Predictors of One-Year Disability and Death in Chinese Hospitalized Women after Ischemic Stroke

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150081 ◽

2015 ◽

Vol 73 (8) ◽

pp. 648-654 ◽

Cited By ~ 8

Author(s):

Marcos C. Lange ◽

Norberto L. Cabral ◽

Carla H. C. Moro ◽

Alexandre L. Longo ◽

Anderson R. Gonçalves ◽

...

Keyword(s):

Ischemic Stroke ◽

Population Based ◽

Large Artery ◽

Vessel Occlusion ◽

Population Based Study ◽

Incidence And Mortality ◽

One Year ◽

Undetermined Etiology ◽

And Control ◽

Adjusted Incidence

Aims To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of atherosclerotic risk factors.

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Abstract TP202: Association of Rs7961894 with Mean Platelet Volume in Patients with Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp202 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Malgorzata Miller ◽

Nils Henninger ◽

Renato Umeton ◽

Agnieszka Slowik

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mean Platelet Volume ◽

Myocardial Infarct ◽

Mortality Data ◽

Platelet Volume ◽

Laboratory Findings ◽

Stroke Subtypes ◽

Increased Risk ◽

One Year

Introduction: Mean platelet volume (MPV) is a marker of platelet function and elevated MPV was found to be an independent risk factor for death after myocardial infarct in patients with coronary artery disease. Higher MPV was associated with increased risk of ischemic stroke, yet there is insufficient data regarding the role of MPV as a marker of outcome in patients with ischemic stroke. The variability of platelet indices in humans is largely determined by genetic factors and rs7961894 located within intron 3 of WDR66 gene showed the strongest association with MPV in all genome wide association (GWA) studies in the European population. Aim: To determine the association of rs7961894 with MPV in patients with acute ischemic stroke and to assess whether rs7961894 and MPV could be markers of one year mortality in different stroke subtypes. Material and methods: For 426 adults with first-ever ischemic stroke MPV was measured within 72h of stroke onset and single nucleotide polymorphism genotyping of rs7961894 was performed accordingly (RT-PCR, Applied Biosystems). Epidemiologic and clinical characteristics (including TOAST classification), laboratory findings as well as one year mortality data were collected for each participant. Results: Allele T and genotypes CT and TT of the rs7961894 polymorphism were associated with the highest (>11.5fL) MPV quartile (Chi 2 test, p<0.01). MPV was significantly higher in patients with genotype TT as compared to CT and CC genotype (12.0±0.24fL vs. 11.10±0.15fL and 10.77±0.05fL, respectively, ANOVA, p <0.005 with Tukey HSD post-hoc test, Figure 1). Conclusions: Allele T of rs7961894 polymorphism is associated with increased MPV in the recessive and dominant model and patients with genotype TT have significantly higher MPV as compared to the rest of the population study. Further analysis is currently being conducted to determine the association of MPV and rs7961894 polymorphism with one year mortality and stroke subtypes.

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Abstract P670: Obesity and Mortality After the First Ischemic Stroke: Is Obesity Paradox Real?

Stroke ◽

10.1161/str.52.suppl_1.p670 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Durgesh Chaudhary ◽

Ayesha Khan ◽

Mudit Gupta ◽

Yirui Hu ◽

Jiang Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards Model ◽

Obesity Paradox ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Obese Patients ◽

Stroke Patients ◽

Stroke Event ◽

One Year ◽

First Time

Introduction: Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a “protective” effect on survival after stroke while other studies have debunked the obesity paradox. This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic stroke patients using data extracted from different resources including electronic health records. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic stroke patients was analyzed using Kaplan-Meier estimator, stratified by different BMI categories. The predictors of mortality at one-year were assessed using a multivariate Cox proportional hazards model. Results: Among 6,703 first-time adult ischemic stroke patients, mean age was 70.2 ±13.5 years and 52% were men. Of these patients, 24% patients were non-overweight (BMI < 25), 34% were overweight (BMI 25-29.9) and 41% were obese (BMI ≥ 30). One-year survival probability was significantly higher in overweight patients (87%, 95% CI: [85.6 - 88.4], p<0.001) and obese patients (89.5%, 95% CI: [88.4 - 90.7], p<0.001) compared to non-overweight patients (78.1%, 95% CI: [76.0 - 80.1]). In multivariate analysis, one-year mortality was significantly lower in overweight and obese patients (overweight patients- HR = 0.61 [95% CI, 0.52 - 0.72]; obese patients- HR = 0.56 [95% CI, 0.48 - 0.67]). Other significant predictors of one-year mortality were age at the ischemic stroke event (HR = 1.04 [95% CI, 1.03 - 1.04]), history of neoplasm (HR = 1.59 [95% CI, 1.38 - 1.85]), atrial fibrillation or flutter (HR = 1.26 [95% CI, 1.09 - 1.46]), heart failure (HR = 1.68 [95% CI, 1.42 - 1.98]), diabetes mellitus (HR = 1.27 [95% CI, 1.1 - 1.47]), rheumatic disease (HR = 1.37 [95% CI, 1.05 - 1.78]) and myocardial infarction ((HR = 1.23 [95% CI, 1.02 - 1.48]). Conclusion: Our results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.

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Trends in One-Year Recurrent Ischemic Stroke among the Elderly in the USA: 1994–2002

Cerebrovascular Diseases ◽

10.1159/000319028 ◽

2010 ◽

Vol 30 (5) ◽

pp. 525-532 ◽

Cited By ~ 40

Author(s):

Norrina B. Allen ◽

Theodore R. Holford ◽

Michael B. Bracken ◽

Larry B. Goldstein ◽

George Howard ◽

...

Keyword(s):

Ischemic Stroke ◽

The Elderly ◽

The Usa ◽

One Year

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Abstract TP317: Utility and Cost of Inpatient Thrombophilia Testing in Ischemic Stroke Patients Aged 18-60

Stroke ◽

10.1161/str.51.suppl_1.tp317 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Effrosyni Apostolidou ◽

Priya Khatri ◽

Eric Thomas ◽

Sean Savitz ◽

Alicia Zha

Keyword(s):

Ischemic Stroke ◽

Cryptogenic Stroke ◽

Inpatient Setting ◽

Initial Hospital ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

One Year ◽

Care Costs ◽

Fvl Mutation

Introduction: Patients (pts) <60 years with ischemic stroke (IS) are commonly tested for thrombophilias (TP) due to the perception that there could be underlying hypercoagulable states. However, inherited TPs are largely not a risk factor for IS; and testing for acquired TPs in an acute inpatient setting may yield erroneous results that increase health care costs. We reviewed the frequency and cost of TP testing at our institution as part of a plan-do-study act cycle for improving the utilization of inpatient TP testing in young pts after IS. Methods: We performed a retrospective review of 18-60 year old pts admitted for IS to our comprehensive stroke center between 11/2016 and 7/2018. Pts discharged with a stroke etiology not attributed to large vessel (LV), small vessel (SV), or cardioembolic (CE) origin and the initial hospital TP testing monitored. Pts seen subsequently in clinic or later admissions in our system were monitored. Results: Of 1,162 pts, 104 without diagnosed LV/SV/CE etiologies were identified. At least one TP test was performed in 82 (79%) pts (Table 1). In 70 pts testing was done in the initial 24 hrs of hospitalization. One test abnormality was seen in 42 (51%) pts but anticoagulation was initiated in only one 1 patient at discharge. Forty-seven (45%) pts were followed in our outpatient clinic, with a mean follow up of 5 (0.2 – 24) months. TP was confirmed in 3 pts in clinic – two with heterozygous FVL mutation and one with known homozygous FVL mutation. The total charges of the initial inpatient testing is estimated to be as high as $222,150 for 82 patients. Conclusion: Frequent inpatient TP testing in young pts with cryptogenic stroke does not change management and can be costly to the hospital. Based on these results, we created a practice guideline to improve utilization of TP testing starting January 2019. A one year analysis of the effectiveness, safety, and cost for these changes is ongoing.

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Abstract WMP113: Serial Cognitive Testing Performance by Baseline Fazekas Category in Stroke Survivors: A Secondary Analysis of the SPS-3 Trial

Stroke ◽

10.1161/str.51.suppl_1.wmp113 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adam H de Havenon ◽

Natalia Rost ◽

Shyam Prabhakaran

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Cognitive Abilities ◽

Secondary Analysis ◽

College Education ◽

Cognitive Testing ◽

White Matter Hyperintensity ◽

Absolute Difference ◽

Stroke Survivors ◽

One Year

Introduction: Prior research has shown that an increased burden of white matter hyperintensity (WMH) is an independent risk factor for the development of dementia. However, research has not focused specifically on stroke survivors, who are also predisposed to dementia. Methods: This is a secondary analysis of patients in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, who had a lacunar ischemic stroke within 6 months of enrollment and an MRI at study baseline. The primary outcome is change in the Cognitive Abilities Screening Instrument (CASI) from baseline to a 12 month follow-up. The primary predictor is the Fazekas score on the baseline MRI, with the scores of 0 and 1 collapsed to balance the cohort. We fit regression models to the 12 month CASI and adjusted for baseline CASI, patient age, gender, white race, Barthel Index score at 3 months from enrollment, college education, employment status, diabetes, COPD, and SPS3 randomization arm. Results: We included 2,413 patients with a mean (SD) age of 62.8 (10.6) years and 63.7% were male. There were 946 patients in Fazekas 0-1, 1,009 in Fazekas 2, and 458 in Fazekas 3. The mean (SD) CASI score at baseline and 12 months were 85.3 (12.4) and 86.0 (12.4). In the adjusted linear regression model, compared to a baseline Fazekas of 0-1, a baseline Fazekas of 2 was associated with a worse cognitive score (β coef = -0.55, 95% CI -1.01, -0.08, p=0.020), as was Fazekas of 3 (β coef = -0.76, 95% CI -1.36, -0.16, p=0.013). Conclusion: In patients with recent lacunar stroke, an increased baseline WMH burden is a risk factor for worse performance over a one year period on a validated test of global cognition. Although the absolute difference in score that we found was small (~0.5-0.8 points), this difference is over one year and, over years to decades, could become clinically significant. The implication of this finding is that lacunar ischemic stroke has additive cognitive consequences for patients with an established WMH burden, suggesting that primary stroke prevention in patients with WMH could be an important public health goal to reduce the burden of dementia.

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Abstract 2917: Outcome Prediction With A Population-based Ischemic Stroke Atlas

Stroke ◽

10.1161/str.43.suppl_1.a2917 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Wieslaw L Nowinski ◽

Varsha Gupta ◽

Guoyu Qian ◽

Wojciech Ambrosius ◽

Jie He ◽

...

Keyword(s):

Ischemic Stroke ◽

Outcome Prediction ◽

Three Dimensional ◽

Prediction Method ◽

Population Based ◽

Novel Approach ◽

History Of ◽

High Prediction ◽

Predicted Values ◽

One Year

Outcome prediction is critical in stroke patient management. We propose a novel approach combining imaging with parameters (including history, hospitalization, demographics, clinical and outcome) for a population of patients in the Probabilistic Stroke Atlas (PSA) along with prediction engine. The PSA aggregates multiplicity of data for a population of stroke patients and presents them in image format. The PSA is composed from a series of three-dimensional (3D) image volumes including scans and parameters. A cohort of over 700 ischemic stroke generally treated patients with 176 parameters per patient, and CT scan performed at admission and on day 7 was acquired. Outcome measurements were assessed up to one year after stroke onset. Cases with old infarcts, infarcts in both hemispheres, and hemorrhagic transformations were rejected. This data was post-processed to build the PSA and then the PSA was used for prediction. The infarcts were delineated on CT scans and their 3D surface models constructed and normalized. The PSA was calculated from the normalized 3D infarct models as frequency of stroke occurrence. Similar maps were calculated for the following parameters: Age; Sex; Survival; NIH Stroke Scale (NIHSS); Barthel Index (BI) at 30, 90, 180, 360 days; modified Rankin Scale (mRS) at 7, 30, 90, 180, 360 days; White blood cell count; C-reative protein; Glucose at emergency department; History of hypertension; and History of diabetes. The PSA was used for prediction of mRS and BI for 50 stroke subjects. For a given case to be predicted, the infarct was delineated and analyzed by the PSA mapped on the scan. The predicted values of the parameters from the PSA were compared with the actual values of the parameters measured in up to 1-year neurological follow up. The accuracy was defined as 100*(1-(actual value-predicted value)/actual value)%. The mean prediction accuracy of mRS at (7, 30, 90, 180, 360) days is (89.7, 90.7, 92.1, 87.0, 83.3)% and that for BI at (30, 90, 180, 360) days is (90.0, 95.4, 94.4, 92.2)% respectively. This novel prediction method has high prediction rates. It can be applied to any other parameters. The PSA is dynamic and its power can increase with additional cases.

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Abstract TP160: Predicting Bone Fracture After Stroke—The Fracture Risk After Ischemic Stroke (FRAC-Stroke) Score

Stroke ◽

10.1161/str.48.suppl_1.tp160 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Eric E Smith ◽

Jiming Fang ◽

Shabbir M Alibhai ◽

Peter M Cram ◽

Angela M Cheung ◽

...

Keyword(s):

Ischemic Stroke ◽

Fracture Risk ◽

Risk Score ◽

Cumulative Incidence ◽

Population Based ◽

World Health ◽

Stroke Severity ◽

Stroke Patients ◽

One Year ◽

Low Trauma Fracture

Background: Risk for low trauma fracture is increased by >30% after ischemic stroke. Additionally, in the IRIS trial pioglitazone therapy prevented ischemic stroke but increased fracture risk. We derived a risk score to predict risk of fracture one year after ischemic stroke. Methods: The Fracture Risk after Ischemic Stroke (FRAC-Stroke) Score was derived in 20,435 ischemic stroke patients from the Ontario Stroke Registry discharged from 2003-2012, using Fine-Gray competing risk regression. Candidate variables were medical conditions included in the validated World Health Organization FRAX risk score complemented by variables related to stroke severity. Registry patients were linked to population-based Ontario health administrative data to identify low trauma fractures (defined as any fracture of the femur, forearm, humerus, pelvis or vertebrae, excluding fractures resulting from trauma, motor vehicle accidents, falls from a height or in people with active cancer). The score was externally validated in 13,698 other ischemic stroke patients in the population-based Ontario stroke audit (2002-2012). Results: Mean age was 72; 42% were women. Low trauma fracture occurred within 1 year of discharge in 741/20435 (3.6%); cumulative incidence increased linearly throughout follow-up. Age, discharge modified Rankin score (mRS), and history of arthritis, osteoporosis, falls and previous fracture contributed significantly to the model. Model discrimination was good (c statistic 0.72). Including discharge mRS significantly improved discrimination (relative integrated discrimination index 8.7%). Fracture risk was highest in patients with mRS 3 and 4 but lowest in bedbound patients (mRS 5). From the lowest to the highest FRAC-Stroke quintile the cumulative incidence of 1-year low trauma fracture increased from 1% to 9%. Predicted and observed rates of fracture were similar in the external validation cohort. Conclusion: The FRAC-Stroke score allows the clinician to identify ischemic stroke patients at higher risk of low trauma fracture within one year. This information might be used to target patients for early bone densitometry screening to diagnose and manage osteoporosis, and to estimate baseline risk prior to starting pioglitazone therapy.

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