Added value of systemic inflammation markers in predicting pulmonary infection in stroke patients

Background: The major endovascular mechanic thrombectomy (MT) techniques are: Stent-Retriever (SR), aspiration first pass technique (ADAPT) and Solumbra (Aspiration + SR), which are interchangeable (defined as switching strategy (SS)). The purpose of this study is to report the added value of switching from ADAPT to Solumbra in unsuccessful revascularization stroke patients. Methods: This is a retrospective, single center, pragmatic, cohort study. From December 2017 to November 2019, 935 consecutive patients were admitted to the Stroke Unit and 176/935 (18.8%) were eligible for MT. In 135/176 (76.7%) patients, ADAPT was used as the first-line strategy. SS was defined as the difference between first technique adopted and the final technique. Revascularization was evaluated with modified Thrombolysis In Cerebral Infarction (TICI) with success defined as mTICI ≥ 2b. Procedural time (PT) and time to reperfusion (TTR) were recorded. Results: Stroke involved: Anterior circulation in 121/135 (89.6%) patients and posterior circulation in 14/135 (10.4%) patients. ADAPT was the most common first-line technique vs. both SR and Solumbra (135/176 (76.7%) vs. 10/176 (5.7%) vs. 31/176 (17.6%), respectively). In 28/135 (20.7%) patients, the mTICI was ≤ 2a requiring switch to Solumbra. The vessel’s diameter positively predicted SS result (odd ratio (OR) 1.12, confidence of interval (CI) 95% 1.03–1.22; p = 0.006). The mean number of passes before SS was 2.0 ± 1.2. ADAPT to Solumbra improved successful revascularization by 13.3% (107/135 (79.3%) vs. 125/135 (92.6%)). PT was superior for SS comparing with ADAPT (71.1 min (CI 95% 53.2–109.0) vs. 40.0 min (CI 95% 35.0–45.2); p = 0.0004), although, TTR was similar (324.1 min (CI 95% 311.4–387.0) vs. 311.4 min (CI 95% 285.5–338.7); p = 0.23). Conclusion: Successful revascularization was improved by 13.3% after switching form ADAPT to Solumbra (final mTICI ≥ 2b was 92.6%). Vessel’s diameter positively predicted recourse to SS.

Download Full-text

ASSOCIATION OF SYSTEMIC INFLAMMATION MARKERS WITH THE PRESENCE AND PROGRESSION OF CORONARY ARTERY CALCIFICATION AND EPICARDIAL FAT VOLUME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)61152-3 ◽

2013 ◽

Vol 61 (10) ◽

pp. E1152

Author(s):

Soeren Gauss ◽

Lutz Klinghammer ◽

Stephan Achenbach ◽

Christoph D. Garlichs

Keyword(s):

Coronary Artery ◽

Systemic Inflammation ◽

Coronary Artery Calcification ◽

Epicardial Fat ◽

Inflammation Markers ◽

Epicardial Fat Volume ◽

Fat Volume

Download Full-text

Persistent inflammation worsens short-term outcomes in massive stroke patients

BMC Neurology ◽

10.1186/s12883-021-02097-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Duanlu Hou ◽

Chunjie Wang ◽

Xiaofei Ye ◽

Ping Zhong ◽

Danhong Wu

Keyword(s):

Blood Glucose ◽

Pulmonary Infection ◽

Laboratory Data ◽

Adverse Outcomes ◽

Imaging Data ◽

Stroke Patients ◽

Short Term ◽

Glucose Levels ◽

Logistic Analysis ◽

Persistent Inflammation

Abstract Background Persistent inflammation is an important driver of disease progression and affects prognosis. Some indicators of inflammation predict short-term outcomes. The relationship between prognosis, especially mortality, and persistent inflammation in massive stroke has not been studied, and this has been the subject of our research. Methods From April 1, 2017 to February 1, 2020, consecutive patients were prospectively enrolled. Clinical data, laboratory data, imaging data and follow-up infections morbidity were compared between 2 groups according to modified Rankin scale (mRS) scores (mRS < 3 and ≥ 3) at 1 month. The binomial logistic analysis was used to determine independent factors of 1-month prognosis. Short-term functional outcome, mortality and infection rates in massive stroke with and without persistent inflammation were compared. Results One hundred thirty-nine patients with massive stroke were included from 800 patients. We found that admission blood glucose levels (p = 0.005), proportions of cerebral hemispheric (p = 0.001), posterior circulatory (p = 0.035), and lacunar (p = 0.022) ischemia were higher in poor outcome patients; neutrophil-to-lymphocyte ratio (odd ratio = 1.87, 95%CI 1.14–3.07, p = 0.013) and blood glucose concentrations (odd ratio = 1.34, 95%CI 1.01–1.79, p = 0.043) can independently predict the short-term prognosis in massive stroke patients. We also found that the incidence of pulmonary infection (p = 0.009), one-month mortality (p = 0.003) and adverse outcomes (p = 0.0005) were higher in patients with persistent inflammation. Conclusions This study suggested that persistent inflammation is associated with poor prognosis, 1-month mortality and the occurrence of in-hospital pulmonary infection and that higher baseline inflammation level predicts short-term poor outcomes in massive stroke.

Download Full-text

Prognostic role of lymphocyte-to-monocyte ratio in pancreatic neuroendocrine neoplasms

Endocrine Connections ◽

10.1530/ec-19-0541 ◽

2020 ◽

Vol 9 (4) ◽

pp. 289-298 ◽

Cited By ~ 1

Author(s):

Wentao Zhou ◽

Tiantao Kuang ◽

Xu Han ◽

Wenqi Chen ◽

Xuefeng Xu ◽

...

Keyword(s):

Multivariate Analysis ◽

Systemic Inflammation ◽

Lymphocyte Count ◽

Neuroendocrine Neoplasms ◽

Inflammation Markers ◽

Clinical Value ◽

Term Survival ◽

Pancreatic Neuroendocrine Neoplasms ◽

Lymphocyte Ratio ◽

Lymphocyte To Monocyte Ratio

Objectives Systemic inflammation markers have been demonstrated to be associated with prognosis in various tumors. In this study, we aimed to assess the value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index and the counts of lymphocyte, monocyte and neutrophil in predicting prognosis among patients with resected pancreatic neuroendocrine neoplasms (pNENs). Methods A total of 174 patients were included in the study. Univariate and multivariate analyses were performed to evaluate the predictive roles of inflammation markers for relapse-free survival (RFS) and overall survival (OS) in pNEN patients. Results The optimal cut-off values of NLR, LMR and lymphocyte count were 1.9, 5.0 and 1.4 × 109/L, respectively, determined by the X-tile software. RFS was found to be significantly longer in patients with NLR ≤1.9 (P = 0.041), LMR >5.0 (P < 0.001) and lymphocyte count >1.4 × 109/L (P = 0.002) in comparison to those with NLR >1.9, LMR ≤5.0 and lymphocyte count ≤1.4 × 109/L, respectively. Multivariate analysis revealed that LMR (hazard ratio 0.30, 95% CI 0.11–0.85, P = 0.023) was an independent predictor for RFS, but not NLR or lymphocyte count. For long-term survival analysis, patients with NLR ≤1.9 (P = 0.016) were found to be associated with favorable OS, but NLR was not an independent factor validated by multivariate analysis. Conclusions Preoperative LMR is an independent systemic inflammation marker to predict relapses in pNEN patients who underwent curative resections, whose clinical value needs to be verified in further large sample-based prospective studies.

Download Full-text

The effect of systemic inflammation markers on predicting pregnancy results in patients admitted to emergency department with threatened miscarriage

Ankara Medical Journal ◽

10.17098/amj.576455 ◽

2019 ◽

Vol 19 (2) ◽

Author(s):

Eda Kan

Keyword(s):

Emergency Department ◽

Systemic Inflammation ◽

Inflammation Markers ◽

Threatened Miscarriage

Download Full-text

P105: Transforming emergency stroke care through innovation: Canadas first stroke ambulance

CJEM ◽

10.1017/cem.2018.303 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S94-S94

Author(s):

L. Morrison ◽

S. Amlani ◽

T. Jeerakathil ◽

A. Shuaib ◽

H. Kalashyan

Keyword(s):

Health Economic ◽

Economic Analysis ◽

Patient Care ◽

Tertiary Care ◽

Added Value ◽

Rural Setting ◽

Stroke Patients ◽

Health Economic Analysis ◽

Economic Implications ◽

Suspected Stroke

Introduction: A two-year Stroke Ambulance (SA) pilot project was implemented at the University of Alberta Hospital (UAH) in February, 2017, the first in the world to utilize this specialized technology in a rural setting. The primary objective is to evaluate clinical and economic implications of timely SA assessment and treatment of hyperacute stroke patients who present to non-stroke centres in rural Alberta and might otherwise have received delayed treatment, or not at all, due to prolonged transfer times. Methods: A steering committee and seven working groups were established, with representation from Alberta Health Services (AHS) programs impacted, to ensure comprehensive project development and implementation. The SA portable CT scanner, point of care laboratory, and videoconference system facilitate diagnosis of stroke in the field. The multidisciplinary team includes a stroke fellow, advanced & primary care paramedics, registered nurse, CT technologist, and telestroke physician. When not dispatched, the team provides stroke expertise and patient care in the emergency department (ED) and diagnostic imaging. The service model includes suspected stroke patients presenting to non-stroke centres within a 250 Km radius of Edmonton (Phase I); patients presenting to Edmonton Zone (EZ) hospitals without CT capability and/or tPA protocols (Phase 2); and expedited transport from EZ hospitals to the UAH for urgent endovascular therapy (EVT) (Phase 3). A health economic analysis will compare stroke ambulance care with standard care. Results: The SA has responded to 54 dispatches, 13 patients thrombolyzed and 3 patients receiving EVT. Median rendezvous to CT time was 10 minutes, median rendezvous to tPA time was 21 minutes, and mean time from symptom onset to tPA was 180 minutes. There were no complications. After SA imaging and assessment, 18 patients were repatriated back to their local community hospital, avoiding unnecessary admission to tertiary care. Conclusion: Our preliminary experience demonstrates that the SA offers a novel approach to performing timely evaluation and treatment of suspected stroke from non-stroke centres and may serve as an excellent triage mechanism, reducing avoidable admissions to overcapacity tertiary care EDs. The SA team provides added value to the ED with stroke expertise and patient care. A comprehensive health economic analysis will determine cost-effectiveness and whether spread is feasible.

Download Full-text