T78. MORTALITY IN PATIENTS WITH SCHIZOPHRENIA ADMITTED FOR INCIDENT ISCHEMIC STROKE: A POPULATION-BASED COHORT STUDY

Abstract Background Evidence shows that schizophrenia is associated with increased incidence of cardiovascular diseases (CVD), including stroke. The relationship between schizophrenia and post-stroke mortality was understudied, and mixed findings were observed. Of note, none of these studies specifically explored the association of schizophrenia with short-term mortality after incident ischemic stroke. One of them specifically examined short-term mortality following ischemic stroke in schizophrenia patients, but it did not address potential confounding by patients who had past history of stroke. The only study which included solely incident stroke patients indicated that patients with psychotic disorders experienced higher short-term mortality ensuing incident stroke. Methods We conducted a retrospective cohort study to investigate short-term mortality of schizophrenia patients after incident ischemic stroke. All individuals admitted for incident ischemic stroke between 2006 and 2016 in Hong Kong were identified using a territory-wide electronic health record database. 817 patients with an ICD-10 diagnosis of schizophrenia (F20) or schizoaffective disorder (F25) (termed schizophrenia henceforth) prior to index admission constituted the study group. The comparison group comprised 8170 patients (10:1 matched to schizophrenia patients on age, sex, treatment sites and calendar-period for index admission) without any non-affective psychoses, mania or bipolar disorder (F20, F22-25, F28-31). Results Multivariate logistic regression revealed that schizophrenia patients had higher 1-year (OR [95% CI] = 1.51 [1.22 – 1.85]) and marginally higher 30-day (OR [95% CI] = 1.34 [1.00 – 1.79]) mortality following incident ischemic stroke, after adjusting for medical comorbidities, including hypertension, diabetes, hyperlipidemia, alcohol and substance use disorders and other comorbidities quantified by Charlson-Deyo comorbidity index. Additional age- (<65 years and ≥65 years) and gender-stratified analyses revealed similar results. Elevated 1-year mortality was exhibited by all schizophrenia subgroups, being more pronounced in younger patients (OR [95% CI] = 2.02 [1.38 – 2.96]). Increase in 30-day mortality was only seen in younger (OR [95% CI] = 1.75 [1.04 – 2.95]) and male (OR [95% CI] = 1.63 [1.06 – 2.50]) schizophrenia patients. Discussion Our results of heightened short-term post-stroke mortality in schizophrenia were in line with the only previous study which compared short-term mortality ensuing incident stroke in patients with and without psychotic disorders. This intuitive result may be explained by some studies which demonstrated that schizophrenic stroke patients were less likely to receive reperfusion treatments and prophylactic medications. The absence of data on lifestyle factors, antipsychotic treatment and post-stroke management is a major limitation in our study. In conclusion, our results indicated that schizophrenia is associated with increased short-term mortality after incident ischemic stroke. Further research is warranted to clarify the contribution of possible risk factors to post-stroke mortality in schizophrenia patients.

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Post-stroke Hyperglycemia in Non-diabetic Ischemic Stroke is Related With Worse Functional Outcome: A Cohort Study

Annals of Rehabilitation Medicine ◽

10.5535/arm.21124 ◽

2021 ◽

Vol 45 (5) ◽

pp. 359-367

Author(s):

Jin A Yoon ◽

Yong-Il Shin ◽

Deog Young Kim ◽

Min Kyun Sohn ◽

Jongmin Lee ◽

...

Keyword(s):

Cohort Study ◽

Ischemic Stroke ◽

Glucose Level ◽

Functional Outcomes ◽

Stroke Patients ◽

Nihss Score ◽

Post Stroke ◽

Significant Difference ◽

Functional Assessments

Objective To investigate long-term and serial functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.Methods The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a large, multi-center, prospective cohort study of stroke patients admitted to participating hospitals in nine areas of Korea. From KOSCO, ischemic stroke patients without diabetes were recruited and divided into two groups: patients without diabetes without (n=779) and with post-stroke hyperglycemia (n=223). Post-stroke hyperglycemia was defined as a glucose level >8 mmol/L. Functional assessments were performed 7 days and 3, 6, and 12 months after stroke onset.Results There were no significant differences in baseline characteristics between the groups, except in the age of onset and smoking. Analysis of the linear correlation between the initial National Institutes of Health Stroke Scale (NIHSS) score and glucose level showed no significant difference. Among our functional assessments, NIHSS, Fugl-Meyer Assessment (affected side), Functional Ambulatory Category, modified Rankin Scale, and Korean Mini-Mental State Examination (K-MMSE) showed statistically significant improvements in each group. All functional improvements except K-MMSE were significantly higher in patients without post-stroke hyperglycemia at 7 days and 3, 6, and 12 months.Conclusion The glucose level of ischemic stroke patients without diabetes had no significant correlation with the initial NIHSS score. The long-term effects of stress hyperglycemia showed worse functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.

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Abstract W P379: Pre-treatment with Selective Serotonin Reuptake Inhibitors is Associated with Improved Short-term Outcome in Acute Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp379 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Timo Siepmann ◽

Jessica Kepplinger ◽

Charlotte Zerna ◽

Ana Isabel Penzlin ◽

Heinz Reichmann ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Stroke Patients ◽

Short Term ◽

Post Stroke ◽

Pre Treatment ◽

Favorable Functional Outcome

Background and Purpose: Treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) following acute ischemic stroke was shown to improve functional and motor recovery independently of depression, possibly mediated by long-term mechanisms such as increased brain plasticity. In animal studies, chronic SSRI treatment is superior over short-term SSRI in evoking neurogenesis but the applicability of this observation to humans remains unelucidated. We hypothesized that pre-treatment with SSRI in acute ischemic stroke patients is associated with improved recovery compared to post-stroke SSRI. Subjects and Methods: We performed an exploratory analysis in consecutive acute ischemic stroke patients who were pre-treated or treated de novo either with fluoxetine, citalopram or escitalopram. Effects of SSRI-pre-treatment on short-term clinical (total NIHSS and NIHSS motor items) and functional (mRS) outcome at discharge compared to post-stroke SSRI were assessed using bivariate and multivariate analyses. Results: Of 2653 patients screened, 239 were included (aged 69±14 years, mean±SD; 42% men, baseline median NIHSS 7 [IQR, 10]). Compared to post-stroke SSRI (n=188), in the SSRI pre-treatment group (n=51) favorable functional outcome at discharge (mRS≤2) was more frequent (41% vs. 20%; p=0.002), duration of hospitalization was shorter (median: 7 versus 11 days; p<0.0001), and there was a non-significant trend toward improved motor recovery (decrease in NIHSS motor items ≥2 points or 0-1 at discharge; 63% vs. 49%; p=0.08). However there was no such difference in total NIHSS recovery (≥4 points or 0-1 at discharge; p=n.s.). Pre-treatment with SSRI was an independent predictor of favorable functional outcome (mRS≤2) at discharge (OR: 4.00; 95%CI: 1.68-9.57; p=0.002) after adjusting for age, pre-stroke mRS, baseline NIHSS and IV-thrombolysis. Conclusions: Our data suggest that pre-treatment with SSRI may be linked to early clinical recovery after acute ischemic stroke and support the hypothesis that pre-stroke SSRI might be superior to post-stroke SSRI.

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Abstract P50: IV Alteplase Use Predicts Favorable Discharge Disposition in Patients With Acute Ischemic Stroke: Insights From the UTHSC Houston Stroke Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap50 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Nneka Ifejika-Jones ◽

Nusrat Harun ◽

Elizabeth Noser ◽

James Grotta

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Status ◽

Inpatient Rehabilitation ◽

Level Of Care ◽

Stroke Patients ◽

Short Term ◽

Post Stroke ◽

Discharge Disposition

Introduction: Acute ischemic stroke patients receiving IV alteplase (t-PA) within 4.5 hours of symptom onset are 30% more likely to have minimal or no disability at 3 months. During hospitalization, short-term disability is subjectively measured by discharge disposition, whether to home or Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute Care (Sub). There are no studies assessing the role of IV t-PA as a predictor of short-term disability, evidenced by post-stroke disposition. Hypothesis: Low NIHSS is a predictor of high functional status. We assessed the hypothesis that similar to low NIHSS, t-PA predicts post-stroke disposition to a level of care suggestive of high functional status. Methods: All patients with acute ischemic stroke admitted to the UT Service between January 2004 and October 2009 were included. Stratification occurred for age>65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed to determine whether there were differences in post-stroke disposition among patients who received t-PA. Results: Patients with mild (NIHSS<8) and moderate (NIHSS 8 to 16) stroke were discharged to the highest level of care in each analysis. Home vs. Other Level of Care Of 2261 patients, 1032 were discharged home, 1229 to another level of care. Patients who received t-PA were 1.7 times more likely to be discharged home (P = <.0001, OR 1.663, 95% CI 1.326 to 2.085). IR vs. SNF Of 1111 patients, 731 patients were discharged to acute IR, 380 to SNF. There were no statistically significant differences in disposition between patients who received t-PA. (P = .0638, OR 1.338, 95% CI 0.983 to 1.822). SNF vs. Sub Of 498 patients, 380 were discharged to SNF, 118 to Sub. There were no significant differences in disposition between patients who received t-PA. Conclusion: Acute stroke patients who receive IV t-PA are more 1.7 times more likely to be discharged home. If post-stroke care is necessary, there is a trend toward rehabilitation at a level reflective of improved functional status (IR vs. SNF). This study is limited by its retrospective nature and the undetermined role of psychosocial factors related to discharge. Prospective studies of time to t-PA therapy in relation to post-stroke disposition are warranted.

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The relationship between lymphocyte / monocyte ratio and short-term mortality in acute ischemic stroke patients.

Cumhuriyet Medical Journal ◽

10.7197/223.v40i37154.410205 ◽

2018 ◽

Vol 40 (2) ◽

pp. 128-134

Author(s):

Aslı Bolayır

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

Short Term ◽

Short Term Mortality ◽

The Relationship

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Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01724-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Gertrude Namale ◽

Onesmus Kamacooko ◽

Anthony Makhoba ◽

Timothy Mugabi ◽

Maria Ndagire ◽

...

Keyword(s):

Cohort Study ◽

Ischemic Stroke ◽

Acute Phase ◽

Hemorrhagic Stroke ◽

Functional Disability ◽

Stroke Severity ◽

Protective Effects ◽

Stroke Patients ◽

Post Stroke ◽

Gcs Score

Abstract Background We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients. Methods Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality. Results We enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39–8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85–10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68–10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13–4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7–13 days (aHR = 0.31, 95% CI: 0.11–0.93) and being married (aHR = 0.22 (95% CI: 0.06–0.84) had protective effects for 30 and 90-day mortality respectively. Conclusion Mortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke- standard of care in the country.

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