, COVID-19, intensive care unit Abstrak: Stroke iskemik akut telah dilaporkan pada pasien dengan coronavirus disease 2019 (COVID-19). Penyebab stroke iskemik akut pada COVID-19 belum diketahui secara menyeluruh, tetapi COVID-19 dapat menyebabkan kejadian hiperkoagulasi ditandai dengan peningkatan kadar d-dimer serta menyebabkan badai sitokin. Beberapa pasien stroke iskemik akut dengan COVID-19 membutuhkan perawatan di ruang perawatan intensif. Penelitian ini bertujuan untuk mengetahui gambaran pasien stroke iskemik akut dengan COVID-19 yang masuk di ruang perawatan intensif. Jenis penelitian ialah literature review dengan pencarian data menggunakan tiga database yaitu Pubmed, ClinicalKey dan Science Direct dengan kata kunci acute ischemic stroke AND COVID-19 AND intensive care unit. Hasil penelitian mendapatkan 10 literatur dengan jumlah subyek penelitian sebanyak 20 orang, jenis kelamin terbanyak ialah perempuan (55%) dengan kelompok usia terbanyak ialah 60-69 tahun (35%). Faktor risiko kardiovaskular yang paling banyak dimiliki subyek penelitian ialah hipertensi (80%, n=10). Terdapat peningkatan kadar LDH, CRP, d-dimer, ferritinin, dan fibrinogen. Pada pemeriksaan radiologi ditemukan bilateral pulmonary infiltrate (33%) dan ground-glass opacitiy (67%) (n=6). Simpulan penelitian ini ialah karakteristik pasien stroke iskemik akut dengan COVID-19 yang masuk ruang perawatan intensif paling banyak ialah perempuan, usia 60-69 tahun, memiliki faktor risiko kardiovaskular hipertensi, mengalami peningkatan kadar LDH, CRP, d-dimer, ferritinin, fibrinogen, dan ditemukan ground-glass opacitiy pada gambaran radiologi.Kata kunci: Stroke iskemik akut, COVID-19, ruang perawatan intensif

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Elevated plasma D-dimer level is associated with short-term poor outcome in patients with acute ischemic stroke: a prospective, observational study

10.21203/rs.2.9184/v1 ◽

2019 ◽

Author(s):

Tao Yao ◽

Bo-Lin Tian ◽

Gang Li ◽

QIN CUI ◽

Cui-fang Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Clinical Laboratory ◽

Predictive Marker ◽

Stroke Severity ◽

Elevated Plasma ◽

Short Term ◽

Poor Outcome ◽

D Dimer

Abstract Background Elevated level of D-dimer increases the risk of ischemic stroke, stroke severity and progression of stroke status, but the association between D-dimer and functional outcome is unclear. The aim of this study is to investigate whether Plasma D-dimer level is a determinant of short-term poor functional outcomes in patients with acute ischemic stroke (AIS). Methods This prospective study included 877 patients with AIS provided plasma D-dimer level after stroke onset. Patients were categorized per D-dimer level: Quartile 1(≤0.24 mg /L), Quartile 2 (0.25–0.56 mg /L), Quartile 3 (0.57–1.78 mg /L), and Quartile 4 (>1.78mg /L). Each patient’s medical record was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted. Functional outcome at 90 days was assessed with the modified Rankin Scale (mRS). Results Of 877 patients were included (mean age, 64 years; male, 68.5%), poor outcome was present in 302 (34.4%) patients. After adjustment for potential confounding variables, higher D-dimer level on admission was associated with poor outcome (adjusted odds ratio [aOR] 2.257, 95% CI1.349-3.777 for Q4:Q1; P trend = 0.004). According to receiver operating characteristic (ROC) analysis, the best discriminating factor was a D-dimer level ≥0.315 mg/L for pour outcome [area under the ROC curve (AUC) 0.657; sensitivity 83.8%; specificity 41.4%]. Conclusion Elevated plasma D-dimer level on admission was significantly associated with increased poor outcome after admission for AIS, suggesting the potential role of D-dimer as a predictive marker for short-term poor outcomes in patients with AIS.

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Neuronal and Glia-Related Biomarkers in Cerebrospinal Fluid of Patients with Acute Ischemic Stroke

Journal of Central Nervous System Disease ◽

10.4137/jcnsd.s13821 ◽

2014 ◽

Vol 6 ◽

pp. JCNSD.S13821 ◽

Cited By ~ 48

Author(s):

Clara Hjalmarsson ◽

Maria Bjerke ◽

Björn Andersson ◽

Kaj Blennow ◽

Henrik Zetterberg ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Experimental Studies ◽

Csf Biomarkers ◽

Stroke Severity ◽

Neurofilament Light ◽

Age Related ◽

T Tau

Background Cerebral ischemia promotes morphological reactions of the neurons, astrocytes, oligodendrocytes, and microglia in experimental studies. Our aim was to examine the profile of CSF (cerebrospinal fluid) biomarkers and their relation to stroke severity and degree of white matter lesions (WML). Methods A total of 20 patients (mean age 76 years) were included within 5–10 days after acute ischemic stroke (AIS) onset. Stroke severity was assessed using NIHSS (National Institute of Health stroke scale). The age-related white matter changes (ARWMC) scale was used to evaluate the extent of WML on CT-scans. The concentrations of specific CSF biomarkers were analyzed. Results Patients with AIS had significantly higher levels of NFL (neurofilament, light), T-tau, myelin basic protein (MBP), YKL-40, and glial fibrillary acidic protein (GFAP) compared with controls; T-Tau, MBP, GFAP, and YKL-40 correlated with clinical stroke severity, whereas NFL correlated with severity of WML (tested by Mann–Whitney test). Conclusions Several CSF biomarkers increase in AIS, and they correlate to clinical stroke severity. However, only NFL was found to be a marker of degree of WML.

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Abstract W P160: Elevated Lipoprotein A Levels Predict Worse Short-term Outcomes in Acute Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp160 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Alyana A Samai ◽

Dominique J Monlezun ◽

Amir Shaban ◽

Alexander George ◽

Janelle Cyprich ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Serum Levels ◽

Stroke Severity ◽

Short Term ◽

Poor Functional Outcome ◽

Lipoprotein A ◽

Stroke Registry ◽

History Of

Background: Lipoprotein A (Lp(a)) is a risk factor for vascular disease; however, few studies have examined the relationship between serum levels of Lp(a) and patient outcomes in acute ischemic stroke (AIS). In this study, we sought to assess whether AIS patients with elevated Lp(a) levels exhibit characteristic differences in stroke severity, in-hospital complications, and short-term outcomes as compared to patients with normal Lp(a) levels. Methods: From our prospective stroke registry, patients consecutively admitted and diagnosed with AIS 07/2008-10/2013 were included if Lp(a) levels were measured during admission. Regressions, adjusting for key covariates, analyzed outcomes in patients with elevated (+) and severely elevated (++) Lp(a) with respect to normal (-) Lp(a). The primary outcome was poor functional outcome (modified Rankin Scale > 2) on discharge. Results: Among the 1,453 patients in our stroke registry, 159 patients met our inclusion criteria; 24 patients (15.1%) were in the +Lp(a) group and 37 patients (23.3%) in the ++Lp(a) group. After adjustment for total cholesterol, LDL, HDL, and triglycerides, patients with ++Lp(a) were more than twice as likely to experience poor functional outcome (OR=2.48, 95% CI 1.0781-5.7231, p=0.033) as those with -Lp(a). Adjusting for age, NIHSS baseline, history of diabetes, admission glucose level, and tPA administration, patients with ++Lp(a) were more than 2.5 times more likely to experience poor functional outcome (OR=2.59, 95% CI 1.0129-6.6282, p=0.047) as compared to those with -Lp(a). Conclusions: Lp(a) elevation predicts higher odds of poor functional outcomes for patients with AIS compared to patients with normal levels. Our findings support the utility of Lp(a) level as a clinically useful biomarker in the development of patient risk profiles.

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