scholarly journals Outcome Predictors in First-Ever Ischemic Stroke Patients: A Population-Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Giovanni Corso ◽  
Edo Bottacchi ◽  
Piera Tosi ◽  
Laura Caligiana ◽  
Chiara Lia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Old Age ◽  
Population Based ◽  
Stroke Severity ◽  
Very Old ◽  
Very Old Age ◽  
Long Term Mortality

Background. There is scant population-based information regarding predictors of stroke severity and long-term mortality for first-ever ischemic strokes. The aims of this study were to determine the characteristics of patients who initially presented with first-ever ischemic stroke and to identify predictors of severity and long-term mortality. Methods. Data were collected from the population-based Cerebrovascular Aosta Registry. Between 2004 and 2008, 1057 patients with first-ever ischemic stroke were included. Variables analysed included comorbidities, sociodemographic factors, prior-to-stroke risk factors, therapy at admission and pathophysiologic and metabolic factors. Multivariate logistic regression models, Kaplan-Meier estimates, and Cox proportional Hazards model were used to assess predictors. Results. Predictors of stroke severity at admission were very old age (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.75–5.06), female gender (OR 1.73, 95% CI 1.21–2.40), atrial fibrillation (OR 2.76, 95% CI 1.72–4.44), low ejection fraction (OR 2.22, CI 95% 1.13–4.32), and cardioembolism (OR 2.0, 95% CI 1.36–2.93). Predictors of long-term mortality were very old age (hazard ratio [HR] 2.02, 95% CI 1.65–2.47), prestroke modified Rankin scale 3–5 (HR 1.82; 95% CI 1.46–2.26), Charlson Index ≥2 (HR 1.97; 95% CI 1.62–2.42), atrial fibrillation (HR 1.43, 95% CI 1.04–1.98), and stroke severity (HR 3.54, 95% CI 2.87–4.36). Conclusions. Very old age and cardiac embolism risk factors are the independent predictors of stroke severity. Moreover, these factors associated with other comorbid medical conditions influence independently long-term mortality after ischemic stroke.

Risk factors for depressive disorders in very old age: a population-based cohort study with a 5-year follow-up

2013 ◽  
Vol 49 (5) ◽  
pp. 831-839 ◽  
Author(s):  
Sofia Petersson ◽  
Johan Mathillas ◽  
Karin Wallin ◽  
Birgitta Olofsson ◽  
Per Allard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Old Age ◽  
Depressive Disorders ◽  
Population Based ◽  
Very Old ◽  
Very Old Age

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

O3-07-04: MIDLIFE RISK FACTORS FOR MORTALITY AND DEMENTIA AT VERY OLD AGE: THE ISRAEL ISCHEMIC HEART DISEASE STUDY

2014 ◽  
Vol 10 ◽  
pp. P222-P222
Author(s):  
Michal Schnaider Beeri ◽  
Ramit Ravona-Springer ◽  
Noa Shalit ◽  
Yuval Berman ◽  
Uri Goldbourt
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Old Age ◽  
Ischemic Heart ◽  
Very Old ◽  
Very Old Age ◽  
Disease Study ◽  
Midlife Risk Factors

scholarly journals The Role of Prestroke Glycemic Control on Severity and Outcome of Acute Ischemic Stroke

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Clara Hjalmarsson ◽  
Karin Manhem ◽  
Lena Bokemark ◽  
Björn Andersson
Keyword(s):  
Ischemic Stroke ◽  
Glycemic Control ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
University Hospital ◽  
Stroke Severity ◽  
Term Survival ◽  
Long Term Mortality

Background/Aim. Relatively few studies have investigated the association of prestroke glycemic control and clinical outcome in acute ischemic stroke (IS) patients, regardless of presence of diabetes mellitus (DM). The aim of this study was to investigate the importance of prestroke glycemic control on survival, stroke severity, and functional outcome of patients with acute IS.Methods. We performed a retrospective survival analysis of 501 patients with IS admitted to Sahlgrenska University Hospital from February 15, 2005, through May 31, 2009. The outcomes of interest were acute and long-term survival; the stroke severity (NIHSS) and the functional outcome, mRS, at 12 months.Results. HbA1c was a good predictor of acute (HR 1.45; CI, 1.09 to 1.93,P=0.011) and long-term mortality (HR 1.29; CI 1.03 to 1.62;P=0.029). Furthermore, HbA1c >6% was significantly correlated with acute stroke severity (OR 1.29; CI 1.01 to 1.67;P=0.042) and predicted worse functional outcome at 12 months (OR 2.68; CI 1.14 to 6.03;P=0.024).Conclusions. Our study suggests that poor glycemic control (baseline HbA1c) prior to IS is an independent risk factor for poor survival and a marker for increased stroke severity and unfavorable long-term functional outcome.

scholarly journals The Hyperbilirubinemia and Potential Predictors Influence on Long-Term Outcomes in Sepsis: A Population-Based Propensity Score-Matched Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Milin Peng ◽  
Fuxing Deng ◽  
Desheng Qi ◽  
Zhonghua Hu ◽  
Lina Zhang
Keyword(s):  
Risk Factors ◽  
Medical Information ◽  
Hazard Analysis ◽  
Survival Curve ◽  
Dynamic Change ◽  
International Normalized Ratio ◽  
Population Based ◽  
Long Term Outcomes ◽  
Long Term Mortality

Objective: Although hyperbilirubinemia has been associated with mortality in patients who are critically ill, yet no clinical studies dissect the effect of dynamic change of hyperbilirubinemia on long-term septic prognosis. The study aims to investigate the specific stages of hyperbilirubinemia and potential risk factors on long-term outcomes in patients with sepsis.Methods: In this retrospective observational cohort study, patients with sepsis, without previous chronic liver diseases, were identified from the Medical Information Mart for the Intensive Care III MIMIC-III database. We used propensity scores (PS) to adjust the baseline differences in septic patients with hyperbilirubinemia or not. The multivariate Cox was employed to investigate the predictors that influence a clinical outcome in sepsis.Results: Of 2,784 patients with sepsis, hyperbilirubinemia occurred in 544 patients (19.5%). After PS matching, a survival curve demonstrated that patients with sepsis with the new onset of total bilirubin (TBIL) levels more than or equal to 5 mg/dl survived at significantly lower rates than those with TBIL levels &lt;5 mg/dl. Multivariate Cox hazard analysis showed that patients with TBIL at more than or equal to 5 mg/dl during sepsis exhibit 1.608 times (95% CI: 1.228–2.106) higher risk of 1-year mortality than those with TBIL levels &lt;5 mg/dl. Also, age above 65 years old, preexisting malignancy, a respiratory rate above 30 beats/min at admission, serum parameters levels within 24-h admission, containing international normalized ratio (INR) above 1.5, platelet &lt;50*10∧9/L, lactate above 4 mmol/L, and bicarbonate &lt;22 or above 29 mmol/L are the independent risk factors for long-term mortality of patients with sepsis.Conclusions: After PS matching, serum TBIL levels at more than or equal to 5 mg/dl during hospitality are associated with increased long-term mortality for patients with sepsis. This study may provide clinicians with some cutoff values for early intervention, which may improve the prognosis of patients with sepsis.

Abstract P349: Risk Factors for Rehospitalization for Syncope and for Long-Term Mortality in 325 Consecutive Patients Hospitalized for Syncope

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
sachin S sule ◽  
Chandrasekar Palaniswamy ◽  
Wilbert S Aronow ◽  
Stephen J Peterson ◽  
Chul Ahn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Coronary Artery ◽  
Odds Ratio ◽  
Coronary Artery Surgery ◽  
Cox Regression Analysis ◽  
Long Term Mortality

Purpose: To investigate in patients hospitalized for syncope risk factors for rehospitalization for syncope and long-term mortality. Methods: We investigated in 325 consecutive patients, mean age 66 ± 17 years, hospitalized for syncope risk factors for rehospitalization for syncope and long-term mortality. Mean follow-up was 27 ± 8 months. Results: Of 325 patients, 13 (4%) were rehospitalized for syncope, and 38 (12%) died. Stepwise logistic regression analysis showed significant independent prognostic factors for rehospitalization for syncope were glomerular filtration rate (GFR) (odds ratio 0.97; 95% CI, 0.95-0.995) diabetes (odds ratio 5.7; 95% CI, 1.6-20.4), atrial fibrillation (odds ratio 4.0; 95% CI, 1.0-15.6), and smoking (odds ratio 4.6 ; 95% CI, 1.3-16.8). Stepwise Cox regression analysis showed significant independent prognostic factors for mortality were GFR (hazard ratio (HR) 0.98 (95% CI, 0.97-0.99), diabetes ( HR 2.7; 95% CI = 1.4-5.2), coronary artery surgery (HR 2.9; 95% CI, 1.3-6.5), malignancy history ( HR 2.5; 95% CI, 1.2-5.2), narcotics use (HR 4.0; 95% CI, 1.7-9.8), smoking (HR 2.8; 95% CI, 1.4-5.5), and atrial fibrillation (HR 2.4; 95% CI, 1.0-5.4). Conclusions: In patients hospitalized for syncope, significant independent prognostic factors for rehospitalization for syncope were GFR, diabetes, atrial fibrillation, and smoking; significant independent prognostic factors for mortality were GFR, diabetes, coronary artery surgery, malignancy history, narcotics use, smoking, and atrial fibrillation.

Abstract W MP106: Clinical Effectiveness of Anticoagulation with Warfarin among Ischemic Stroke Patients with Atrial Fibrillation: Findings from the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Jingjing Wu ◽  
Emily C O’Brien ◽  
Gregg C Fonarow ◽  
DaiWai M Olson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Warfarin Therapy ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Warfarin Treatment

Background: Oral anticoagulation is recommended for ischemic stroke patients with atrial fibrillation, based on clinical trials done in selected populations. However, little is known about whether the clinical benefit of warfarin is preserved outside the clinical trial setting, especially in older patients with ischemic stroke. Methods: PROSPER, a PCORI-funded research program designed by stroke survivors and stakeholders, used American Heart Association Get With The Guidelines (GWTG)-Stroke data linked to Medicare claims to evaluate the association between warfarin treatment at discharge and long-term outcomes among ischemic stroke survivors with atrial fibrillation (AF) and no contraindication to or prior anticoagulation therapy. The primary outcome prioritized by patients was home-time (defined as days spent alive and not in inpatient post-acute care facility) within 2-year follow-up after discharge. Results: Of 12,552 ischemic stroke patients with AF admitted from 2009-2011, 11,039 (88%) received warfarin treatment at discharge. Compared with those not receiving any anticoagulation, warfarin-treated patients were slightly younger (mean 80 vs. 83, p<0.001), less likely to have a history of prior stroke or coronary artery disease, but had similar stroke severity as measured by NIHSS (median 5 [IQR 2-12] vs. 6 [2-13], p=0.09). After adjustment for all observed baseline characteristics using propensity score inverse probability weighting method, patients discharged on warfarin therapy had 45 more days of home-time during 2-year follow-up than those not receiving any oral anticoagulant (513 vs. 468 days, p<0.001). Warfarin use was also associated with a lower risk of all-cause mortality, cardiovascular readmission or death, and ischemic stroke (Table). Conclusions: Among ischemic stroke patients with atrial fibrillation, warfarin therapy was associated with improved long-term outcomes.

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