Perioperative Acute Ischemic Stroke in Noncardiac and Nonvascular Surgery

Background Perioperative acute ischemic stroke (AIS) is a recognized complication of noncardiac, nonvascular surgery, but few data are available regarding incidence and effect on outcome. This study examines the epidemiology of perioperative AIS in three common surgeries: hemicolectomy, total hip replacement, and lobectomy/segmental lung resection. Methods Discharges for patients aged 18 yr or older who underwent any of the surgical procedures listed above were extracted from the Nationwide Inpatient Sample, an administrative database that contains 20% of all discharges from non-Federal hospitals each year, for years 2000 to 2004. Using appropriate International Classification of Diseases, 9th revision, Clinical Modification codes, patients with perioperative AIS were identified, as were comorbid conditions that may be risk factors for perioperative AIS. Multivariate logistic regression was performed to identify independent predictors of perioperative AIS and to ascertain the effect of AIS on outcome. Results A total of 0.7% of 131,067 hemicolectomy patients, 0.2% of 201,235 total hip replacement patients, and 0.6% of 39,339 lobectomy/segmental lung resection patients developed perioperative AIS. For patients older than 65 yr, AIS rose to 1.0% for hemicolectomy, 0.3% for hip replacement, and 0.8% for pulmonary resection. Multivariate logistic regression analysis revealed renal disease (odds ratio, 3.0), atrial fibrillation (odds ratio, 2.0), history of stroke (odds ratio, 1.6), and cardiac valvular disease (odds ratio, 1.5) to be the most significant risk factors for perioperative AIS. Conclusions Perioperative AIS is an important source of morbidity and mortality associated with noncardiac, nonvascular surgery, particularly in elderly patients and patients with atrial fibrillation, valvular disease, renal disease, or previous stroke.

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Development of a prediction model for 1-year poor prognosis in patients with acute ischemic stroke

Journal of Investigative Medicine ◽

10.1136/jim-2018-000883 ◽

2019 ◽

Vol 67 (6) ◽

pp. 957-963 ◽

Cited By ~ 1

Author(s):

Xia Ling ◽

Bo Shen ◽

Kangzhi Li ◽

Lihong Si ◽

Xu Yang

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Ischemic Stroke ◽

Prediction Model ◽

Acute Ischemic Stroke ◽

Poor Prognosis ◽

Multivariate Logistic Regression ◽

Lemeshow Test ◽

Independent Risk Factors ◽

Auc Value

The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. We identified 196 (25.4%) patients with poor prognosis at 1-year follow-up, and of these 68 (68/196, 34.7%) had died. Multivariate logistic regression and receiver operating characteristic curve analyses showed that age ≥70 years, consciousness (lethargy or coma), history of stroke or transient ischemic attack, cancer, abnormal fasting blood glucose levels ≥7.0 mmol/L, and National Institutes of Health Stroke Scale score were independent risk factors for 1-year poor prognosis in patients with AIS. Scores were assigned for each variable by rounding off β coefficient to the integer score, and a new prediction model with a maximum total score of 9 points was developed. The AUC value of the new prediction model was higher than the THRIVE score (p<0.05). The χ2 value for the Hosmer-Lemeshow test was 7.337 (p>0.05), suggesting that the prediction model had a good fit. The new prediction model can accurately predict 1-year poor prognosis in Chinese patients with AIS.

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Fibrinogen Level Combined With Platelet Count for Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Frontiers in Neurology ◽

10.3389/fneur.2021.716020 ◽

2021 ◽

Vol 12 ◽

Author(s):

Changchun Lin ◽

Hui Pan ◽

Yuan Qiao ◽

Peisheng Huang ◽

Jingjing Su ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Platelet Count ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Fibrinogen Level ◽

Hemorrhagic Transformation ◽

Multivariate Logistic Regression ◽

Platelet Counts

A serious complication of acute ischemic stroke (AIS) after mechanical thrombectomy (MT) is hemorrhagic transformation (HT), which is potentially associated with clinical deterioration. This study examined predictors of HT following MT in AIS patients. Patients with AIS due to large artery occlusion in the anterior circulation, treated with MT and successfully recanalized (modified Thrombolysis in Cerebral Infarction score 2b/3), were studied retrospectively. HT was evaluated by computed tomography (CT) 24 h after MT and was diagnosed and classified into parenchymal hematoma (PH) and hemorrhagic infarction (HI). Multivariate logistic regression models were used to determine the risk factors for HT. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive utility of risk factors for HT. We enrolled 135 patients: 49 in the HT group and 86 in the non-HT group. The two groups differed significantly in baseline fibrinogen levels (p = 0.003) and platelet counts (p = 0.006). Multivariate logistic regression analyses showed that lower fibrinogen levels [odds ratio (OR), 0.41; 95% CI, 0.23–0.72; p = 0.002] and platelet counts (OR, 0.58; 95% CI, 0.33–0.99; p = 0.048) were independently associated with a higher risk of HT. Together, the binary variates fibrinogen and platelets well-predicted HT (area under the curve, 0.703; specificity, 77.9%; sensitivity, 55.1%). The combination of fibrinogen <2.165 g/L and platelets <171.5 × 109/L was the strongest predictor of HT (OR, 23.17; 95% CI, 5.75–126.80; p < 0.0001). Our study suggests that lower baseline fibrinogen levels and platelet counts may be risk factors for HT in AIS patients following MT and reperfusion. Specifically, the combination of fibrinogen level and platelet count may predict the risk of HT after MT in these patients.

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Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

BMC Geriatrics ◽

10.1186/s12877-021-02728-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Rui He ◽

Guoyou Wang ◽

Ting Li ◽

Huarui Shen ◽

LijuanZhang

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Logistic Regression ◽

Ischemic Stroke ◽

Hip Fracture ◽

Total Hip Arthroplasty ◽

Older Age ◽

Factors Associated ◽

Independent Risk Factors ◽

D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

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Atrial fibrillation risk factors in patients with ischemic stroke

Archives of Medical Science ◽

10.5114/aoms.2019.84212 ◽

2021 ◽

Vol 17 (1) ◽

pp. 19-24

Author(s):

Paweł Wańkowicz ◽

Przemysław Nowacki ◽

Monika Gołąb-Janowska

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Coronary Heart Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Nonvalvular Atrial Fibrillation ◽

Multivariable Logistic Regression Model ◽

Lipid Metabolism Disorders

IntroductionAtrial fibrillation (AF) is the most common heart arrhythmia. The condition is known to increase the risk of ischemic stroke (IS). Classical risk factors for the development of AF include advanced age, hypertension, diabetes mellitus, coronary heart disease and lipid metabolism disorders. Importantly, these are also recognized risk factors for ischemic stroke. Therefore, the purpose of this study was to investigate AF risk factors in patients with IS.Material and methodsThis is single-centre retrospective study which included 696 patients with acute ischemic stroke and nonvalvular atrial fibrillation and 1678 patients with acute ischemic stroke without atrial fibrillation.ResultsIn this study we found – based on a univariable and multivariable logistic regression model – that compared to the patients with IS without AF, the group of patients which suffered from IS with nonvalvular atrial fibrillation (NVAF) had a higher proportion of patients who smoked cigarettes (OR = 15.742, p < 0.01; OR = 41.1, p < 0.01), had hypertension (OR = 5.161, p < 0.01; OR = 5.666, p < 0.01), history of previous stroke (OR = 3.951, p < 0.01; OR = 4.792, p < 0.01), dyslipidemia (OR = 2.312, p < 0.01; OR = 1.592, p < 0.01), coronary heart disease (OR = 2.306, p < 0.01; OR = 1.988, p < 0.01), a greater proportion of female patients (OR = 1.717, p < 0.01; OR = 2.095, p < 0.01), higher incidence of diabetes mellitus (OR = 1.341, p < 0.01; OR = 1.261, p = 0.106) and more patients in old age (OR = 1.084, p < 0.01; OR = 1.101, p < 0.01).ConclusionsOur study demonstrates a need for thorough and systematic monitoring of post-ischemic stroke patients in whom AF has not been detected and who display other important risk factors. Regardless of the stroke, these factors may be responsible for development of AF.

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Decreased eGFR Is Associated With Ischemic Stroke in Patients With Dilated Cardiomyopathy

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619866909 ◽

2019 ◽

Vol 25 ◽

pp. 107602961986690 ◽

Cited By ~ 1

Author(s):

Yuqing Deng ◽

Zhiqing Chen ◽

Lili Hu ◽

Zhenyan Xu ◽

Jinzhu Hu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Dilated Cardiomyopathy ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Analysis Model ◽

Multivariate Logistic Regression ◽

Increased Risk

Dilated cardiomyopathy (DCM) is increasingly indicated as a cause of cardioembolic syndrome, in particular, cardioembolic ischemia stroke. However, the potential risk factors for stroke among DCM patients remain under investigated. DCM patients hospitalized from June 2011 to June 2016 were included. The cases were defined as the group of DCM patients with stroke compared with those without stroke. Clinical characteristic data were collected and compared between the two groups including demographic data, complicated diseases, echocardiography index, and laboratory parameters and estimated glomerular filtration rate (eGFR). A multivariate logistic regression analysis model adjusted by sex and age was used to explore the related risk factors for stroke in DCM patients. A total of 779 hospitalized patients with DCM were included. Of these, 55 (7.1%) had experienced a stroke. Significantly lower eGFR levels (68.03 ± 26.22 vs 79.88 ± 24.25 mL/min/1.73 m2, P = .001) and larger left atrial diameters (45.32 ± 7.79 vs 43.25 ± 7.11 mm, P = .04) were found in the group of patients having DCM with stroke compared to those without stroke. When the eGFR was categorized as eGFR >60, 30<eGFR≤ 60 and eGFR ≤ 30, there were more patients with 30<eGFR≤ 60 (30.9% vs 17.7%) and eGFR≤ 30 (9.1% vs 3.3%) in the ischemic stroke group ( P = 0.003). A multivariate logistic regression analysis model adjusted by sex and age showed that 30 <eGFR≤60 (odds ratio [OR]: 2.07, 95% confidence interval [CI]: [1.05-4.07], P = .035) and eGFR≤30 (OR: 4.04, 95% CI: [1.41-11.62], P = .009) were statistically associated with ischemic stroke in patients with DCM. It is concluded that decreased eGFR is significantly associated with an increased risk of ischemic stroke in patients with DCM.

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Risk Factors of Changes in Hepatitis B Antibody Status after Allogeneic Hematopoietic Stem Cell Transplantation in Chinese Children with Thalassemia Major

Blood ◽

10.1182/blood.v124.21.5809.5809 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5809-5809

Author(s):

Xiaoqin Feng ◽

Lina Long ◽

Chunfu Li

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Odds Ratio ◽

Thalassemia Major ◽

Enzyme Linked Immunosorbent Assay ◽

Hbv Reactivation ◽

Type I ◽

Multivariate Logistic Regression ◽

Post Transplant

Abstract Objective: This retrospective study evaluated the risk factors involved in the changes in HBsAb status in patients with thalassemia major at a single center in China. Methods: A total of 104 children who underwent allo-HSCT, using NF-08-TM transplant protocol in our center, between January 2010 and June 2012 were recruited.Hepatitis B markers, including HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc were examined by TRFIA (time-resolved fluoroimmunoassay) or ELISA (Enzyme-Linked Immunosorbent Assay) for recipients before and after allo-HSCT (at least up to 6 months) and for donors prior to transplantation. HBsAg positive recipients and donors received lamivudine antiviral therapy before allo-HSCT and the treatment was continued in recipients up to 6 months post transplantation. The demographic and clinical characteristics of the patients and their donors were summarized by descriptive statistics. For identification of risk factors that influenced the post-transplant anti-HBs loss and HBV reactivation, both univariate and multivariate logistic regression was used, and odds ratio (OR) and 95% confidence interval (CI) were determined for the covariates that were shown to be statistically significant. All tests were 2-sided, with the type I error rate fixed at 0.05. Statistical analyses were performed using IBM SPSS 20 (SPSS Statistics V20, IBM Corporation, Somers, New York). Results: Of the 104 patients, 2（1.9%） recipients were positive for HBsAg and 102（98.1%） recipients were negative for HBsAg. Of the 102 patients negative for HBsAg before transplantation, the proportion of positive anti-HBs was 69.6% (71 of 102 patients). Of the 104 donors, 99 (95.2%)were negative for HBsAg and 5 (4.8%)were positive for HBsAg. Of the 99 donors negative for HBsAg before transplantation, 72 donors (72.7%) had anti-HBs. After transplantation, of the 69 patients, 27 (39.1%) patients lost their HBV immunity in a median follow-up period of 30 months (range: 21–45); the remaining 42 (60.9 %) patients maintained the immunity against HBV after a median follow-up period of 28.5 months (range: 19–46). 33 patients were anti-HBs negative before the allo-HSCT. The 33 patients included 11 patients with donors who had no anti-HBs and 22 patients with donors who had anti-HBs. After the allo-HSCT, 15 of the 33 patients were found to have newly gained HBV immunity, as represented by the presence of anti-HBs. While 14 of them who developed adoptive immunity had immunized donors (63.6%; 14 out of 22), 1 of them (9.1%; 1 out of 11) with a non-immunized donor (donors without anti-HBs) also had developed HBV immunity. Multivariate logistic regression analysis of 104 patients who underwent allo-HSCT revealed that, patients with pre-HSCT titer of HBsAb < 257.47mIU/mL (adjusted odds ratio, 10.5, 95% CI, 2.1–53.3) and HBsAb-immunized donors (51.3, 2.8–938.6) were significant risk factors for post allo-HSCT HBV loss and acquisition, respectively. In addition, the post-transplant HBV reactivation rate was 11.1%. Conclusions: Current results indicate that pre-transplant HBsAb titer is a key determinant in the loss of HBV immunity after allo-HSCT and HBsAb negative patients with immunized donors are more likely to gain HBV immunity after allo-HSCT than those with non-immunized donors. Further, preemptive antiviral treatment with lamivudine significantly reduces HBV reactivation. This is the first study to have indicated the significant predictors of changes in HBsAg status in children with thalassemia major. Disclosures No relevant conflicts of interest to declare.

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Risk factors for periprocedural ischemic stroke following endovascular treatment of intracranial aneurysms

Chinese Neurosurgical Journal ◽

10.1186/s41016-021-00255-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yisen Zhang ◽

Chao Wang ◽

Zhongbin Tian ◽

Wei Zhu ◽

Wenqiang Li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Treatment Modality ◽

Intracranial Aneurysms ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Flow Diverter ◽

Multivariate Logistic Regression

Abstract Background The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world database. Methods From August 2016 to March 2017, 167 patients were enrolled. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic stroke. Results Among the 167 cases, periprocedural ischemic stroke occurred in 20 cases (11.98%). After univariate analysis, the ischemic group had a higher proportion of large (≥ 10 mm) aneurysms than the control group (45.0% vs. 23.1%, p = 0.036). The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter (21.6%) or stent-assisted coiling (11.8%) than in cases treated by coiling only (2.7%), and the differences were statistically significant (p = 0.043). After multivariate logistic regression analysis, treatment modality was the independent risk factor for periprocedural ischemic stroke. Compared with the coiling-only procedure, flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke (OR 9.931; 95% CI 1.174–84.038; p = 0.035). Conclusions Aneurysm size and treatment modality were associated with periprocedural ischemic stroke. Larger aneurysms were associated with increased risk of periprocedural ischemic stroke. Flow diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.

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Delayed Stroke Treatment during COVID-19 Pandemic in China

10.1101/2020.11.17.20228122 ◽

2020 ◽

Author(s):

Shiyuan Gu ◽

Zhengze Dai ◽

Huachao Shen ◽

Yongjie Bai ◽

Xiaohao Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Intravenous Thrombolysis ◽

Multivariate Logistic Regression ◽

Delayed Treatment

ABSTRACTBackgroundSocial distance, quarantine, pathogen testing and other preventive strategies implemented during COVID-19 pandemic may negatively influence the management of acute stroke.ObjectiveThe current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of acute stroke in China.MethodsThis study included patients with acute stroke admitted in two hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 epidemic outbreak (January 31, 2020, as officially announced by Chinese government) were compared for pre- (measured as onset-to-door time) and post-hospital delay (measured as door-to-needle time). The influence factors for delayed treatment (indicated as onset-to-needle time >4.5 hours) were analyzed with multivariate logistic regression analysis.ResultsOnset-to-door time increased from 202 min (IQR 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (P=0.001). Door-to-needle time increased from 50min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (P=0.048). The proportion of patients with intravenous thrombolysis in those with acute ischemic stroke was decreased significantly after the pandemic (15.4% vs 20.1%; P=0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms and transported by other means than ambulance were associated with delayed treatment.ConclusionsCOVID-19 pandemic has remarkable impacts on the management of acute ischemic stroke. Both pre- and post-hospital delays were prolonged significantly, and proportion of patient arrived within the 4.5-hour time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.

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Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

10.21203/rs.3.rs-42112/v1 ◽

2020 ◽

Author(s):

Xiaohua Yang ◽

Huijuan Chen ◽

Wanling Yang ◽

Bin Deng ◽

Jialing Zheng ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Ischemic Stroke ◽

Dental Caries ◽

Acute Ischemic Stroke ◽

Oral Hygiene ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional

Abstract Background: Stroke-associated pneumonia (SAP) is a major complication after stroke, oral microorganisms are important contributors to SAP. Here, we aimed to investigate whether the oral hygiene was associated with SAP and related risk factors of them in patients with acute ischemic stroke. Methods: We performed a cross-sectional study that recruited 331 patients with acute ischemic stroke from two medical centers. A series of assessments were performed to evaluate the neurological status and habits of oral hygiene. According to whether the oral hygiene was abnormal and SAP occurred, univariate analyses were performed in cohort 1 (normal / abnormal oral hygiene groups) and cohort 2 (SAP / non-SAP groups). Multiple logistic regression analyses were conducted to confirm risk factors of oral cleanliness and SAP in stroke patients. Results: A total of 12 and 8 independent variables were included in the model 1 and 2 analysis. After adjusting for confounders, multivariable logistic regression analysis showed that oral cleanliness was not only closely related to SAP (OR=2.219, P=0.026), dental caries (OR=1.292, P=0.005) and age (OR=1.030, P=0.006) in model 1, but also an independent risk factor for predicting SAP (OR=1.678, P=0.001) in model 2. Barthel index was a protective factor for oral cleanliness (OR=0.986, P=0.019) and SAP (OR=0.977, P=0.002) in ischemic stroke patients. Conclusions: Mutually primary risk roles of abnormal oral cleanliness and SAP exist in patients with acute ischemic stroke. Dental caries and aging are important risk factors for oral health disorders. Improving the activities of daily living would have protective effects on both oral hygiene and SAP prevention in stroke patients.

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