Prior antiplatelet therapy and haematoma expansion after primary intracerebral haemorrhage: an individual patient-level analysis of CLEAR III, MISTIE III and VISTA-ICH

2020 ◽  
pp. jnnp-2020-323458
Author(s):  
Santosh Murthy ◽  
David J Roh ◽  
Abhinaba Chatterjee ◽  
Nichol McBee ◽  
Neal S Parikh ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Intracerebral Haemorrhage ◽  
Phase Iii ◽  
Clot Lysis ◽  
Study Cohort ◽  
Haematoma Volume ◽  
All Cause Mortality ◽  
Secondary Analyses ◽  
Haematoma Expansion ◽  
The Relationship

ObjectiveTo evaluate the relationship between prior antiplatelet therapy (APT) and outcomes after primary intracerebral haemorrhage (ICH), and assess if it varies by haematoma location.MethodsWe pooled individual patient data from the Virtual International Stroke Trials Archive-ICH trials dataset, Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III trial and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III trial. The exposure was APT preceding ICH diagnosis. The primary outcome was haematoma expansion at 72 hours. Secondary outcomes were admission haematoma volume, all-cause mortality, death or major disability (modified Rankin Scale (mRS) score ≥4) and shift in mRS distribution. Mixed-effects models were used to assess the relationship between APT and outcomes. Secondary analyses were stratified by ICH location and study cohort.ResultsAmong 1420 patients with ICH, there were 782 (55.1%) lobar and 596 (42.0%) deep haemorrhages. APT was reported in 284 (20.0%) patients. In adjusted regression models, prior APT was not associated with haematoma expansion (OR, 0.97; 95% CI 0.60 to 1.57), major disability or death (OR, 1.05; 95% CI 0.61 to 1.63), all-cause mortality (OR, 0.89; 95% CI 0.47 to 1.85), admission haematoma volume (beta, −0.17; SE, 0.09; p=0.07) and shift in mRS (p=0.43). In secondary analyses, APT was associated with admission haematoma volume in lobar ICH (beta, 0.25; SE, 0.12; p=0.03), but there was no relationship with other ICH outcomes when stratified by haematoma location or study cohort.ConclusionsIn a large heterogeneous cohort of patients with ICH, prior APT was not associated with haematoma expansion or functional outcomes after ICH, regardless of haematoma location. APT was associated with admission haematoma volumes in lobar ICH.

scholarly journals Relationship between Cataract Surgery and Mortality in Elderly Patients with Cataract: Nationwide Population-Based Cohort Study in South Korea

2021 ◽  
Vol 11 (11) ◽  
pp. 1128
Author(s):  
Jae-Yong Kim ◽  
Ho-Seok Chung ◽  
Ji-Sung Lee ◽  
Hun Lee ◽  
Hungwon Tchah
Keyword(s):  
Elderly Patients ◽  
Cataract Surgery ◽  
Cox Regression ◽  
Population Based ◽  
Charlson Comorbidity Index Score ◽  
Study Cohort ◽  
All Cause Mortality ◽  
Korean Elderly ◽  
Time Varying Covariates ◽  
The Relationship

We aimed to investigate the relationship between cataract surgery and all-cause and cause-specific mortality in Korean elderly patients with cataract using the Korean National Health Insurance Service-Senior cohort database. Elderly patients (≥60 years) diagnosed with cataract from 2002 through 2012 were included. The baseline characteristics included demographics and systemic and ocular comorbidities. Adjusted Cox regression models with time-varying covariates for cataract surgery were used to assess the relationship between cataract surgery and mortality. The study cohort included 241,062 patients, of whom 127,941 were in the cataract surgery group and 113,121 were in the cataract diagnosis group. The incidence of all-cause mortality was 3.62 deaths/100 person-years and 3.19 deaths/100 person-years in the cataract surgery and cataract diagnosis groups, respectively. Cataract surgery was associated with a decreased hazard of all-cause mortality after adjusting for demographics as well as systemic and ocular comorbidities (hazard ratio (HR), 0.93; p < 0.001). A protective association was noted between cataract surgery and mortality from vascular (HR, 0.92; p < 0.001) or neurologic (HR, 0.64; p < 0.001) causes. Patients with cataract who were 85 years of age and older, women, those who had lower income, and a Charlson comorbidity index score of 5 or more, or those without glaucoma revealed the largest reductions in mortality hazards resulting from cataract surgery.

scholarly journals Plasma Total Cysteine, Mortality, and Cardiovascular Disease Hospitalizations: The Hordaland Homocysteine Study

2003 ◽  
Vol 49 (6) ◽  
pp. 895-900 ◽  
Author(s):  
Lina El-Khairy ◽  
Stein E Vollset ◽  
Helga Refsum ◽  
Per M Ueland
Keyword(s):  
Cardiovascular Disease ◽  
Artery Bypass ◽  
Positive Association ◽  
Study Cohort ◽  
Data Set ◽  
Men And Women ◽  
All Cause Mortality ◽  
Mortality Ratio ◽  
The Relationship

Abstract Background: We have previously reported a positive association between tHcy and mortality and cardiovascular disease (CVD) hospitalizations in the Hordaland Homocysteine Study cohort. Using the same data set, we assessed the relationship between plasma total cysteine (tCys) and mortality from all causes and from cardiovascular and noncardiovascular conditions, and the association between tCys and the risk of hospitalizations from CVD. Methods: We measured plasma tCys in blood samples from 12 595 men and women 40–42 years of age and from 4766 men and women 65–67 years of age, collected as part of the Hordaland Homocysteine Study in the year 1992–1993. Follow-up data on mortality were collected through 1999. Data on CVD hospitalizations were collected from hospital records up to May 31, 1998. Results: After a follow-up time of 6.6–7.6 years, there were a total of 610 deaths, of which 243 were cardiovascular deaths and 367 were noncardiovascular deaths. There was no association between tCys and all-cause, cardiovascular, or noncardiovascular mortality. When we used tCys values &lt;247.6 μmol/L (lowest quartile) as the reference category, the adjusted mortality ratio (MR) for all-cause mortality at tCys concentrations of 247.6–270.79, 270.8–295.79, and ≥295.8 μmol/L (highest quartile) were 1.0, 0.9, and 1.0, respectively. The adjusted MRs for cardiovascular mortality were 1.0, 1.1, and 1.1, respectively. There were no associations between tCys and 1275 CVD hospitalizations, except that tCys was significantly associated with hospitalizations from coronary artery bypass grafting. Conclusion: Plasma tCys is not associated with mortality or CVD hospitalizations.

scholarly journals Gravidity, parity, blood pressure and mortality among women in Bangladesh from the HEALS cohort

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037244
Author(s):  
Yu-Hsuan Shih ◽  
Molly Scannell Bryan ◽  
Faruque Parvez ◽  
Keriann Hunter Uesugi ◽  
Mohammed Shahriar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cox Proportional Hazards ◽  
Reproductive History ◽  
Study Cohort ◽  
Rural Bangladesh ◽  
Baseline Visit ◽  
Nulliparous Women ◽  
All Cause Mortality ◽  
The Relationship

ObjectivesDespite a hypothesised connection of reproductive history with hypertension and mortality, the nature of this association is poorly characterised. We evaluated the association of parity and gravidity with blood pressure, hypertension and all-cause mortality.DesignProspective cohort study.SettingHealth Effects of Arsenic Longitudinal Study cohort in rural Bangladesh.ParticipantsThere were 21 634 Bangladeshi women recruited in 2000–2002, 2006–2008 and 2010–2014 included in the present analysis.MethodsReproductive history was ascertained through an interviewer-administered questionnaire at the baseline visit. Blood pressure was measured by a trained study physician following a standard protocol at the baseline visit. Vital status was ascertained at the biennial follow-up of study participants through June 2017. Linear and logistic regression models estimated the relationship between parity and gravidity with blood pressure and hypertension, respectively. Cox proportional hazards models estimated the relationship with all-cause mortality only among women aged >45 years.ResultsDiastolic blood pressure was lowest in women with parity one (reference) and elevated in nulliparous women (adjusted % change=3.12; 95% CI 1.93 to 4.33) and women with parity >2 (adjusted % change=1.71; 95% CI 1.12 to 2.31). The associations with nulliparity were stronger for women aged >45 years. Similar association patterns were observed with hypertension. Further, in nulliparous women aged >45 years, 265 deaths (6.6%) were ascertained during the follow-up period (median follow-up time=8 years), and we observed suggestive elevated risks of all-cause mortality (adjusted HR 3.83; 95% CI 0.74 to 19.78). The relationships between reproductive history, blood pressure, hypertension and mortality were similar when modelling reproductive history as gravidity rather than parity.ConclusionsFor women in rural Bangladesh, nulliparity and nulligravidity appear to be associated with higher blood pressure and subsequent elevated risk of mortality.

scholarly journals Meta-analysis of haematoma volume, haematoma expansion and mortality in intracerebral haemorrhage associated with oral anticoagulant use

2019 ◽  
Vol 266 (12) ◽  
pp. 3126-3135 ◽  
Author(s):  
David J. Seiffge ◽  
Martina B. Goeldlin ◽  
Turgut Tatlisumak ◽  
Philippe Lyrer ◽  
Urs Fischer ◽  
...  
Keyword(s):  
Vitamin K ◽  
Intracerebral Haemorrhage ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Age Difference ◽  
Haematoma Volume ◽  
Haematoma Expansion ◽  
Reported Data ◽  
Volume Difference

Abstract Objective To obtain precise estimates of age, haematoma volume, secondary haematoma expansion (HE) and mortality for patients with intracerebral haemorrhage (ICH) taking oral anticoagulants [Vitamin K antagonists (VKA-ICH) or non-Vitamin K antagonist oral anticoagulants (NOAC-ICH)] and those not taking oral anticoagulants (non-OAC ICH) at ICH symptom onset. Methods We conducted a systematic review and meta-analysis of studies comparing VKA-ICH or NOAC-ICH or both with non-OAC ICH. Primary outcomes were haematoma volume (in ml), HE, and mortality (in-hospital and 3-month). We calculated odds ratios (ORs) using the Mantel–Haenszel random-effects method and corresponding 95% confidence intervals (95%CI) and determined the mean ICH volume difference. Results We identified 19 studies including data from 16,546 patients with VKA-ICH and 128,561 patients with non-OAC ICH. Only 2 studies reported data on 4943 patients with NOAC-ICH. Patients with VKA-ICH were significantly older than patients with non-OAC ICH (mean age difference: 5.55 years, 95%CI 4.03–7.07, p < 0.0001, I2 = 92%, p < 0.001). Haematoma volume was significantly larger in VKA-ICH with a mean difference of 9.66 ml (95%CI 6.24–13.07 ml, p < 0.00001; I2 = 42%, p = 0.05). HE occurred significantly more often in VKA-ICH (OR 2.96, 95%CI 1.74–4.97, p < 0.00001; I2 = 65%). VKA-ICH was associated with significantly higher in-hospital mortality (VKA-ICH: 32.8% vs. non-OAC ICH: 22.4%; OR 1.83, 95%CI 1.61–2.07, p < 0.00001, I2 = 20%, p = 0.27) and 3-month mortality (VKA-ICH: 47.1% vs. non-OAC ICH: 25.5%; OR 2.24, 95%CI 1.52–3.31, p < 0.00001, I2 = 71%, p = 0.001). We did not find sufficient data for a meta-analysis comparing NOAC-ICH and non-OAC-ICH. Conclusion This meta-analysis confirms, refines and expands findings from prior studies. We provide precise estimates of key prognostic factors and outcomes for VKA-ICH, which has larger haematoma volume, increased rate of HE and higher mortality compared to non-OAC ICH. There are insufficient data on NOACs.

scholarly journals Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid–eligible patients

Neurology ◽  
2018 ◽  
Vol 91 (17) ◽  
pp. e1553-e1558 ◽  
Author(s):  
Erica C. Leifheit ◽  
Yun Wang ◽  
George Howard ◽  
Virginia J. Howard ◽  
Larry B. Goldstein ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Mixed Models ◽  
Significant Interaction ◽  
Clinical Characteristics ◽  
Study Cohort ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
All Cause Mortality ◽  
Dual Eligible ◽  
The Relationship

ObjectiveTo determine whether patients who are dual eligible for Medicare and Medicaid benefits have outcomes after carotid endarterectomy (CEA) that are comparable to the outcomes of those eligible for Medicare alone.MethodsThe study cohort included fee-for-service Medicare beneficiaries ≥65 years of age who underwent CEA (ICD-9-CM code 38.12) between 2003 and 2010. Beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We fit mixed models to assess the relationship between coverage (dual eligible vs Medicare only) and outcomes over time after adjustment for demographic and clinical characteristics.ResultsThere were 53,773 dual-eligible and 452,182 Medicare-only beneficiaries hospitalized for CEA. The percentage of dual-eligible patients receiving CEA increased from 10.1% in 2003 to 11.5% in 2010, with no change in geographic distribution across the country. In adjusted analyses, dual-eligible vs Medicare-only beneficiaries had a higher rate of 30-day ischemic stroke or death; higher in-hospital, 30-day, and 1-year all-cause mortality; and higher 30-day all-cause readmission. Relative annual reductions in outcomes from 2003 to 2010 ranged from 2% to 5%, but there was no significant interaction between dual-eligible status and time.ConclusionsDual-eligible beneficiaries had worse outcomes than those eligible for Medicare alone. Additional work is necessary to understand the reasons for this difference.

scholarly journals Relationship Between Cataract Surgery and Mortality in Elderly Patients with Cataract: Nationwide Population-based Cohort Study in South Korea

2021 ◽  
Author(s):  
Hun Lee ◽  
Jae Yong Kim ◽  
Ji Sung Lee ◽  
Hungwon Tchah
Keyword(s):  
Elderly Patients ◽  
Cataract Surgery ◽  
Cox Regression ◽  
Population Based ◽  
Charlson Comorbidity Index Score ◽  
Study Cohort ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Korean Elderly ◽  
The Relationship

Abstract There were a few studies showing conflicting findings with regard to the relationship between cataract surgery and all-cause mortality. It is uncertain whether cataract surgery could affect all-cause and cause-specific mortality in the Korean elderly population. We aim to investigate the relationship between cataract surgery and all-cause and cause-specific mortality in Korean elderly patients with cataract using the Korean National Health Insurance Service-Senior cohort database. Elderly patients (≥60 years) diagnosed with cataract from 2002 through 2012 were included. The baseline characteristics included demographics, and systemic and ocular comorbidities. Adjusted cox regression models with time-varying covariate for cataract surgery were used to assess the relationship between cataract surgery and mortality. The study cohort included 241,062 patients, of whom 127,491 were in the cataract surgery group and 113,121 were in the cataract diagnosis group. The incidence of all-cause mortality was 3.62 deaths/100 person-years and 3.19 deaths/100 person-years in the cataract surgery and cataract diagnosis groups, respectively. Cataract surgery was associated with a decreased hazard of all-cause mortality after adjusting for demographics, and systemic and ocular comorbidities (hazard ratio [HR],0.93;P<0.001). Protective association was noted between cataract surgery and mortality from vascular (HR,0.92;P<0.001) or neurologic (HR,0.64;P<0.001) causes in the adjusted model. Patients with cataract who were 85 years of age and older, women, those who had lower income and a Charlson comorbidity index score of 5 or more, or those without glaucoma revealed the largest reductions in mortality hazards resulting from cataract surgery. Further studies are needed to investigate the mechanisms underlying the relationship between cataract surgery and mortality.

scholarly journals Homocysteine and stroke: another brick in the wall

2009 ◽  
Vol 118 (3) ◽  
pp. 183-185 ◽  
Author(s):  
Simona Sacco ◽  
Antonio Carolei
Keyword(s):  
Cardiovascular Disease ◽  
Intracerebral Haemorrhage ◽  
Recurrent Stroke ◽  
Case Series ◽  
Chinese Patients ◽  
Stroke Recurrence ◽  
Increased Risk ◽  
All Cause Mortality ◽  
The Relationship

After a long debate, due to conflicting data from clinical studies, homocysteine is now largely accepted as a risk factor for cardiovascular diseases including stroke. To date, the role of elevated homocysteine levels in stroke recurrences has not been evaluated. In the present issue of Clinical Science, Zhang and co-workers prove that Chinese patients with high homocysteine levels have an increased risk of stroke recurrence and of all-cause mortality with respect to patients with lower levels. Remarkably, in their study, high homocysteine levels were associated with an increased risk of stroke recurrence for atherothrombotic stroke and intracerebral haemorrhage, but not lacunar stroke. The study by Zhang and co-workers provides important information for clinical practice and represents the basis for further investigations, as it raises questions referring to the puzzling relationship between homocysteine and cardiovascular disease. Moreover, the results support the hypothesis that, for undisclosed reasons, the relationship between homocysteine and cardiovascular disease may not be homogeneous for all the conditions encompassed in the category of cardiovascular disease, being peculiar for stroke patients. The finding of an association between high homocysteine levels and a risk of recurrent stroke or all-cause mortality in patients with intracerebral haemorrhage should be taken with caution until this same result is confirmed in other case series with different ethnicity.

The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

2021 ◽  
pp. 1-7
Author(s):  
Emre Erdem ◽  
Ahmet Karatas ◽  
Tevfik Ecder
Keyword(s):  
Serum Ferritin ◽  
Hemodialysis Patients ◽  
Rank Test ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

<b><i>Introduction:</i></b> The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. <b><i>Methods:</i></b> A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin &#x3c;800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin &#x3e;1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. <b><i>Results:</i></b> Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, <i>p</i> = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; <i>p</i> = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; <i>p</i> = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; <i>p</i> = 0.063). <b><i>Conclusion:</i></b> Time-averaged serum ferritin levels &#x3e;1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

scholarly journals Changes in Neutrophil–Lymphocyte or Platelet–Lymphocyte Ratios and Their Associations with Clinical Outcomes in Idiopathic Pulmonary Fibrosis

2021 ◽  
Vol 10 (7) ◽  
pp. 1427
Author(s):  
Steven D. Nathan ◽  
Jayesh Mehta ◽  
John Stauffer ◽  
Elizabeth Morgenthien ◽  
Ming Yang ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Clinical Outcomes ◽  
Predictive Biomarkers ◽  
Phase Iii ◽  
Response To Treatment ◽  
Reference Ranges ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
The Relationship

Identification of prognostic and predictive biomarkers in idiopathic pulmonary fibrosis (IPF) could aid assessment of disease severity and prediction of progression and response to treatment. This analysis examined reference ranges for neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) in IPF, and the relationship between NLR or PLR changes and clinical outcomes over 12 months. This post hoc analysis included patients with IPF from the Phase III, double-blind trials of pirfenidone, ASCEND (NCT01366209) and CAPACITY (NCT00287716 and NCT00287729). The relationship between change from baseline to Month 12 in NLR or PLR (divided into quartiles (Q1–Q4)) and outcomes (mortality, respiratory hospitalization, declines in lung function, exercise capacity and quality of life) was assessed. Estimated reference ranges at baseline for all patients analyzed (n = 1334) were 1.1–6.4 for NLR and 56.8–250.5 for PLR. Significant trends were observed across NLR and PLR quartiles for all outcomes in placebo-treated patients, with patients manifesting the greatest NLR or PLR changes experiencing the worst outcomes. These results suggest that the greatest NLR or PLR changes over 12 months were associated with worse clinical outcomes. Further research is needed to determine the utility of NLR and PLR as prognostic biomarkers in IPF.

Sign in / Sign up

Export Citation Format

Share Document