scholarly journals Intraventricular Extension of Supratentorial Intracerebral Hemorrhage: The Modified Graeb Scale Improves Outcome Prediction in Lund Stroke Register

2015 ◽  
Vol 46 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Björn M. Hansen ◽  
Timothy C. Morgan ◽  
Joshua F. Betz ◽  
Pia C. Sundgren ◽  
Bo Norrving ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Outcome Prediction ◽  
Characteristic Analysis ◽  
Poor Functional Outcome ◽  
Survival Status ◽  
Prognostic Accuracy ◽  
Unselected Population ◽  
Stroke Register

Background/Aims: The modified Graeb Scale (mGS) is a semi-quantitative method to assess the extension of intraventricular hemorrhage (IVH) in patients with intracerebral hemorrhage (ICH). The mGS has been shown to prognosticate outcome after ICH in cohorts derived from convenience samples. We evaluated the external validity of mGS in supratentorial ICH-patients from an unselected cohort. Methods: ICH-patients were included prospectively and consecutively in Lund Stroke Register. Follow-up survival status was obtained from the National Census Office; functional outcome was obtained from the Swedish Stroke Register or medical records. Using multivariate analyses, we examined if mGS was related to 30-day survival or poor functional outcome (modified Rankin Scale ≥4) at 90 days. Results: Of 198 supratentorial ICH-patients, 86 (43%) had IVH (median mGS 12, range 1-28). In multivariate regression analyses, the mGS independently predicted 30-day mortality (per point; OR 1.16; 95% CI 1.06-1.27; p = 0.002) and poor functional outcome (OR 1.11; 95% CI 1.02-1.20; p = 0.011) after ICH. In receiver-operator characteristic analysis, the addition of mGS tended to be associated with a higher prognostic accuracy for survival (area under curve 0.886 vs. not including mGS 0.812; p = 0.053). Conclusions: The mGS improves outcome prediction after supratentorial ICH beyond other previously established factors in an unselected population.

Abstract WP356: Eligibility Criteria in Clinical Trials on Intracerebral Hemorrhage Applied to an Unselected Cohort: The Lund Stroke Register

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Björn M Hansen ◽  
Natalie Ullman ◽  
Bo Norrving ◽  
Daniel F Hanley ◽  
Arne Lindgren
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Therapeutic Benefit ◽  
Inclusion Criteria ◽  
Poor Functional Outcome ◽  
Eligibility Criteria ◽  
Survival Status ◽  
Lower Baseline ◽  
Unselected Cohort ◽  
Stroke Register

Introduction: Strict patient selection in medical or surgical trials on intracerebral hemorrhage (ICH) is needed to optimize therapeutic benefit but limits trial enrolment as well as overall applicability of results. We studied the applicability of previous, current, and planned large interventional ICH trials by applying each trial’s defined inclusion criteria to an unselected cohort of ICH patients. Methods: Large interventional ICH trials were identified via trial registration databases. To estimate eligibility rates, each trial’s inclusion criteria were applied on an unselected consecutive group of first-ever ICH patients from the prospective hospital-based Lund Stroke Register. Subsequently, 30 day survival status was obtained from the National Census Office and 90 day poor functional outcome (modified Rankin Scale ≥4 or death) from the Swedish Stroke Register or medical files. Results: Among 253 included ICH patients, estimated eligibility rates ranged from 2-38% for the identified 11 large interventional ICH trials (Figure 1). Patients not eligible for any of the trials (N=91, 36%) had: more extensive intraventricular hemorrhage (p<0.001); lower baseline level of consciousness (p<0.001); higher rate of cerebellar ICH and lower rates of lobar ICH (p<0.001). No significant age, sex, or ICH volume differences were observed. The 30 day mortality rates among eligible patients were 0-33% depending on selected trial. The mortality rate for patients not eligible for any trial was 55% vs 19% for patients eligible in ≥1 trial (95% CI: 45-65% vs 13-25%; p<0.001). Non-eligible ICH patients more frequently had poor functional outcome (75% vs 49%; 95% CI: 65-85% vs 41-57%; p<0.001). Conclusions: There is great variation in proportions of unselected ICH patients eligible for inclusion in treatment trials. Even in trials with broad entry criteria only a minority is eligible, which need to be considered when translating ICH-trial results into clinical practice.

scholarly journals Cerebral Small Vessel Disease Load Predicts Functional Outcome and Stroke Recurrence After Intracerebral Hemorrhage: A Median Follow-Up of 5 Years

2021 ◽  
Vol 13 ◽  
Author(s):  
Mangmang Xu ◽  
Baojin Li ◽  
Di Zhong ◽  
Yajun Cheng ◽  
Qian Wu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Stroke Recurrence ◽  
Poor Functional Outcome ◽  
Vessel Disease

Background: Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH).Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1–6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome.Results: A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220–3.456, p = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230–6.878, p = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039–3.157, p = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017–2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080–4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB &lt; 10 (adjusted HR 2.669, 95% CI 1.248–5.707, p = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066–9.250, p = 0.038).Conclusions: Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.

Abstract 182: "Spot" Sign vs "Dot" Sign as Predictor of Hemorrhagic Stroke Outcomes

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Katherine O Brag ◽  
Erica Jones ◽  
Dominique Monlezun ◽  
Alex George ◽  
Michael Halstead ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Clinical Significance ◽  
Statistical Tests ◽  
Hematoma Expansion ◽  
Poor Functional Outcome ◽  
Spot Sign ◽  
Post Contrast ◽  
Stroke Registry ◽  
Logistic Regression Models

Introduction: Hematoma expansion (HE) is an established predictor of mortality and poor functional outcome after intracerebral hemorrhage (ICH). The computed tomography angiography (CTA) “spot” sign predicts HE and deterioration. The “dot” sign on delayed post-contrast CT (PCCT) has undetermined clinical significance but is thought to represent a slower rate of bleeding than the “spot” sign. We aimed to compare the sensitivity of a “dot” sign with the “spot” sign and establish the clinical significance of the “dot” sign. Methods: Patients with ICH presenting to our center July 2008-May 2013 were identified from our stroke registry. Only patients with baseline CT, CTA and PCCT and follow-up CT 6-36 hours later were included. Patients with clot evacuation between baseline and follow-up CT were excluded. HE was defined as 1) any ≥ 1cc increase and 2) significant ≥ 12.5cc increase or >33% increase in volume. Differences in cohort characteristics were assessed using appropriate statistical tests and sensitivity was calculated from 2x2 tables. Unadjusted logistic regression models were used to investigate the relation of “spot” and “dot” signs with HE and poor functional outcome (discharge mRS 4-6). Results: Of the 210 ICH patients included in the analyses (median age 61, 44.7% female, 66.2% black), 39 (18.5%) patients had a PCCT “dot” sign and 19 (9%) had a CTA “spot” sign. Significant HE occurred in 15% with “dot” sign and 8% with “spot” sign. The PCCT “dot” sign had a sensitivity of 0.52 in predicting significant HE and a sensitivity of 0.69 in predicting discharge mRS 4-6 (compared with 0.24 and 0.30 for “spot” sign, respectively). Patients with a “dot” sign, but without a “spot” sign, had significantly increased odds of any HE (OR 5.7, 95% CI 1.9-17.8, p=0.003), mRS 4-6 (OR 8.1, 95% CI 1.03-64.6, p=0.048), and death (OR 8.1, 95% CI 1.4-48.4, p=0.02), but not significant HE (OR 2.2, 95% CI 0.7-6.7, p=0.15). Conclusions: The PCCT “dot” sign was more sensitive in predicting hematoma expansion than the CTA “spot” sign and predicted hematoma expansion and poor functional outcome even in the absence of the “spot sign.” The utility of PCCT imaging in acute evaluation of ICH patients requires validation, but our study supports clinical relevance of the “dot” sign.

scholarly journals 192 Interleukin-6 and C-Reactive Protein Predict all Cause Death and Poor Functional Outcome after Non-Severe Stroke and Transient Ischaemic Attack

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Sarah Coveney ◽  
John J McCabe ◽  
Murphy Sean ◽  
Orina Belton ◽  
M Crowe ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Trauma Surgery ◽  
C Reactive Protein ◽  
Poor Functional Outcome ◽  
Severe Stroke ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Unit Increase

Abstract Background Inflammation plays a role in the development of ischaemic cerebrovascular events. High sensitivity C-reactive protein (CRP) is known to predict recurrent events. Little data exists for more upstream serum markers of inflammation. Methods BIO-STROKE and BIO-TIA were multicentre prospective biomarker and imaging studies of patients with non-severe stroke, TIA and controls. Exclusion criteria were malignancy, infection, recent trauma / surgery, recurrent stroke before phlebotomy/MRI. Serum biomarkers analysed included Interleukin (IL) – 6, CRP, IL-1, IL-8, IL10, IL12p70, IFN and TNF.Plasma CRP and IL-6 were measured by mass spectrometry. Additional biomarkers were measured using ELISA. Follow up was performed at 7, 28, 90 days and 1 year. Results 680 patients (439 strokes, 241 TIAs) and 68 controls were included in the analysis. The median age was 70 for cases. Carotid stenosis was present in 23.6% of cases. Median CRP was 3.75mg/L, 2.36mg/l and 1.87mg/L in the stroke, TIA and control groups (p=<0.001). Median IL-6 was 5.86pg/ml (stroke), 4.25pg/ml (TIA), 3.06pg/ml (control) (p=<0.001). On multivariate cox regression analysis baseline IL6 and CRP were independent predictors of all cause death at 1 year with a HR of 1.005 (95% CI 1.002-1.007, p<0.001).and 1.005(95% CI 1.002-1.007, p<0.001) per unit increase. Both IL6 and CRP were associated with vascular death at 1 year. In adjusted analyses, IL6 and CRP were associated with poor functional outcome at 1 year (OR of 1.02(CI 1.01 -1.03) and 1.02(CI 1.01-1.03) per unit increase, for IL6 and CRP respectively). On adjusted analysis, when IL6 was analysed as quartiles, there was a strong association with death at 1 year with an OR 1.87 (95% CI 1.19-2.93).CRP, analysed as quartiles, demonstrated an OR for death at 1 year of 1.64 (1.10-2.46). Conclusion IL-6 and CRP may be a useful prognostic factor for the prediction of outcome and death after stroke at 1 year follow up.

Serum omentin-1 is a novel biomarker for predicting the functional outcome of acute ischemic stroke patients

2018 ◽  
Vol 56 (2) ◽  
pp. 350-355 ◽  
Author(s):  
Tian Xu ◽  
Peng Zuo ◽  
Yuqin Wang ◽  
Zhiwei Gao ◽  
Kaifu Ke
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Logistic Model ◽  
Critical Role ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Multivariable Logistic Regression Model ◽  
Poor Functional Outcome

Abstract Background: Recent studies have suggested that omentin-1 plays a critical role in the development of cardiovascular disease. However, reported findings are inconsistent, and no study has evaluated the association between omentin-1 levels and a poor functional outcome after ischemic stroke onset. Methods: A total of 266 acute ischemic stroke patients were included in this study. All patients were prospectively followed up for 3 months after acute ischemic stroke onset and a poor functional outcome was defined as a major disability or death occurring during the follow-up period. A multivariable logistic model was used to evaluate the association between serum omentin-1 levels and the functional outcome of ischemic stroke patients at 3 months. Results: Ischemic stroke patients with poor functional outcome had significantly lower levels of serum omentin-1 than patients without poor functional outcome at the 3-month follow-up (50.2 [40.2–59.8] vs. 58.3 [44.9–69.6] ng/mL, p<0.01). Subjects in the highest tertile of serum omentin-1 levels had a 0.38-fold risk of having poor functional outcome, compared with those in the lowest tertile (p<0.05). A negative association between omentin-1 levels and poor functional outcome was found (p for trend=0.02). The net reclassification index was significantly improved in predicting poor functional outcome when omentin-1 data was added to the multivariable logistic regression model. Conclusions: Higher omentin-1 levels at baseline were negatively associated with poor functional outcome among ischemic stroke patients. Omentin-1 may represent a biomarker for predicting poor functional outcome of acute ischemic stroke patients.

scholarly journals Prediabetes is associated with poor functional outcome in patients with intracerebral hemorrhage

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Qiongzhang Wang ◽  
Guiqian Huang ◽  
Fei Chen ◽  
Pinglang Hu ◽  
Wenwei Ren ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Poor Functional Outcome

Prognostic Significance of Serum Magnesium in Acute Intracerebral Hemorrhage Patients

2019 ◽  
Vol 16 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Xianjun Han ◽  
Shoujiang You ◽  
Zhichao Huang ◽  
Qiao Han ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Serum Magnesium ◽  
Prognostic Significance ◽  
Stroke Severity ◽  
Linear Regression Models ◽  
Poor Functional Outcome ◽  
All Cause Mortality ◽  
Acute Intracerebral Hemorrhage

Background: Experimental animal model studies have shown neuroprotective properties of magnesium. We assessed the relationship between admission magnesium and admission stroke severity and 3-month clinical outcomes in patients with acute intracerebral hemorrhage (ICH). Methods: The present study included 323 patients with acute ICH who were prospectively identified. Demographic characteristics, lifestyle risk factors, National Institute of Health Stroke Scale (NIHSS) score, hematoma volumes, and other clinical features were recorded at baseline for all participants. Patients were divided into three groups based on the admission magnesium levels (T1: <0.84; T2: 0.84-0.91; T3: =0.91 mmol/L). Clinical outcomes were death, poor functional outcome (defined by modified rankin ccale [mRS] scores 3-6) at 3 months. Results: After 3-month follow-up, 40 (12.4%) all-cause mortality and 132 (40.9%) poor functional outcome were documented. Median NIHSS scores for each tertile (T1 to T3) were 8.0, 5.5, and 6.0, and median hematoma volumes were 10.0, 8.05, and 12.4 ml, respectively. There was no significant association between baseline NIHSS scores (P=0.176) and hematoma volumes (P=0.442) in T3 and T1 in multivariable linear regression models. Compared with the patients in T1, those in T3 were associated with less frequency of all-cause mortality [adjusted odds ratio (OR), 0.10; 95% confidence interval (CI), 0.02-0.54; P-trend=0.010] but not poor functional outcome (adjusted OR, 1.80; 95%CI, 0.71-4.56; P-trend=0.227) after adjustment for potential confounders. Conclusion: Elevated admission serum magnesium level is associated with lower odds of mortality but not poor functional outcome at 3 months in patients with acute ICH.

Predictors of surgical outcome among patients with spontaneous supratentorial intracerebral hemorrhage: A prospective single institutional study

2021 ◽  
Vol 18 (2) ◽  
pp. 23-29
Author(s):  
Somraj Lamichhane ◽  
Ruchi Devbhandari ◽  
Sabin Tripathee ◽  
Manisha Chapagain
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Decompressive Craniectomy ◽  
Young Patients ◽  
Functional Independence ◽  
Modified Rankin Scale ◽  
Dominant Hemisphere ◽  
Co Morbidity ◽  
Surgical Evacuation

Introduction: Intracerebral hemorrhage (ICH) is a potentially devastating neurologic emergency with long-term functional independence achieved in only limited patients with good prognostic factors. The objective of this study is toidentify the predictors of functional outcome in terms of modified Rankin Scale (mRS) following craniotomy and evacuation of spontaneous supratentorial ICH.   Methodology: It is a prospective study of forty patients conducted at the College of Medical Sciences (CMS) from May 2019 to April 2020 with three months follow-up. Patients of spontaneous supratentorial ICH with features of raised ICP and deteriorating GCS underwent surgical evacuation. The various predictors of outcome like Glasgow Coma Score (GCS) and pupillary inequality at presentation, age, location of hematoma, clot volume, comorbidities, intra-ventricular extension and involvement of dominant hemisphere were documented and compared with outcome in terms of modified Rankin Scale (mRS).   Results: The mortality rate at three months was 25% (32% in deep seated and 13.3% in lobar ICH) and higher in patients with poor GCS and pupillary inequality at presentation, volume >100 ml, intra-ventricular extension and patients undergoing decompressive craniectomy. Twenty patients (50%) had a favorable outcome (mRS 1-3) at follow-up, while 20 (50%) had a poor outcome (mRS 4-6). Unfavorable outcome was significantly higher among deep seated hematoma, age>70 years, poor GCS and pupillary inequality at presentation, clot volume >100ml, pre-existing co-morbidity, patients undergoing decompressive craniectomy and involvement of dominant hemisphere.   Conclusion: Surgical evacuation of spontaneous supratentorial ICH is associated with high mortality in patients with poor GCS and pupillary inequality at presentation, and large clot volume with intraventricular extension. However, young patients with good pre-morbid status, moderate volume of hematoma, not involving dominant hemisphere and moderate to good GCS have good functional outcome.

Abstract P440: Inpatient Blood Pressure Variability is Associated With Mortality and Poor Functional Outcome in Patients With Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Evangelos Pavlos Myserlis ◽  
Jessica R Abramson ◽  
Haitham Alabsi ◽  
Christopher D Anderson ◽  
Alessandro Biffi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Poor Functional Outcome ◽  
Logistic Regression Models ◽  
Established Risk Factor ◽  
The Impact

Introduction: Although elevated blood pressure (BP) is an established risk factor for intracerebral hemorrhage (ICH), the impact of acute BP fluctuations on ICH outcomes remains unclear. In this study, we sought to investigate the effect of acute BP variability (BPV) on mortality and functional outcome in ICH survivors. Methods: Subjects were consecutive ICH patients ≥ 18 years with available inpatient BP data, who survived hospitalization. Four measures of systolic BPV were calculated: standard deviation (SD), coefficient of variation (CoV), average real variability (ARV), and successive variation (SV). Our outcomes were (1) death and (2) poor functional outcome, defined as a modified Rankin Score (mRS) of 3-6 in a period between 60-120 days after discharge. We assessed the effect of hyperacute (ICH event-72 hours) and acute/subacute (72 hours-discharge) BPV on outcomes. We constructed Cox proportional hazards and logistic regression models to investigate the associations of BPV (per 10 mmHg increase) with mortality and poor functional outcome, respectively, after adjustment for potential confounders. Results: We included 345 patients, 120 of whom had available mRS data. 151 (43.8%) patients were female and 280 (81.2%) were white; mean age was 71 (±13) years. SBP ARV and SBP SV were the strongest predictors of mortality (HR 2.53-2.91 per 10 mmHg increase), while SBP SD, CoV, and SV were the strongest predictors of poor functional outcome (OR 2.89-5.14 per 10 mmHg increase) (Table) . These associations remained significant when analyzing both hyperacute as well as acute/subacute BPV. Compared to hyperacute BPV, acute/subacute BPV was more strongly associated with both mortality and poor functional outcome. Conclusion: Inpatient blood pressure variability is an important determinant of mortality and poor functional outcome in ICH survivors. Further studies are needed to investigate the role of addressing BPV as a potential target for intervention.

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