Factors associated with symptomatic intracranial haemorrhage after intravenous thrombolysis in severe white matter lesions: a retrospective analysis

2021 ◽  
pp. postgradmedj-2021-140886
Author(s):  
Yu Shen ◽  
DeFu Li ◽  
BoJi Tang ◽  
Qian Cao ◽  
Zhuo Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Retrospective Analysis ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Intravenous Thrombolysis ◽  
White Matter Lesions ◽  
Cerebral Haemorrhage ◽  
Distribution Width ◽  
Nihss Score

Background and purposeWhite matter lesions (WMLs) are thought to cause damage to the blood–brain barrier, thereby aggravating bleeding after intravenous thrombolysis. However, the risk factors for symptomatic cerebral haemorrhage after thrombolysis are still unclear. This study explored the risk factors for bleeding in patients with severe WMLs after intravenous thrombolysis to prevent bleeding as soon as possible.MethodsA large single-centre observational study conducted a retrospective analysis of intravenous thrombolysis in patients with severe WMLs from January 2018 to March 2021. According to whether symptomatic cerebral haemorrhage occurred, the patients were divided into two groups, and then statistical analysis was performed.ResultsAfter a retrospective analysis of the data of nearly 1000 patients with intravenous thrombolysis and excluding invalid information, 146 patients were included, of which 23 (15.8%) patients had symptomatic cerebral haemorrhage. Univariate analysis showed that a history of hypertension (20% vs 4.9%, p=0.024), hyperlipidaemia (38.7% vs 9.6%, p<0.001), the National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis (median 17 vs 6, p<0.001), low-density lipoprotein levels (median 2.98 vs 2.44, p=0.011), cholesterol levels (mean 4.74 vs 4.22, p=0.033), platelet count (median 161 vs 191, p=0.031), platelet distribution width (median 15.2 vs 12.1, p=0.001) and sodium ion levels (median 139.81 vs 138.67, p=0.043) were significantly associated with symptomatic cerebral haemorrhage. Further multivariate logistic regression analysis showed that hyperlipidaemia (OR=9.069; 95% CI 2.57 to 32.07; p=0.001) and the NIHSS score before thrombolysis (OR=1.33; 95% CI 1.16 to 1.52; p<0.001) were comprehensive risk factors for symptomatic cerebral haemorrhage.ConclusionHyperlipidaemia and the NIHSS score before thrombolysis are independent risk factors for bleeding after intravenous thrombolysis in patients with severe WMLs. Delaying the onset of white matter and preventing risk factors for bleeding will help improve the prognosis of cerebral infarction and reduce mortality. These risk factors need to be further evaluated in future studies.

scholarly journals Compressed Sensing Algorithm-Based Magnetic Resonance Imaging Guided for Prognosis of Early Neurological Deterioration after Intravenous Thrombolysis in Ischemic Stroke Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yiwei Huang ◽  
Xiaoyun Sun ◽  
Yinping Yao ◽  
Yejun Chen ◽  
Yan Chen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Resonance Imaging ◽  
Blood Cell Count ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Watershed Infarction

This work was aimed to study the risk factors and prognostic treatment for acute ischemic stroke (AIS) patients with early neurological deterioration (END) after intravenous thrombolytic therapy via compressed sensing algorithm-based magnetic resonance imaging (CS-MRI). 231 patients who were diagnosed with AIS were selected, and the final involved number of patients was 182. Patients with AIS were treated with intravenous thrombolysis with alteplase within 4.5 hours of onset. After treatment, patients with early neurological deterioration were defined as the deteriorating group and those without early neurological impairment were defined as the nondeteriorating group. In univariate analysis, hypertension, white blood cell count, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the occurrence of END. Under the CS-MRI theory, the two groups of patients were evaluated for middle cerebral artery basal ganglia infarction and internal watershed infarction. After univariate analysis, the P < 0.1 variables were taken as the independent variable, and the binary logistic regression model was adopted for multivariate regression analysis. It was disclosed that NIHSS score was not correlated with the occurrence of early neurological function deterioration, while homocysteine was. Hypertension, white blood cell count, homocysteine, and NIHSS score were risk factors for END. The image analysis revealed that the incidence of deteriorating basal ganglia infarction group was lower relative to the nondeteriorating group, and the incidence of watershed infarction was higher in the deteriorating group versus the nondeteriorating group. The image analysis suggested that predicting the occurrence of END through risk factors can actively provide endovascular treatment for patients with AIS.

scholarly journals Prevalence and Risk Factors of White Matter Lesions in Tibetan Patients Without Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 149-153 ◽  
Author(s):  
Haiqiang Jin ◽  
Zhijie Ding ◽  
Siqing Lian ◽  
Yuhua Zhao ◽  
Shihua He ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Acute Stroke ◽  
Univariate Analysis ◽  
White Matter Lesions ◽  
Primary Headache ◽  
High Altitudes ◽  
Related Factors ◽  
Logistic Analysis ◽  
History Of

Background and Purpose— Studies on the prevalence and risk factors of white matter lesions (WMLs) in Tibetans living at high altitudes are scarce. We conducted this study to determine the prevalence and risks of WMLs in Tibetan patients without or with nonacute stroke. Methods— We undertook a retrospective analysis of medical records of patients treated at the People’s Hospital of Tibetan Autonomous Region and identified a total of 301 Tibetan patients without acute stroke. WML severity was graded by the Fazekas Scale. We assessed the overall and age-specific prevalence of WMLs and analyzed associations between WMLs and related factors with univariate and multivariate methods. Results— Of the 301 patients, 87 (28.9%) had peripheral vertigo, 83 (27.3%) had primary headache, 52 (17.3%) had a history of stroke, 36 (12.0%) had an anxiety disorder, 29 (9.6%) had epilepsy, 12 (4.0%) had infections of the central nervous system, and 3 (1.0%) had undetermined diseases. WMLs were present in 245 (81.4%) patients, and 54 (17.9%) were younger than 40 years. Univariate analysis showed that age, history of cerebral infarction, hypertension, the thickness of the common carotid artery intima, and plaque within the intracarotid artery were related risks for WMLs. Ordered logistic analysis showed that age, history of cerebral ischemic stroke, hypertension, male sex, and atrial fibrillation were associated with WML severity. Conclusions— Risk factors for WMLs appear similar for Tibetans residing at high altitudes and individuals living in the plains. Further investigations are needed to determine whether Tibetans residing at high altitudes have a higher burden of WMLs than inhabitants of the plains.

scholarly journals A population-based exposure assessment of risk factors associated with gastrointestinal pathogens: a Campylobacter study

2012 ◽  
Vol 141 (5) ◽  
pp. 976-986 ◽  
Author(s):  
L. A. MacRITCHIE ◽  
C. J. HUNTER ◽  
N. J. C. STRACHAN
Keyword(s):  
Risk Factors ◽  
Population Density ◽  
Exposure Assessment ◽  
Disease Incidence ◽  
Univariate Analysis ◽  
Age Groups ◽  
Multivariate Logistic Regression Analysis ◽  
Environmental Water ◽  
Population Based ◽  
Elevated Exposure

SUMMARYA questionnaire survey was undertaken to determine the exposure of a study population to campylobacteriosis source risk factors (environmental, water, food) and results were stratified by age, population density and deprivation. Data were gathered using an exposure assessment carried out by telephone in the Grampian region of Scotland. Univariate analysis showed that children aged 5–14 years, living in low population density (0–44·4 persons/km2) and affluent areas had elevated exposure to environmental and water risk factors. Multivariate logistic regression analysis revealed that younger age groups and lower population density were significant indicators for most environmental risk factors. The results compared to reported disease incidence in Grampian showed that greater exposure to risk factors does not necessarily coincide with greater disease incidence for age groups, particularly for the 0–4 years age group. Further research is required to explain the relationship between exposure and disease incidence.

scholarly journals Cognitive features of white matter lesions accompanied by different risk factors of cerebrovascular diseases

2019 ◽  
Vol 28 (12) ◽  
pp. 1705-1710
Author(s):  
Yafei Shangguan ◽  
Tao Xiong ◽  
Changwei Jiang ◽  
Wei Chen ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
White Matter Lesions ◽  
Cerebrovascular Diseases

scholarly journals Risk factors affecting the 1-year outcomes of minor ischemic stroke: results from Xi’an stroke registry study of China[1]

2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Multivariate Logistic Regression ◽  
Factors Affecting ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
Independent Risk Factors

Abstract Background: The incidences of stroke recurrence, disability, and all-cause death of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year percentage of stroke recurrence, disability, and all-cause death were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the percentage of stroke recurrence, disability, and all-cause death at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause death. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China, especially high percentage of disability. In this study, we found the risk factors affecting 1-year stroke recurrence, disability and, all-cause death which need further verification in the subsequent studies.

Abstract P274: Evaluation of Glycemic Variability and Discharge Outcomes in Patients Presenting With Ischemic Stroke Following Intravenous Thrombolysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mackenzie Steck ◽  
Omar Saeed ◽  
Balaji Krishnaiah ◽  
Samarth Shah ◽  
Jaclyn Stoffel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Glycemic Variability ◽  
P Value ◽  
Nihss Score ◽  
Discharge Disposition ◽  
Discharge Outcomes

Presentation Objective: Does glycemic variability worsen Modified Rankin Score (mRS) following ischemic stroke in patients treated with thrombolytics (tPA)? Background/Purpose: Acute hyperglycemia and strict glucose control have been identified as predictors of hemorrhage, increased length of stay and hypoglycemia following ischemic stroke. However, the role of glucose variability in patients with ischemic stroke treated with tPA is largely unknown. The aim of this study was to evaluate the role of glycemic variability on discharge outcomes in patients treated with tPA for ischemic stroke. Methodology: A retrospective review of adults with ischemic stroke who received tPA was completed. Patients hospitalized for at least 48 hours with image-confirmed ischemic stroke and symptom onset within 4.5 hours of presentation were included. Glycemic variability was measured using the J-index calculation and groups were defined as patients with normal or abnormal J-indices. Logistic regression models were developed to determine odds ratios for defined outcomes including NIHSS score, mRS and disposition at discharge. Statistical significance was a p-value of <0.05. Results: Of the 229 patients included, 132 (58%) had a normal J-index (4.7 – 23.6). In the univariate analysis, abnormal J-index was associated with higher rates of hypertension (94% vs 73%), type 2 diabetes mellitus (74% vs 12%), chronic kidney disease (34% vs 11%), higher initial blood glucose values (220 ±172 vs 111 ±20) and HbA1c, and worse outcomes in terms of NIHSS score, mRS and disposition at discharge. In the multivariate analysis, patients with an abnormal J-index had higher odds of unfavorable outcomes in terms of discharge mRS (OR 2.1; 95% CI 1.0 – 4.3, p=0.045) and hemorrhagic transformation (OR 4.1; 95% CI 1.7 – 10.2, p=0.002). There was no difference in discharge disposition (OR 1.4; 95% CI 0.7 – 3.0 p=0.4). Conclusion: Glycemic variability, following ischemic stroke, may result in unfavorable patient outcomes in patients treated with tPA. Additional studies are needed to determine the appropriate glucose management strategy.

scholarly journals The study on analysis of risk factors for severity of white matter lesions and its correlation with cerebral microbleeds in the elderly with lacunar infarction

Medicine ◽  
2020 ◽  
Vol 99 (4) ◽  
pp. e18865
Author(s):  
Yu-Ni Zhou ◽  
Hao-Yuan Gao ◽  
Fang-Fang Zhao ◽  
Ying-Chun Liang ◽  
Yuan Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
White Matter Lesions ◽  
The Elderly ◽  
Cerebral Microbleeds ◽  
Lacunar Infarction

scholarly journals Evaluation of carotid atherosclerosis and related risk factors using ultrasonic B-Flow technology in elderly patients

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096122
Author(s):  
Hai-Ying Gong ◽  
Xiao-Ke Shi ◽  
Heng-Quan Zhu ◽  
Xian-Zhong Chen ◽  
Jiang Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ultrasound Examination ◽  
Multivariate Logistic Regression Analysis ◽  
Density Lipoprotein ◽  
Plaque Formation ◽  
Cholesterol Concentration ◽  
Atheromatous Plaque ◽  
Cross Sectional ◽  
Distribution Width ◽  
Bilateral Carotid

Objective This study was performed to identify the risk factors for carotid atherosclerotic plaque formation using B-Flow ultrasound. Methods In total, 120 patients who underwent bilateral carotid ultrasound examination were enrolled in this cross-sectional study. The intima–media thickness was measured, and the risk factors for carotid atheromatous plaque formation were investigated. Results Age, sex, medical history of hypertension, coronary heart disease, and diabetes were risk factors for carotid atheromatous plaque formation. Multivariate logistic regression analysis revealed that the main risk factors for carotid atheromatous plaque formation were male sex, advanced age, a high hemoglobin concentration, a high red cell distribution width, and a high low-density lipoprotein cholesterol concentration. Conclusion The risk factors for carotid atheromatous plaque formation were basically the same as those for stroke. Early ultrasound examination of the carotid artery enables the identification of risk factors associated with stroke.

scholarly journals Risk Factors for Mortality in Patients with Elizabethkingia Infection and the Clinical Impact of the Antimicrobial Susceptibility Patterns of Elizabethkingia Species

2020 ◽  
Vol 9 (5) ◽  
pp. 1431 ◽  
Author(s):  
Hye Seong ◽  
Jung Ho Kim ◽  
Jun Hyoung Kim ◽  
Woon Ji Lee ◽  
Jin Young Ahn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antimicrobial Susceptibility ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Intrinsic Resistance ◽  
Albumin Ratio ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Susceptibility Patterns

Elizabethkingia species (spp.), which can colonize hospital environments, are emerging nosocomial pathogens presenting high mortality. Due to their intrinsic resistance to a broad range of antibiotics, optimal antibiotic dosage has yet to be determined against infections caused by Elizabethkingia spp. This study aimed to investigate the risk factors for the mortality of infections caused by Elizabethkingia spp. and assess the clinical implications of their antimicrobial susceptibility patterns. Data from 210 patients affected by Elizabethkingia-induced pneumonia and bacteremia between 1 November 2005 and 31 May 2016, were analyzed. Further antimicrobial susceptibility tests for moxifloxacin, rifampin, and vancomycin using Elizabethkingia isolates were performed to compensate for the Elizabethkingia spp. susceptibility panel in patients affected after 2013. The mean age of the patients was 66.5 ± 18 years and the 28-day mortality rate was 25.2% (53/210). In the univariate analysis, history of prior stay in an intensive care unit, central venous catheter use, presented thrombocytopenia, immunocompetent status, a high simplified acute physiology score II (SAPS II score), a high C-reactive protein (CRP)/albumin ratio on the day of isolation and seven days later, and a high minimum inhibitory concentration (MIC) value of rifampin were significantly associated with a higher mortality rate. In the multivariate logistic regression analysis, the MIC values of rifampin (odds ratio (OR): 1.045; 95% confidence interval (CI): 1.006–1.085; p = 0.023), SAPS II score (OR: 1.053; 95% CI: 1.022–1.084; p = 0.001), and initial CRP/albumin ratio (OR: 1.030; 95% CI: 1.009–1.051; p = 0.004) were significantly associated with 28-day mortality. To reduce the mortality associated with Elizabethkingia infections, prediction of the clinical course using initial CRP/albumin ratio and SAPS II and early intervention are essential. Rifampin is a promising candidate as the drug of choice in treating Elizabethkingia infections.

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