scholarly journals Predicting long-term outcomes in acute intracerebral haemorrhage using delayed prognostication scores

2021 ◽  
pp. svn-2020-000656
Author(s):  
Ronda Lun ◽  
Vignan Yogendrakumar ◽  
Tim Ramsay ◽  
Michel Shamy ◽  
Robert Fahed ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Intracerebral Haemorrhage ◽  
Functional Outcomes ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Long Term Outcomes ◽  
Poor Functional Outcome ◽  
Delayed Imaging ◽  
Ich Score

ObjectiveThe concept of the ‘self-fulfilling prophecy’ is well established in intracerebral haemorrhage (ICH). The ability to improve prognostication and prediction of long-term outcomes during the first days of hospitalisation is important in guiding conversations around goals of care. We previously demonstrated that incorporating delayed imaging into various prognostication scores for ICH improves the predictive accuracy of 90-day mortality. However, delayed prognostication scores have not been used to predict long-term functional outcomes beyond 90 days.Design, setting and participantsWe analysed data from the ICH Deferoxamine trial to see if delaying the use of prognostication scores to 96 hours after ICH onset will improve performance to predict outcomes at 180 days. 276 patients were included.Interventions and measurementsWe calculated the original ICH score (oICH), modified-ICH score (MICH), max-ICH score and the FUNC score on presentation (baseline), and on day 4 (delayed). Outcomes assessed were mortality and poor functional outcome in survivors (defined as modified Rankin Scale of 4–5) at 180 days. We generated receiver operating characteristic curves, and measured the area under the curve values (AUC) for mortality and functional outcome. We compared baseline and delayed AUCs with non-parametric methods.ResultsAt 180 days, 21 of 276 (7.6%) died. Out of the survivors, 54 of 255 had poor functional outcome (21.2%). The oICH, MICH and max-ICH performed significantly better at predicting 180-day mortality when calculated 4 days later compared with their baseline equivalents ((0.74 vs 0.83, p=0.005), (0.73 vs 0.80, p=0.036), (0.74 vs 0.83, p=0.008), respectively). The delayed calculation of these scores did not significantly improve our accuracy for predicting poor functional outcomes.ConclusionDelaying the calculation of prognostication scores in acute ICH until day 4 improved prediction of 6-month mortality but not functional outcomes.Trial registration numberClinicalTrials.gov Registry (NCT02175225).

scholarly journals Calculation of Prognostic Scores, Using Delayed Imaging, Outperforms Baseline Assessments in Acute Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (4) ◽  
pp. 1107-1110 ◽  
Author(s):  
Ronda Lun ◽  
Vignan Yogendrakumar ◽  
Andrew M. Demchuk ◽  
Richard I. Aviv ◽  
David Rodriguez-Luna ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Prognostic Scores ◽  
Hematoma Expansion ◽  
Imaging Data ◽  
Spot Sign ◽  
Delayed Imaging ◽  
Predictive Values ◽  
Ich Score

Background and Purpose— Patients with intracerebral hemorrhage (ICH) are often subject to rapid deterioration due to hematoma expansion. Current prognostic scores are largely based on the assessment of baseline radiographic characteristics and do not account for subsequent changes. We propose that calculation of prognostic scores using delayed imaging will have better predictive values for long-term mortality compared with baseline assessments. Methods— We analyzed prospectively collected data from the multicenter PREDICT study (Prediction of Hematoma Growth and Outcome in Patients With Intracerebral Hemorrhage Using the CT-Angiography Spot Sign). We calculated the ICH Score, Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) Score, and modified ICH Score using imaging data at initial presentation and at 24 hours. The primary outcome was mortality at 90 days. We generated receiver operating characteristic curves for all 3 scores, both at baseline and at 24 hours, and assessed predictive accuracy for 90-day mortality with their respective area under the curve. Competing curves were assessed with nonparametric methods. Results— The analysis included 280 patients, with a 90-day mortality rate of 25.4%. All 3 prognostic scores calculated using 24-hour imaging were more predictive of mortality as compared with baseline: the area under the curve was 0.82 at 24 hours (95% CI, 0.76–0.87) compared with 0.78 at baseline (95% CI, 0.72–0.84) for ICH Score, 0.84 at 24 hours (95% CI, 0.79–0.89) compared with 0.76 at baseline (95% CI, 0.70–0.83) for FUNC, and 0.82 at 24 hours (95% CI, 0.76–0.88) compared with 0.74 at baseline (95% CI, 0.67–0.81) for modified ICH Score. Conclusions— Calculation of the ICH Score, FUNC Score, and modified ICH Score using 24-hour imaging demonstrated better prognostic value in predicting 90-day mortality compared with those calculated at presentation.

scholarly journals Long term Post-Stroke Functional Outcomes: a comparison of diabetics and non-diabetics

2021 ◽  
Author(s):  
Deidre Anne de Silva ◽  
Kaavya Narasimhalu ◽  
Ian Wang Huang ◽  
Fung Peng Woon ◽  
John C. Allen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Age Group ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Post Stroke ◽  
The Impact

Introduction: Diabetes mellitus (DM) is known to influence outcomes in the short-term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and non-diabetic ischemic stroke patients and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes. We also studied the influence of age on the diabetes-functional outcome association. Methods: This is a longitudinal observational cohort study of 802 acute ischemic stroke patients admitted to the Singapore General Hospital from 2005 to 2007. Functional outcomes were assessed using the modified Rankin Scale (mRS) with poor functional outcome defined as mRS≥3. Follow-up data was determined at 6 months and at median follow-up durations of 29 and 86 months. Results: Among the 802 ischemic stroke patients studied (mean age 64 ± 12 years, male 63%), 42% had DM. In regression analyses adjusting for covariates, diabetic patients were more likely to have poor functional outcomes at 6 months (OR=2.12, 95% CI: 1.23–3.67) and at median follow-up durations of 29 months (OR=1.96, 95% CI: 1.37–2.81) and 86 months (OR=2.27, 95% CI: 1.58–3.25). In addition, age modulated the effect of DM, with younger stroke patients (≤65 years) more likely to have long term poor functional outcome at the 29-month (p=0.0179) and 86-month (p=0.0144) time points. Conclusions: DM was associated with poor functional outcomes following ischemic stroke in the long term with the effect remaining consistent throughout the 7-year follow-up period. Age modified the effect of DM in the long term, with an observed increase in risk in the ≤65 age group but not in the >65 age group.

Scaphoid Nonunion Is a Disabling Problem in a Military Population

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Nicholas H. Lake ◽  
Rafae Khan ◽  
Kyle W. Mombell ◽  
Mary Fergus ◽  
Dominic Gomez-Leonardelli
Keyword(s):  
Functional Outcome ◽  
Military Service ◽  
Functional Outcomes ◽  
High Rate ◽  
Scaphoid Nonunion ◽  
Military Population ◽  
Outcome Scores ◽  
The Mean ◽  
Return To Duty

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

Abstract W P225: The Relationship between Leukocytosis and Time to Neurodeterioration

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Amelia K Boehme ◽  
James E Siegler ◽  
Karen C Albright ◽  
Alexander J George ◽  
Dominique Monlezun ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Poor Functional Outcome ◽  
Improve Outcome ◽  
Future Studies ◽  
Point Increase ◽  
Stroke Center ◽  
The Relationship

Background: Previous research has illustrated how leukocytosis after acute ischemic stoke (AIS) is related to poor functional outcome. A main predictor of poor functional outcome is neurodeterioration (ND). We sought to explore the relationship between leukocytosis and time to ND to identify a risk factor for a process that predicts poor functional outcome. Methods: Patients admitted to our stroke center (07/08-06/12) were retrospectively assessed. Leukocytosis was defined as WBC >11,000, ND was characterized as ≥ 2 point increase in NIHSS scale and poor functional outcome was classified as modified Rankin Scale (mRS) of 3-6. Patients were grouped into 2 categories: (1) the leukocytosis group- those who developed leukocytosis ≥24 hours after admission and those who presented with leukocytosis and remained at 24 hours and, (2) the non-leukocytosis group- those that did not have leukocytosis and those where the leukocytosis resolved within 24 hours of admission. Results: A cohort of AIS patients (N=476) with median age 64 years, 43% female and 69% Black were assessed. Of the patients with ND (27%), median time to ND was 43 hours. In the leukocytosis group (N=84), 42 (50.6%) of them developed ND. In the non-leukocytosis group (N=312), 75 (24.5%) developed ND. Leukocytosis within 24 hours of admission is predictive of earlier time to ND (p<0.0001; Figure 1). Adjusting for age, stroke severity, glucose, tPA and infection, the leukocytosis group had a 2 times greater risk for developing ND (HR 2.49, 95%CI 1.61-3.84, p<0.0001). Conclusion: Having leukocytosis persist from admission to 24 hours or developing leukocytosis within 24 hours of admission is a significant predictor of early ND, which often results in poor functional outcome. Identifying such a predictor can enable physicians to identify those at risk for ND and subsequent poor functional outcomes. Future studies are needed to identify if interventions targeting leukocytosis may improve outcome after stroke.

Long-Term Effects of Decompressive Craniectomy on Functional Outcomes after Traumatic Brain Injury: A Multicenter Study

2018 ◽  
Vol 84 (8) ◽  
pp. 1314-1318 ◽  
Author(s):  
Eliza Moskowitz ◽  
Claudia I. Melendez ◽  
Julie Dunn ◽  
Abid D. Khan ◽  
Richard Gonzalez ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Confidence Interval ◽  
Functional Outcome ◽  
Decompressive Craniectomy ◽  
Functional Outcomes ◽  
Structured Interview ◽  
Good Functional Outcome

Decompressive craniectomy (DC) is a surgical modality sometimes used in the management of elevated intracranial pressure. Questions remain as to its long-term benefits in traumatic brain injury patients. The extended Glasgow Outcome Scale (eGOS) is a scoring system based on a structured interview that allows for consistent and reproducible measurement of long-term functional outcomes. The purpose of this study was to determine the eGOS score of post-craniectomy patients after discharge and stratify survivors based on outcome. A multicenter review of patients who underwent DC was performed. Survivors underwent a phone survey at which time the eGOS was calculated. Patients with an eGOS ≥ 5 were considered to have a good functional outcome. Fifty-four patients underwent DC. Age (OR 1.038; confidence interval 1.003–1.074) and Glasgow Coma Scale (OR 0677; confidence interval 0.527–0.870) were predictors of mortality. Patients who were available for follow-up (n = 13) had poor functional outcomes at discharge (eGOS = 3); however, this improved at the time of follow-up survey (eGOS = 5; P = 0.005). DC is a controversial operation with high mortality and uncertain benefit. Among our cohort, the eGOS score was significantly higher at follow-up survey than it was at discharge. Although the mortality was high, if patients survived to discharge, most had a good functional outcome at follow-up survey.

scholarly journals Soluble vascular endothelial-cadherin in CSF after subarachnoid hemorrhage

Neurology ◽  
2020 ◽  
Vol 94 (12) ◽  
pp. e1281-e1293
Author(s):  
Hajime Takase ◽  
Sherry Hsiang-Yi Chou ◽  
Gen Hamanaka ◽  
Ryo Ohtomo ◽  
Mohammad R. Islam ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
External Ventricular Drain ◽  
Clinical Severity ◽  
Vascular Endothelial ◽  
Long Term Outcomes ◽  
Anterior Circulation ◽  
Vascular Endothelial Cadherin ◽  
Tnf Α

ObjectiveTo determine if CSF and plasma levels of soluble vascular endothelial (sVE)-cadherin are associated with functional outcome after subarachnoid hemorrhage (SAH) and to investigate sVE-cadherin effects on microglia.MethodsSerial CSF and plasma were collected from prospectively enrolled patients with nontraumatic SAH from a ruptured aneurysm in the anterior circulation and who required an external ventricular drain for clinical indications. Patients with normal-pressure hydrocephalus without SAH served as controls. For prospective assessment of long-term outcomes at 3 and 6 months after SAH, modified Rankin Scale scores (mRS) were obtained and dichotomized into good (mRS ≤ 2) vs poor (mRS > 2) outcome groups. For SAH severity, Hunt and Hess grade was assessed. Association of CSF sVE-cadherin levels with long-term outcomes, HH grade, and CSF tumor necrosis factor (TNF)-α levels were evaluated. sVE-cadherin effects on microglia were also studied.ResultssVE-cadherin levels in CSF, but not in plasma, were higher in patients with SAH and were associated with higher clinical severity and higher CSF TNF-α levels. Patients with SAH with higher CSF sVE-cadherin levels over time were more likely to develop worse functional outcome at 3 months after SAH. Incubation of cultured microglia with sVE-cadherin resulted in increased inducible nitric oxide synthase, interleukin-1β, reactive oxygen species, cell soma size, and metabolic activity, consistent with microglia activation. Microinjection of sVE-cadherin fragments into mouse brain results in an increased number of microglia surrounding the injection site, compared to injection of denatured vascular endothelial–cadherin fragments.ConclusionsThese results support the existence of a novel pathway by which sVE-cadherin, released from injured endothelium after SAH, can shift microglia into a more proinflammatory phenotype and contribute to neuroinflammation and poor outcome in SAH.

The Preoperative Prognostic Nutritional Index Predicts Short-Term and Long-Term Outcomes of Patients with Stage II/III Gastric Cancer: Analysis of a Multi-Institution Dataset

2019 ◽  
Vol 37 (2) ◽  
pp. 135-144 ◽  
Author(s):  
Masahiro Sasahara ◽  
Mitsuro Kanda ◽  
Seiji Ito ◽  
Yoshinari Mochizuki ◽  
Hitoshi Teramoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Area Under The Curve ◽  
Prognostic Nutritional Index ◽  
Stage Ii ◽  
Long Term Outcomes ◽  
Short Term ◽  
Nutritional Index ◽  
Appropriate Treatment ◽  
Disease Free

Background/Aims: Identification of nutritional indicators to predict short-term and long-term outcomes is necessary to provide appropriate treatment to patients with gastric cancer. Methods: We designed an analysis of a multicenter dataset of patients with gastric cancer who underwent gastrectomy between 2010 and 2014. We enrolled 842 eligible patients who had stage II/III gastric cancer. The area under the curve (AUC) values were compared among prognostic nutritional index (PNI), calculated as 10 × albumin g/dL + 0.005 × total lymphocyte count/mm3, and its constituents, and the predictive value of preoperative PNI for postoperative short-term and long-term outcomes was evaluated. Results: Preoperative PNI exhibited higher AUC values (0.719) for 1-year survival than its constituents, and the optimal cutoff value was 47. The disease-free and overall survival of patients in the PNI-low group were significantly shorter compared with those in the PNI-high group. The prognostic difference between the PNI-high and PNI-low groups was significantly greater in the subgroup of patients who underwent total gastrectomy. Clinically relevant postoperative complications were more frequently observed in the PNI-low group. Conclusions: The preoperative PNI is a useful predictor reflecting the incidence of complications after gastrectomy and the prognosis of patients with stage II/III gastric cancer.

scholarly journals Outcomes of Reconstructive Surgery for Defects of the Articular Ends of Bones Using Home Joint Implants

2015 ◽  
pp. 36-40
Author(s):  
S. P. Mironov ◽  
A. V. Balberkin ◽  
D. A. Shavyrin ◽  
V. N. Karpov ◽  
A. F. Kolondaev ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Functional Results ◽  
Long Term Outcomes ◽  
Bone Pathology ◽  
Hip Joints ◽  
Shoulder Joints ◽  
Reconstructive Operations ◽  
Joint Implants ◽  
Arthroplasty Failure

Long-term outcomes of reconstructive operations for substitution of post-resection defects of the articular ends of tubular bones that form the hip, knee and shoulder joints using home endoprosthesis were studied. The study included 344 patients who were treated at CITO department of bone pathology from 2004 to 2014. Substitution of the defect was performed in 236 and 108 cases for the knee, hip joints, respectively. Indications for surgical intervention were: bone tumors; previously performed arthroplasty failure; defects of the articular ends after failed traumatologic and orthopaedic operations; severe forms of knee arthroses. Functional results (MSTS scale), survival of constructions, inflammatory complications were analyzed and comparative evaluation with imported analogues was performed. General functional outcomes and rate of complications correspond to the data on application of new oncologic and modular endoprostheses presented in foreign literature.

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