Both Ends of Values in the Hemoglobin Spectrum Are Associated with Adverse Stroke Outcomes

Background and Purpose: Existing studies on the association between hemoglobin values and stroke outcomes mostly focus on the lower side and mortality, often the only and primary endpoint. The current study was conducted to assess the association between hemoglobin concentration and a variety of poor stroke outcomes in patients with acute ischemic stroke. Methods: We studied 8,321 patients enrolled in the China National Stroke Registry (CNSR) between 2007 and 2008. Patients were divided into 7 groups, and a logistic regression model was used to evaluate the association. Endpoints of interest included 1-year all-cause mortality, stroke recurrence, combined endpoint, and stroke disability. Stroke disability was defined as a modified Rankin Scale of 2–6. Results: Patients with low and high hemoglobin values (≤11.6 g/dL and >16.1 g/dL) had higher proportion of poststroke adverse events than those in other groups. As compared with the fourth group of hemoglobin values of 13.5–14.2 g/dL, the adjusted odds ratios (ORs) with 95% confidence interval (CI) of low hemoglobin values (≤11.6 g/dL) were 2.25 (1.72–2.93) for all-cause mortality, 1.30 (1.04–1.61) for stroke recurrence, 1.63 (1.33–2.01) for combined endpoint, and 1.37 (1.12–1.67) for stroke disability, respectively. And, the ORs of high hemoglobin values (>16.1 g/dL) for adverse stroke outcomes were 1.72 (1.25–2.37), 1.43 (1.13–1.82), 1.43 (1.13–1.81), and 1.31 (1.06–1.63), respectively. Stratified analysis showed significant interactions between sex and categories of hemoglobin values for all-cause mortality (p = 0.05), stroke recurrence (p = 0.03), and combined endpoint (p = 0.01) but not for stroke disability (p = 0.24). Conclusions: Our study found both low and high hemoglobin values were associated with adverse stroke outcomes including all-cause mortality, stroke recurrence, combined endpoint, and stroke disability, which showed a U-shaped association. And, significant interactions between sex and hemoglobin concentration on all-cause mortality and stroke recurrence were also identified.

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Fasting and Non-Fasting Triglycerides in Patients With Acute Ischemic Stroke

10.21203/rs.3.rs-750314/v1 ◽

2021 ◽

Author(s):

Jun Yup Kim ◽

Keon-Joo Lee ◽

Jihoon Kang ◽

Beom Joon Kim ◽

Moon-Ku Han ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Primary Outcome ◽

Stroke Recurrence ◽

Stroke Registry ◽

Premature Coronary Heart Disease ◽

Clinical Events ◽

Younger Age ◽

All Cause Mortality ◽

One Year

Abstract Introduction: Clinical implications of elevated fasting triglycerides (FTG) and non-fasting triglycerides (NFTG) in acute ischemic stroke (AIS) remain unknown. We aimed to elucidate the correlation and clinical significance of FTG and NFTG levels in AIS patients. Methods Using a multicenter prospective stroke registry, we identified AIS patients hospitalized within 24h of onset with available NFTG results. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to one year. Results This study analyzed 2,176 patients. The prevalence of fasting and non-fasting hypertriglyceridemia was 11.5% and 24.6%, respectively. Multivariate analysis revealed that younger age, diabetes, higher body mass index and initial systolic blood pressure were independently associated with both fasting and non-fasting hypertriglyceridemia (all p < 0.05). Patients with higher quartiles of NFTG were more likely to be male, younger, ever-smokers, diabetic, and have family histories of premature coronary heart disease and stroke (all p < 0.05). Similar tendencies were observed for FTG. The composite outcome was not associated with FTG or NFTG quartiles. Conclusion The fasting and non-fasting hypertriglyceridemia were prevalent in AIS patients and showed similar clinical characteristics and outcomes. High FTG and NFTG levels were not associated with occurrence of subsequent clinical events up to one year.

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The Association between Baseline and 3-Month Albuminuria and 1-Year Prognosis of Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000518180 ◽

2021 ◽

pp. 1-8

Author(s):

Dongxue Wang ◽

Yuesong Pan ◽

Hao Li ◽

Hongyi Yan ◽

Xia Meng ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Stroke Recurrence ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Clinical Prognosis ◽

Stroke Outcomes ◽

Stroke Registry ◽

Confounding Variables ◽

Ischemic Attack

Introduction: The association between the changes in albuminuria levels and the clinical prognosis of stroke is unknown. The present study aimed to explore the relationships between changes in albuminuria and the risk of adverse stroke outcomes. Methods: The patients with ischemic stroke or transient ischemic attack from the Third China National Stroke Registry (CNSR-III) who had the urinary albumin-to-creatinine ratio (ACR) detected at baseline and 3-month were recruited. They were classified into 4 groups according to baseline and 3-month ACR and followed up for 1 year. Results: A total of 5,311 patients were finally included in the study. There were 3,738 (70.4%), 483 (9.1%), 451 (8.5%), and 639 (12.0%) patients with no albuminuria, baseline albuminuria, 3-month albuminuria, and persistent albuminuria, respectively. After adjustment for confounding variables, persistent albuminuria was independently associated with all-cause death (hazard ratio [HR], 2.23; 95% CI, 1.17–4.25; p = 0.02), stroke recurrence (HR, 1.55; 95% CI, 1.02–2.36; p = 0.04), and poor functional outcome (OR, 2.22; 95% CI, 1.66–2.96; p < 0.001). Baseline albuminuria was independently associated with poor functional outcome (OR, 1.65; 95% CI, 1.19–2.28; p = 0.003), while 3-month albuminuria was independently associated with stroke recurrence (HR, 1.68; 95% CI, 1.06–2.65; p = 0.03). Conclusions: Changes in albuminuria can predict adverse 1-year outcomes in Chinese ischemic stroke patients. In particular, persistent albuminuria was independently associated with 1-year all-cause death, stroke recurrence, and poor functional outcome.

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Associations of Aminotransferases with Adverse Outcomes after Acute Ischemic Stroke: Results from China National Stroke Registry

10.21203/rs.3.rs-18585/v1 ◽

2020 ◽

Author(s):

Lixia Zong ◽

Xianwei Wang ◽

Zixiao Li ◽

Xingquan Zhao ◽

Liping Liu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Recurrent Stroke ◽

Composite Endpoint ◽

Stroke Recurrence ◽

Poor Functional Outcome ◽

Stroke Registry ◽

All Cause Mortality ◽

One Year

Abstract Background The relationship between aminotransferases and cardiovascular outcomes has been inconsistent in previous studies. We aimed to investigate the association of aminotransferases with clinical outcomes after acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods 17,178 AIS or TIA patients with serum alanine aminotransferase (ALT) levels < 120 U/L were included from the China National Stroke Registry (CNSR) for current analysis. Composite endpoint is comprised of recurrent stroke and all-cause mortality. Poor functional outcome is defined as modified Rankin scale of 3-6. Multivariable logistic regression was used to evaluate the risks of one-year all-cause mortality, recurrent stroke, composite endpoint and poor functional outcome according to increasing sex-specific quintiles of ALT/ aspartate aminotransferase (AST) respectively. Results One-year incidences of all-cause mortality, recurrent stroke, composite endpoint and poor functional outcome were 11.9%, 6.0%, 13.7% and 28.2% respectively in patients with the lowest quintile of ALT, and 7.4%, 3.6%, 9.0% and 17.9% respectively in the highest quintile. Compared with the lowest ALT quintile, the adjusted odds ratios with 95% confidence interval of the highest quintile were 0.55 (0.43-0.70) for all-cause mortality, 0.61 (0.45-0.83) for stroke recurrence, 0.62 (0.49-0.77) for composite endpoint, and 0.67 (0.56-0.80) for poor functional outcome. There was no significant interaction of ALT with age, sex, diabetes, dyslipidemia and alcohol consumption for all outcomes (p for interaction ≥ 0.10). Conclusions Low serum ALT may serve as an independent predictor for all-cause mortality, stroke recurrence, composite endpoint and poor functional outcome after stroke.

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Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420971895 ◽

2020 ◽

Vol 13 ◽

pp. 175628642097189

Author(s):

Clare Lambert ◽

Durgesh Chaudhary ◽

Oluwaseyi Olulana ◽

Shima Shahjouei ◽

Venkatesh Avula ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Rural Population ◽

The United States ◽

Competing Risk ◽

Stroke Recurrence ◽

Composite Outcome ◽

Stroke Patients ◽

Central Pennsylvania ◽

All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

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Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Respiration ◽

10.1159/000513440 ◽

2021 ◽

pp. 1-8

Author(s):

Clemens F. Hinke ◽

Rudolf A. Jörres ◽

Peter Alter ◽

Robert Bals ◽

Florian Bornitz ◽

...

Keyword(s):

Pulmonary Disease ◽

Predictive Value ◽

Hemoglobin Concentration ◽

Blood Gas Analysis ◽

Study Data ◽

Gas Analysis ◽

Chronic Obstructive ◽

Acute Exacerbations ◽

All Cause Mortality

Background: Oxygenated hemoglobin(OxyHem) is a simple-to-measure marker of oxygen content capable of predicting all-cause mortality in stable chronic obstructive pulmonary disease (COPD). Objectives: We aimed to analyze its predictive value during acute exacerbations of COPD (AECOPD). Methods: In this retrospective study, data from 227 patients discharged after severe AECOPD at RoMed Clinical Center Rosenheim, Germany, between January 2012 and March 2018, was analyzed. OxyHem (hemoglobin concentration [Hb] × fractional SpO2, g/dL) was calculated from oxygen saturation measured by pulse oximetry and hemoglobin assessed within 24 h after admission. The follow-up (1.7 ± 1.5 years) covered all-cause mortality, including readmissions for severe AECOPD. Results: During the follow-up period, 127 patients died, 56 due to AECOPD and 71 due to other reasons. Survivors and non-survivors showed differences in age, FVC % predicted, C-reactive protein, hemoglobin, Cr, Charlson Comorbidity Index (CCI), and OxyHem (p < 0.05 each). Significant independent predictors of survival were BMI, Cr or CCI, FEV1 % predicted or FVC % predicted, Hb, or OxyHem. The predictive value of OxyHem (p = 0.006) was superior to that of Hb or SpO2 and independent of oxygen supply during blood gas analysis. OxyHem was also predictive when using a cutoff value of 12.1 g/dL identified via receiver operating characteristic curves in analyses including either the CCI (hazard ratio 1.85; 95% CI 1.20, 2.84; p = 0.005) or Cr (2.04; 95% CI 1.35, 3.10; p = 0.001) as covariates. Conclusion: The concentration of OxyHem provides independent, easy-to-assess information on long-term mortality risk in COPD, even if measured during acute exacerbations. It therefore seems worth to be considered for broader clinical use.

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Predictors of Stroke Recurrence in Malaysian Diabetic Population with Different Body Mass Index Classification: The observation from Malaysian National Stroke Registry

Frontiers in Pharmacology ◽

10.3389/conf.fphar.2018.63.00078 ◽

2018 ◽

Vol 9 ◽

Author(s):

Sabariah Noor Harun ◽

Siti Maisharah Sheikh Ghadzi ◽

Nur Ezzati Abidin ◽

Balamurugan Tangiisuran ◽

Hadzliana Zainal ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Stroke Recurrence ◽

Stroke Registry ◽

Diabetic Population ◽

Body Mass Index Classification

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Racial and ethnic disparities in stroke outcomes: a scoping review of post-stroke disability assessment tools

Disability and Rehabilitation ◽

10.1080/09638288.2018.1448467 ◽

2018 ◽

Vol 41 (15) ◽

pp. 1835-1845 ◽

Cited By ~ 4

Author(s):

Suzanne Perea Burns ◽

Brandi M. White ◽

Gayenell Magwood ◽

Charles Ellis ◽

Ayaba Logan ◽

...

Keyword(s):

Scoping Review ◽

Ethnic Disparities ◽

Assessment Tools ◽

Disability Assessment ◽

Racial And Ethnic Disparities ◽

Stroke Outcomes ◽

Post Stroke ◽

Stroke Disability

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Abstract 116: Relationship of Stroke Unit Status With Quality of Care and Outcome for Acute Stroke Patients: Results From China National Stroke Registry II

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.116 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Xinmiao Zhang ◽

Zixiao Li ◽

Chunjuan Wang ◽

Caiyun Wang ◽

Xin Yang ◽

...

Keyword(s):

Clinical Outcomes ◽

Cox Model ◽

Frailty Model ◽

Stroke Care ◽

Estimating Equation ◽

Composite Score ◽

Stroke Recurrence ◽

Stroke Units ◽

Stroke Registry ◽

Processes Of Care

Introduction: A key element in modern stroke care is dedicated stroke units. However, it is unclear whether processes of acute ischemic stroke (AIS) care and outcomes are different between hospitals with and without stroke units in China. Methods: We analyzed the China National Stroke Registry II data from June 2012 to January 2013. Processes of care were examined by 13 individual national guideline-recommended indicators and composite score. Patients’ outcomes included all caused death, stroke recurrence, and disability (modified Rankin Score ≥3) at 3, 6 and 12month after discharge. Propensity score matching was used to balance the baseline characteristics. We used cox model with shared frailty model and logistic regression with generalized estimating equation to analysis the relationship between stroke units and clinical outcomes. Results: Among 19 604 AIS patients, there were 11050 (56.4%) patients in 121 hospitals with stroke units, and 8554 (43.6%) patients in 96 hospitals without stroke units. After matching, 8125 pairs of patients were analyzed. Totally, the composite score of processes was higher in hospitals with stroke units than that without(77% versus 74%, p<0.05). Hospitals with stroke units were more likely to conduct anticoagulation for atrial fibrillation, early antithrombotic treatment, smoking cessation, and stroke education (Figure 1). However, there are no differences between patients in hospitals with and without stroke units in clinical outcomes(Table 1). Conclusions: Our study showed that processes of care of AIS were better in patients in hospitals with stroke units. However, patients in hospitals with stroke units didn’t performance differences in clinical outcomes after discharge.

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The impact of atrial fibrillation on hospitalization outcomes for patients with chronic lymphocytic leukemia: A large database analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e19508 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e19508-e19508

Author(s):

Mohammad Ammad Ud Din ◽

Samarthkumar Thakkar ◽

Harsh P. Patel ◽

Syed Ather Hussain ◽

Aneeqa Zafar ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Logistic Regression ◽

Chronic Lymphocytic Leukemia ◽

Regression Model ◽

Logistic Regression Model ◽

Lymphocytic Leukemia ◽

Total Cost ◽

Patient Admissions ◽

All Cause Mortality

e19508 Background: With the increased use of novel agents like Bruton tyrosine kinase inhibitors (BTKi) for the treatment of chronic lymphocytic leukemia (CLL), the incidence of atrial fibrillation (AF) is on the rise in these patients. However, the excess burden added by AF to the morbidity and mortality of CLL patients is unclear. Methods: Using the appropriate ICD-9 and ICD-10 codes, the National Inpatient Sample (NIS) database was accessed to gather data of hospitalized CLL patients with AF from 2008 to 2019. Propensity-score matching (PSM) and logistic regression model were performed to control for baseline patient factors like age, sex, income, and the relevant co-morbidities to match 7265 CLL patient admissions with AF and 7265 CLL patient admissions without AF. The primary outcome was all-cause mortality (ACM), while secondary outcomes included stroke, acute heart failure (AHF), and total cost of hospital stay. Results: The mean age of the cohorts was 82 years. Females made up 44% of both groups. The AF group had similar prevalence of systemic hypertension (62.38% vs 62.10%; p= 0.73), diabetes mellitus (5.09% vs 5.43%; p= 0.35), congestive heart failure (5.57% vs 5.36%; p= 0.58), valvular heart disease (1.17% vs 1.44%; p= 0.14), and pulmonary hypertension (0.21% vs 0.14%; p= 0.31) compared to the group without AF. PSM revealed CLL patients with AF had a higher rate of ACM (6.06% vs 4.47%; p= <0.0001), AHF (7.50% vs 3.85%; p= <0.001), and stroke (3.09% vs 1.65%; p= <0.0001). Admission in the AF group also had a higher median total cost of hospital stay ($9097 vs $7646). A logistic regression model was done to adjust for confounders which revealed similar results for the AF group with increased adjusted odd’s ratio (aOR) of ACM (aOR:1.39, 95% confidence interval (CI): 1.19-1.61; p= <0.001), AHF (aOR: 2.16, 95% CI: 1.85-2.52; p= <0.001), and stroke (aOR:1.94, 95% CI: 1.54-2.44; P= <0.001) (Table). Conclusions: Our data suggest that hospitalized CLL patients with AF are at a significantly increased risk of all-cause mortality, AHF, and stroke. Several limitations like the inability to establish the temporal relationship between CLL and AF and the lack of data regarding medications of individual patients are important to keep in mind while interpreting the results.[Table: see text]

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Antiplatelet Therapy After Spontaneous Intracerebral Hemorrhage and Functional Outcomes

Stroke ◽

10.1161/strokeaha.119.025972 ◽

2019 ◽

Vol 50 (11) ◽

pp. 3057-3063

Author(s):

Santosh B. Murthy ◽

Alessandro Biffi ◽

Guido J. Falcone ◽

Lauren H. Sansing ◽

Victor Torres Lopez ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Antiplatelet Therapy ◽

Functional Outcomes ◽

Randomized Clinical Trials ◽

Massachusetts General Hospital ◽

Meta Analysis ◽

Hazard Ratio ◽

Stroke Registry ◽

All Cause Mortality

Background and Purpose— Observational data suggest that antiplatelet therapy after intracerebral hemorrhage (ICH) alleviates thromboembolic risk without increasing the risk of recurrent ICH. Given the paucity of data on the relationship between antiplatelet therapy after ICH and functional outcomes, we aimed to study this association in a multicenter cohort. Methods— We meta-analyzed data from (1) the Massachusetts General Hospital ICH registry (n=1854), (2) the Virtual International Stroke Trials Archive database (n=762), and (3) the Yale stroke registry (n=185). Our exposure was antiplatelet therapy after ICH, which was modeled as a time-varying covariate. Our primary outcomes were all-cause mortality and a composite of major disability or death (modified Rankin Scale score 4–6). We used Cox proportional regression analyses to estimate the hazard ratio of death or poor functional outcome as a function of antiplatelet therapy and random-effects meta-analysis to pool the estimated HRs across studies. Additional analyses stratified by hematoma location (lobar and deep ICH) were performed. Results— We included a total of 2801 ICH patients, of whom 288 (10.3%) were started on antiplatelet medications after ICH. Median times to antiplatelet therapy ranged from 7 to 39 days. Antiplatelet therapy after ICH was not associated with mortality (hazard ratio, 0.85; 95% CI, 0.66–1.09), or death or major disability (hazard ratio, 0.83; 95% CI, 0.59–1.16) compared with patients not started on antiplatelet therapy. Similar results were obtained in additional analyses stratified by hematoma location. Conclusions— Antiplatelet therapy after ICH appeared safe and was not associated with all-cause mortality or functional outcome, regardless of hematoma location. Randomized clinical trials are needed to determine the effects and harms of antiplatelet therapy after ICH.

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