Abstract WMP96: The Iscore Predicts Clinical Response To Thrombolysis: Results From VISTA

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gustavo Saposnik ◽  
S. C Johnston ◽  
Matthew Reeves ◽  
Philip M Bath ◽  
Bruce Ovbiagele ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Response ◽  
Clinical Outcomes ◽  
Direct Interaction ◽  
High Risk Group ◽  
P Value ◽  
Stroke Severity ◽  
Risk Of Death ◽  
Secondary Outcomes

Background: The iScore is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. It includes demographics, stroke severity and subtype, comorbidities, pre-stroke status, and glucose on admission. Objective: To determine the ability of the iScore to predict the clinical response after iv thrombolysis (tPA) in the Virtual International Stroke Trials Archive (VISTA). Methods: We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration. We explored the association between the iScore (as continuous and binary [<200 and ≥200] measures) and the outcomes of interest. Outcome Measures: The primary outcome was death or disability at 90 days defined as a modified Rankin scale (mRS) 4-to-6. Secondary outcomes included death at 90 days and favorable outcome (mRS 0-2). Results: Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 712 (10%) had an iScore ≥200. Patients with higher iScore had worse clinical outcomes (p<0.0001 for all outcomes; c-statistics 0.777 for mRS0-6 and 0.748 for death at 90 days). Overall, an iScore ≥200 was associated with nine fold higher risk of death or disability at 90 days (OR 9.41, 95%CI 7.00-12.6). Similar trends were observed for secondary outcomes (Figure). tPA administration in stroke patients with an iScore≥200 was associated with a lower risk of death or disability at 90 days (OR 0.48; 95%CI 0.32-0.72). There was a direct interaction between the iScore and tPA for both death or disability and death alone at 90 days (p-value for the interaction <0.001). Conclusion: The iScore is a useful tool that can be used to estimate clinical outcomes after tPA. Although outcomes were poorer for the high-risk group (iScore≥200), the benefits of tPA in this group were greater than for low-risk patients. Figure

Abstract 58: The Iscore Predicts Efficacy Of Thrombolytic Therapy For Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Gustavo Saposnik ◽  
Jiming Fang ◽  
Moira Kapral ◽  
Jack Tu ◽  
Muhammad Mamdani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Clinical Response ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Neurological Deterioration ◽  
Stroke Severity ◽  
Risk Of Death ◽  
Poor Outcome

Background: The iScore is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. It includes demographics, stroke severity and subtype, vascular risk factors, cancer, renal failure, and pre-admission functional status. Limited information is available to predict the clinical response after intravenous thrombolytic therapy (tPA). Objective: To determine the ability of the iScore to predict the clinical response and risk of hemorrhagic transformation after tPA. Methods: We applied the iScore ( www.sorcan.ca/iscore ) to patients presenting with an acute ischemic stroke at 11 stroke centres in Ontario, Canada, between 2003 and 2008, identified from the Registry of the Canadian Stroke Network (RCSN). We compared outcomes between patients receiving and not receiving tPA adjusting for differences in baseline characteristics through matching by propensity scores. Three groups were defined a priori as per the iScore (low risk 180). Outcome Measures: Poor outcome, the primary outcome measure, was defined as disability at discharge or death at 30 days. Secondary outcomes included disability at discharge, neurological deterioration and intracranial hemorrhage (any type and symptomatic). Results: Among 12,686 patients with an acute ischemic stroke, 1696 (13.4%) received intravenous thrombolysis. Overall, 589 tPA patients were matched with 589 non-tPA patients (low iScore risk), 682 tPA were matched with 682 non-tPA patients (medium iScore risk) and 419 tPA patients were matched with 419 non-tPA patients (high iScore risk). There was good matching in all three groups. Higher iScore was associated with poor functional outcome in both the tPA and non-tPA groups (p<0.001). Among those with low and medium iScore risk, tPA use was associated with lower risk of poor outcome (Low iScore RR 0.74; 95%CI 0.67-0.84; medium iScore RR 0.88; 95%CI 0.84-0.93). There was no difference in clinical outcomes between matched patients receiving and not receiving tPA in the highest iScore group (RR 0.97; 95%CI 0.94-1.01). Similar results were observed for disability at discharge and length of stay. The incident risk of neurological deterioration and hemorrhagic transformation (any or symptomatic) increased with the iScore risk ( Figure ). Conclusion: The iScore appears to predict clinical response and risk of hemorrhagic complications after tPA for an acute ischemic stroke. Patients with high iScores may not benefit from tPA and have higher risk of hemorrhagic transformation, though this finding should be validated independently (underway) before clinical use.

scholarly journals Hemoglobin, Albumin, Lymphocyte, and Platelet Score is Associated With Adverse Clinical Outcomes of Acute Ischemic Stroke: A Prospective Cohort Study

2020 ◽  
Author(s):  
Mengke Tian ◽  
Youfeng Li ◽  
Xiao Wang ◽  
Xuan Tian ◽  
Lu-lu Pei ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Risk Of Death ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background The combined index of hemoglobin, albumin, lymphocyte and platelet (HALP) is considered as a novel score to reflect systemic inflammation and nutritional status. This study aimed to investigate the association between HALP score and adverse clinical events in patients with acute ischemic stroke (AIS). Methods This study prospectively included patients with AIS within 24 hours of admission to the First Affiliated Hospital of Zhengzhou University. The primary outcomes were all-cause death within 90 days and 1 year. The secondary outcomes included stroke recurrence and combined vascular events. The association between HALP score and adverse clinical outcomes was analyzed using Cox proportional hazards. Results A total of 1337 patients were included. Patients in the highest tertile of HALP score had a lower risk of death within 90 days and 1 year (Hazard ratio: 0.20 and 0.30; 95% confidence intervals: 0.06–0.66 and 0.13–0.69, P for trend < 0.01 for all) compared with the lowest tertile after adjusting relevant confounding factors. Similar results were found for secondary outcomes. Subgroup analyses further confirmed these association. Adding HALP score to the conventional risk factors improved prediction of death in patients with AIS within 90 days and 1 year (net reclassification index, 38.63% and 38.68%; integrated discrimination improvement, 2.43% and 2.57%; P < 0.02 for all). Conclusions High HALP score levels were associated with decreased risk of adverse clinical outcomes within 90 days and 1 year after stroke onset, suggesting that HALP score may serve as a powerful indicator for AIS.

Association of Iron Deficiency Anemia with Stroke Severity in patients with Acute Ischemic Stroke

2021 ◽  
Vol 15 (11) ◽  
pp. 3004-3006
Author(s):  
Rabia Rathore ◽  
Nasir Farooq Butt ◽  
Adil Iqbal ◽  
Hina Latif ◽  
Mariam Azeem ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Iron Deficiency ◽  
Acute Ischemic Stroke ◽  
Iron Deficiency Anemia ◽  
Descriptive Study ◽  
World Health ◽  
Deficiency Anemia ◽  
P Value ◽  
Stroke Severity ◽  
Cross Sectional

Aim: To study the relationship of Iron Deficiency anemia (IDA) with severity of acute ischemic stroke. Study Design: A cross-sectional descriptive study. Place & Duration of Study: Department of Medicine, Mayo Hospital, Lahore from March 2020 to February 2021 Methods: A descriptive study of cross-sectional type was done on 200 individuals who had acute ischemic stroke (AIS) and were hospitalized at Mayo Hospital Lahore. Consecutive non-probability convenience sampling method was used to gather the data. Severity of stroke was assessed at the time of admission using the National Institute of Health Stroke Scale, (NIHSS) at the same time blood complete examination along with peripheral blood film was done to diagnose anemia in these patients. Iron studies were done to diagnose iron deficiency anemia (IDA). P-value less than 0.05 was taken as significant. Results: About 200individuals presenting with AIS were enrolled in the research work. Anemia according to World Health Organization was seen in 80(40%) and was not present in 120(60%) patients. Among the subjects who had anemia, 16(20%) had a minor AIS, 23(28.75%) had a moderately severe AIS, and 41(51.25%) reported with a severe AIS, according to NIHSS criteria. A notable relationship was found to exist between anemia and stroke severity, (P-value 0.000). Conclusion: Anemia was a commonly found in individuals with acute stroke due to ischemia and had direct relation with severity of stroke. Keywords: Iron deficiency Anemia, severity, ischemic stroke.

Abstract 3436: Specific NIH Stroke Scale Items Strongly Predict Hospital Arrival Mode, Thrombolysis Administration, and Clinical Outcomes in Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Bruce Ovbiagele ◽  
Rema Raman ◽  
Thomas M Hemmen ◽  
Brett C Meyer ◽  
Dawn M Meyer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Functional Activity ◽  
Stroke Severity ◽  
Multivariable Logistic Regression Model ◽  
Hospital Arrival ◽  
Level Of Consciousness ◽  
Race Ethnicity ◽  
Abnormal Level

Background: The 11-item National Institutes of Health Stroke Scale (NIHSS) is widely used as an index of stroke severity and prognostication. However, no studies have specifically examined the influence of NIHSS items on care processes and outcomes in Acute Ischemic Stroke (AIS). Furthermore, potential distinctions in neurologic signs of AIS that may contribute to disparities in race-ethnic treatment rates and outcomes have not been evaluated. We assessed the relation of neurological signs on the NIHSS to arrival mode, thrombolysis treatment and clinical outcomes in AIS, and also evaluated the influence of race-ethnicity. Methods: We analyzed the dataset of a hospital network comprising prospectively collected data on AIS patients presenting within 12 hours of ictus between June 2004 and May 2011. Outcomes evaluated were mode of arrival (ambulance vs. other), IV thrombolysis (yes vs. no), discharge destination (home vs. other), unfavorable day-90 functional activity (modified Rankin Scale (mRS) score >1), unfavorable day-90 disability (Barthel Index <95), and day-90 mortality. Outcomes were adjusted for pre-specified covariates in a multivariable logistic regression model. Results: Of 972 AIS patients 462 (48%) were women, 635 (65%) Non-Hispanic White, 162 (17%) White Hispanic, 106 (11%) Black, and 69 (7%) other race/ethnicity. Overall, the presence of extinction/neglect was the strongest predictor of arriving by ambulance (adjusted OR 2.32, 95% CI: 1.53-3.51), and abnormal level of consciousness (LOC) was the strongest predictor of receipt of IV thrombolysis (adjusted OR 2.25, 95% CI: 1.67-3.04), while limb ataxia was the only NIHSS item not significantly associated with either arrival mode or thrombolysis treatment. Presence of gaze preference was the strongest predictor of not going home directly from the hospital (adjusted OR 0.2, 95% CI: 0.14-0.29), unfavorable day-90 functional activity (adjusted OR 0.21, 95% CI: 0.12-0.37) and poor mortality outcome (adjusted OR 5.92, 95% CI: 3.42-10.25), while abnormal LOC was the strongest predictor of unfavorable day-90 disability (adjusted OR 0.27, 95% CI: 0.15-0.47). White Hispanic AIS patients with sensory symptoms were less likely to arrive by ambulance (adjusted OR 0.31, 95%CI: 0.13-0.74) but more likely to go home directly (adjusted OR 2.81, 95% CI: 21.31-6.02), while Black AIS patients with abnormal level of consciousness were more likely to receive IV thrombolysis (adjusted OR 4.69, 1.80-12.26). Conclusions: Specific items on the NIHSS are strongly related to hospital arrival mode, thrombolysis treatment, and clinical outcomes among AIS patients. Some of these associations vary by race and ethnicity. These results could aid prognostication and identify areas in the community, pre-hospital and emergency department phases of stroke care requiring more education, training, or intervention, to boost AIS outcomes.

scholarly journals Predicting Clinical Outcomes After Thrombolysis Using the iScore

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2755-2759 ◽  
Author(s):  
Gustavo Saposnik ◽  
Mathew J. Reeves ◽  
S. Claiborne Johnston ◽  
Philip M.W. Bath ◽  
Bruce Ovbiagele
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Favorable Outcome ◽  
Tissue Type ◽  
Modified Rankin Scale ◽  
Secondary Outcomes

Background and Purpose— The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA). Methods— We applied the iScore ( www.sorcan.ca/iscore ) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4–6), and Barthel index >90 at 3 months. Results— Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P <0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P =0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30–1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45–1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. Conclusions— The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.

scholarly journals Frequency of Hypoalbuminemia in Acute Ischemic Stroke patients Based on Stroke Severity

2021 ◽  
Vol 15 (6) ◽  
pp. 1335-1339
Author(s):  
E. U Haq ◽  
A. Qayyum ◽  
H. A. Qayyum ◽  
M. Anam ◽  
A. R. Khan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Serum Albumin ◽  
Acute Ischemic Stroke ◽  
Public Health Issue ◽  
P Value ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Baseline Serum ◽  
Nihss Score ◽  
The Mean

Background: Stroke is a serious public health issue and third leading cause of death worldwide. Hypoalbuminemia is commonly found factor in patients of stroke and is also associated with severe disease as well as pro inflammatory patterns of serum protein electrophoresis. Therefore, further research for understanding the role of Hypoalbuminemia in stroke is important to devise strategies for better management of stroke. Aim : To determine the frequency of hypoalbuminemia in acute ischemic stroke patients based on stroke severity. Methods: This descriptive cross- sectional study was conducted in Shifa International hospital stroke unit for 6 months from May 15, 2018 till Nov 15, 2018. Data was collected from 100 patients using purposive sampling. After taking consent from patient or attendant, the demographic data was collected on a structured proforma. Baseline serum albumin and stroke severity using the NIHSS score was also assessed. All data was entered and analysed using SPSS 21. After descriptive analysis, post stratified Chi Square test was applied for gender and age categories. Results: The mean age of patients was 63.60 ± 11.87 years with 57(57%) male and 43(43%) female cases. The mean serum albumin level was 4.03 ± 0.94 with minimum and maximum values as 1.50 and 5.5. Among cases with minor, moderately severe and with severe stroke, 6(37.5%) cases, 18(25.7%) cases and 6(42.9%) cases had Hypoalbuminemia. The frequency of hypoalbuminemia was statistically same with respect to severity of stroke, p-value > 0.05. Conclusion: This study concludes that the frequency of hypoalbuminemia in acute ischemic stroke patients was diagnosed in almost one third cases, however, no statistical association could be found. Hence, screening for hypoalbuminemia should be done for better management of stroke patients. Keywords: Storke, NIHSS score, serum albumin, hypoalbuminemia, mortality

Abstract TP495: Symptom Onset To Arrival Time And Outcomes Among Acute Ischemic Stroke Patients, Paul Coverdell National Acute Stroke Program (PCNASP) 2016-2018

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amena Y Abbas ◽  
Erika C Odom ◽  
Sallyann Coleman King ◽  
Xin Tong ◽  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
Arrival Time ◽  
Treatment Guidelines ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Early Management ◽  
Arrival Times

Introduction: Early use of intravenous (IV) alteplase among those with Acute Ischemic Stroke (AIS) has been associated with better outcomes. However, many patients are ineligible for treatment due to late arrival or contraindications. We used PCNASP data to examine the descriptive characteristics and clinical outcomes associated with arrival time. Methods: A total of 233,794 patients were identified with an AIS in PCNASP data from 2016-2018. A total of 131,195 (56%) patients had documented last known well time (LKW). Symptom onset to arrival times (OAT) were categorized into the following using LKW and ED arrival times: 0-2, >2 and ≤3, >3 and ≤4.5, >4.5 hours. We assessed associations between OAT and two outcomes - discharge to home and independent ambulation at discharge using generalized estimating equations (GEE) modeling. Results: Patients with documented LKW time had the following OAT: 39,694 (30.3%) 0-2 hours, 11,573 (8.8%) >2 and ≤3 hours, 13,582 (10.3%) >3 and ≤4.5 hours, and 66,346 (50.6%) >4.5 hours. Overall, 51% were male, 75% were Whites, and 51% of patients arrived by ambulance. Only 17% of patients received IV alteplase. After adjusting for age, sex, race, arrival by ambulance, stroke severity score, and IV alteplase use, compared to those arriving >4.5 hours of symptom onset, patients arriving ≤4.5 hours were more likely to be discharged to home (0-2, 1.85 [1.79, 1.92]; >2 and ≤3, 1.38 [1.32, 1.45]; >3 and ≤4.5, 1.13 [1.08, 1.18]; referent >4.5), and independently ambulate at discharge (0-2, 1.89 [1.82, 1.96]; >2 and ≤3, 1.41 [1.34, 1.48]; >3 and ≤4.5, 1.15 [1.10, 1.21], referent >4.5) (Table). Conclusion: In this study, shorter OAT were associated with better outcomes for AIS patients. Although significant progress has been made in the early management and treatment of stroke, continued efforts are needed to emphasize the significance of early hospital arrival and promote implementation of treatment guidelines to improve clinical outcomes for all stroke patients.

P5744Sleep-disordered breathing assessed by holter-monitoring is associated to worsened one-year clinical outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D O Kang ◽  
C K Kim ◽  
Y Park ◽  
W Y Jang ◽  
W Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Narrow Band ◽  
Holter Monitoring ◽  
P Value ◽  
Stroke Patients ◽  
Coupling Analysis ◽  
One Year ◽  
Ischemic Attack

Abstract Background Sleep-disorder breathing (SDB) using polysomnography is closely associated to poor functional and clinical outcomes in ischemic stroke patients. The cardiopulmonary coupling analysis using Holter-monitoring (CPC-Holter analysis) is an emerging feasible modality to investigate SDB. Purpose We investigated the association between SDB defined by CPC-Holter analysis and one-year clinical outcome in patients with acute ischemic stroke. Methods Total 666 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC-Holter analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. Primary outcome was recurrent ischemic stroke, and secondary outcome was major adverse cerebrovascular event (MACE), a composite of recurrent ischemic stroke, transient ischemic attack, and all-cause mortality within one year since discharge. Result The NB coupling was present in 205 (30.8%) of 666 patients with mean age of 64.1±12.8 years. The NB group showed significantly higher incidence of both recurrent ischemic stroke (8.3% vs. 1.4%, p<0.001) and MACE (14.9% vs. 3.0%, p<0.001) within one-year. In multivariate analysis, presence of NB coupling remained as an independent predictor of both recurrent ischemic stroke and MACE (HR: 4.81; 95% CI: 1.73–13.4; p=0.003; and HR 4.17; 95% CI: 1.74–10.0; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 164 patient pairs (C-statistics=0.757). One-year clinical outcomes Overall population (n=666) PSM population (n=328) no NB (=461) NB (n=205) Log-rank p-value OR (95% CI) no NB (n=164) NB (n=164) Log-rank p-value OR (95% CI) Recurrent ischemic stroke 6 (1.4) 14 (8.3) <0.001 5.73 (2.20–14.9) 3 (2.0) 11 (8.1) 0.026 3.85 (1.07–13.8) Transient ischemic attack 3 (0.7) 3 (1.7) 0.275 2 (1.3) 3 (2.1) 0.633 Hemorrhagic stroke 0 (0.0) 2 (1.2) 0.027 0 (0.0) 2 (1.5) 0.148 Total death 3 (0.7) 9 (4.8) 0.001 2 (1.3) 3 (1.9) 0.641 MACEs 12 (3.0) 25 (14.9) <0.001 4.63 (2.06–10.4) 7 (5.2) 17 (13.1) 0.030 2.95 (1.06–8.21) Data are expressed as n (%). CI = confidence interval; MACE = major adverse cardiovascular event; NB = narrow-band; OR = odds ratio. One-year clinical outcomes Conclusion SDB assessed by CPC-Holter analysis at early phase of ischemic stroke is a powerful prognostic marker for predicting one-year adverse clinical outcomes. The CPC analysis using Holter-monitoring is a useful modality and could be easily applied to predict clinical outcomes in acute ischemic stroke patients.

scholarly journals Association of Serum Bilirubin with Stroke Severity and Clinical Outcomes

2013 ◽  
Vol 40 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Tian Xu ◽  
Jintao Zhang ◽  
Tan Xu ◽  
Wenqing Liu ◽  
Yan Kong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Direct Bilirubin ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Short Term ◽  
Fourth Quartile

Objective:The aim of the study is to explore the association of serum bilirubin levels with admission severity and short term clinical outcomes among acute ischemic stroke patients.Methods:Data were collected from 2361 acute ischemic stroke patients in four hospitals of Shangdong Province during January 2006 and December 2008. National Institutes of Health Stroke Scale (NIHSS) was used to assess admission and discharge severity. NIHSS≥10 at discharge or in-hospital death was defined as short-term clinical outcomes. Logistic regression and trend test were used to examine the association of serum bilirubin levels with admission severity and short term clinical outcomes.Results:Serum bilirubin levels were significantly and positively associated with admission severity (P for trend <0.05). The age-sex adjusted odds ratios (95% confidential intervals) of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.245 (0.873, 1.777)/1.276 (0.895, 1.818), 1.484 (1.048, 2.102)/1.628 (1.158, 2.289) and 2.869 (2.076, 3.966)/2.765 (1.996, 3.828), respectively, compared with the lowest quartile; the multivariate adjusted odds ratios of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.088(0.711, 1.665)/1.436(0.94, 2.193), 1.328(0.877, 2.011)/1.647(1.092, 2.485) and 2.336(1.579, 3.458)/3.079 (2.049, 4.623), respectively, compared with the lowest quartile. However, no association between serum bilirubin levels and short-term clinical outcomes was observed in our study.Conclusion:Serum bilirubin levels were associated with initial stroke severity closely. Nevertheless, there is no significant relationship between serum bilirubin levels and short-term clinical outcomes among acute ischemic stroke patients.

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