Abstract W P160: Elevated Lipoprotein A Levels Predict Worse Short-term Outcomes in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Alyana A Samai ◽  
Dominique J Monlezun ◽  
Amir Shaban ◽  
Alexander George ◽  
Janelle Cyprich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Serum Levels ◽  
Stroke Severity ◽  
Short Term ◽  
Poor Functional Outcome ◽  
Lipoprotein A ◽  
Stroke Registry ◽  
History Of

Background: Lipoprotein A (Lp(a)) is a risk factor for vascular disease; however, few studies have examined the relationship between serum levels of Lp(a) and patient outcomes in acute ischemic stroke (AIS). In this study, we sought to assess whether AIS patients with elevated Lp(a) levels exhibit characteristic differences in stroke severity, in-hospital complications, and short-term outcomes as compared to patients with normal Lp(a) levels. Methods: From our prospective stroke registry, patients consecutively admitted and diagnosed with AIS 07/2008-10/2013 were included if Lp(a) levels were measured during admission. Regressions, adjusting for key covariates, analyzed outcomes in patients with elevated (+) and severely elevated (++) Lp(a) with respect to normal (-) Lp(a). The primary outcome was poor functional outcome (modified Rankin Scale > 2) on discharge. Results: Among the 1,453 patients in our stroke registry, 159 patients met our inclusion criteria; 24 patients (15.1%) were in the +Lp(a) group and 37 patients (23.3%) in the ++Lp(a) group. After adjustment for total cholesterol, LDL, HDL, and triglycerides, patients with ++Lp(a) were more than twice as likely to experience poor functional outcome (OR=2.48, 95% CI 1.0781-5.7231, p=0.033) as those with -Lp(a). Adjusting for age, NIHSS baseline, history of diabetes, admission glucose level, and tPA administration, patients with ++Lp(a) were more than 2.5 times more likely to experience poor functional outcome (OR=2.59, 95% CI 1.0129-6.6282, p=0.047) as compared to those with -Lp(a). Conclusions: Lp(a) elevation predicts higher odds of poor functional outcomes for patients with AIS compared to patients with normal levels. Our findings support the utility of Lp(a) level as a clinically useful biomarker in the development of patient risk profiles.

Abstract TP207: Pre-stroke Dementia is Associated With Poor Functional Outcome After Acute Ischemic Stroke: The Fukuoka Stroke Registry

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Junya Hata ◽  
Junya Kuroda ◽  
Tetsuro Ago ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Increased Risk

Introduction: With an aging population, an increased number of acute stroke patients with pre-stroke dementia is expected. Although both stroke and dementia are major cause of disability, the effect of pre-stroke dementia on functional outcome after stroke has been still on debate. Hypothesis: Pre-stroke dementia is associated with poor functional outcome after acute ischemic stroke. Methods: Of 9198 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 2007 to May 2014, 3843 patients with first-ever ischemic stroke within 24h of onset, who had been functionally independent before the onset, were enrolled in this study (cardioembolism [n=926], large artery atherosclerosis [n=583], small vessel occlusion [n=1045], others [n=1289]). Pre-stroke dementia was defined as any type of dementia that was present prior to the stroke. For propensity score (PS)-matched analysis, 320 pairs of patients with and without pre-stroke dementia were also selected. Study outcome was poor functional outcome (modified Rankin Scale 3-6) at discharge. Results: In the total cohort, 330 (8.6%) had pre-stroke dementia. The age (80±8 vs 69±13, year, mean±SD, p<0.01), frequencies of female (46 vs 36, %, p<0.01) and cardioembolism (41 vs 23, %, p<0.01), and NIHSS score on admission (6 [3 - 12] vs 3 [1 - 6], median [interquartile], p<0.01) were higher in patients with pre-stroke dementia than those without the dementia. Poor functional outcome (62 vs 25, %, p<0.01) were more prevalent in patients with pre-stroke dementia than those without the dementia. Multivariable-adjusted analysis showed that pre-stroke dementia was significantly associated with increased risk for poor functional outcome (OR 2.3, 95% CI 1.7-3.2). There were no interactions between pre-stroke dementia and 4 variables (age, sex, stroke subtype, and initial stroke severity [NIHSS≤7 or NIHSS≥8]). In the PS-matched analysis, pre-stroke dementia was still associated with poor functional outcome (OR 4.3, 95%CI 2.1-8.8). Conclusions: Pre-stroke dementia was significantly associated with poor functional outcome at discharge in patients with acute ischemic stroke.

Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry

2021 ◽  
pp. 1-7
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Kuniyuki Nakamura ◽  
Tetsuro Ago ◽  
Masahiro Kamouchi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neurological Deterioration ◽  
Stroke Outcome ◽  
Matched Cohort ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Chei Treatment

Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3–6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46–0.99]) and neurological deterioration (0.52 [0.31–0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40–0.92]) and between the treatment and neurological deterioration (0.47 [0.25–0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.

scholarly journals Evaluation of serum retinol-binding protein-4 levels as a biomarker of poor short-term prognosis in ischemic stroke

2018 ◽  
Vol 38 (5) ◽  
Author(s):  
Yan-yan Zhu ◽  
Jian-long Zhang ◽  
Li Liu ◽  
Yingbo Han ◽  
Xiaomin Ge ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Serum Levels ◽  
Retinol Binding Protein ◽  
Short Term ◽  
Poor Functional Outcome ◽  
Nihss Score ◽  
Retinol Binding Protein 4 ◽  
The Poor ◽  
Poor Outcomes

The aim was to investigate the relationship between retinol-binding protein 4 (RBP4) levels and short-term functional outcome, and to determine its possible role in acute ischemic stroke (AIS). In a prospective observational study, 299 first-ever AIS who were admitted to our hospital were included. Serum levels of RBP4 were assayed and severity of stroke was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score on admission. The prognostic value of RBP4 to predict the poor outcome within 3 months was compared with the NIHSS and with other known outcome predictors. The median age of the included patients was 66 (interquartile range (IQR): 55–77) years and 155 (51.8%) were women. A poor functional outcome was found in 88 patients (29.4%), and significantly higher RBP4 values were found in poor outcomes rather than good outcomes patients (P<0.001). The poor outcomes distribution across the RBP4 quartiles ranged between 9.3% (first quartile) and 60.8% (fourth quartile). In multivariate models comparing the second(Q2), third, and fourth quartiles against the first quartile of the RBP4, RBP4 in Q3 and Q4 were associated with poor functional outcome, and increased risk of poor functional outcome by 144% (OR: 2.44; 95% confidence interval (CI): 1.22–5.03) and 602% (7.02; 3.11–12.24), respectively. Interestingly, RBP4 improved the NIHSS score (area under the curve (AUC) of the combined model, 0.79; 95% CI: 0.74–0.85; P<0.001). The data showed that elevated serum levels of RBP4 at admission were associated with severity and prognosis of AIS, suggesting that vitamin A metabolism or impaired insulin signaling could be involved.

scholarly journals Elevated plasma D-dimer level is associated with short-term poor outcome in patients with acute ischemic stroke: a prospective, observational study

2019 ◽  
Author(s):  
Tao Yao ◽  
Bo-Lin Tian ◽  
Gang Li ◽  
QIN CUI ◽  
Cui-fang Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Laboratory ◽  
Predictive Marker ◽  
Stroke Severity ◽  
Elevated Plasma ◽  
Short Term ◽  
Poor Outcome ◽  
D Dimer

Abstract Background Elevated level of D-dimer increases the risk of ischemic stroke, stroke severity and progression of stroke status, but the association between D-dimer and functional outcome is unclear. The aim of this study is to investigate whether Plasma D-dimer level is a determinant of short-term poor functional outcomes in patients with acute ischemic stroke (AIS). Methods This prospective study included 877 patients with AIS provided plasma D-dimer level after stroke onset. Patients were categorized per D-dimer level: Quartile 1(≤0.24 mg /L), Quartile 2 (0.25–0.56 mg /L), Quartile 3 (0.57–1.78 mg /L), and Quartile 4 (>1.78mg /L). Each patient’s medical record was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted. Functional outcome at 90 days was assessed with the modified Rankin Scale (mRS). Results Of 877 patients were included (mean age, 64 years; male, 68.5%), poor outcome was present in 302 (34.4%) patients. After adjustment for potential confounding variables, higher D-dimer level on admission was associated with poor outcome (adjusted odds ratio [aOR] 2.257, 95% CI1.349-3.777 for Q4:Q1; P trend = 0.004). According to receiver operating characteristic (ROC) analysis, the best discriminating factor was a D-dimer level ≥0.315 mg/L for pour outcome [area under the ROC curve (AUC) 0.657; sensitivity 83.8%; specificity 41.4%]. Conclusion Elevated plasma D-dimer level on admission was significantly associated with increased poor outcome after admission for AIS, suggesting the potential role of D-dimer as a predictive marker for short-term poor outcomes in patients with AIS.

Abstract WP168: Neutrophil to Lymphocyte Ratio is a Useful Predictor of Short-term Functional Outcome in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Tae Jung Kim ◽  
Min-Kyung Kang ◽  
Kiwoong Nam ◽  
Heejung Mo ◽  
Sang Joon An ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cardiovascular Diseases ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Unfavorable Outcome ◽  
Neutrophil To Lymphocyte Ratio ◽  
Short Term ◽  
Lymphocyte Ratio ◽  
Outcome Group ◽  
History Of

Introduction: Inflammation is associated with the initiation and progression of cardiovascular diseases. The neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a prognostic marker in cardiovascular diseases. However, impact of NLR on the functional outcome in patients with ischemic stroke remains unclear. Hypothesis: The aim of the study was to investigate the prognostic role of the NLR in patients with acute ischemic stroke. Methods: A consecutive 1,113 patients who were admitted within 7 days after ischemic stroke onset between March 2010 and December 2014 were included for analysis. The patients were categorized into tertiles on the basis of NLR. We evaluated the short-term outcomes using a modified Rankin Scale (mRS) at three-months after onset of ischemic stroke. We divided patients into two groups with favorable outcome (mRS score ≤2) and unfavorable outcome (mRS score ≥3). We compared the clinical characteristics and NLR between two groups. Results: From all the patients included in this study (mean age, 67.8 years; men, 60.0%), 284 (25.5%) patients had unfavorable outcome. The patients with unfavorable outcome were older and more likely to have atrial fibrillation, history of previous stroke, and diabetes mellitus. In addition, participants with unfavorable outcome tended to have lower body mass index and higher initial NIHSS. The percentage values of the tertile 3 were significantly higher in the unfavorable outcome group (28.3% vs. 47.9%, P < 0.001). After adjustment for covariates, the highest tertile were at an exaggerated risk for unfavorable outcome [Odds ratio (95% confidence interval); tertile 3, 1.75 (1.17 - 2.63), P = 0.007]. Conclusions: This study demonstrated that higher NLR predicted worse outcome at 3 months following acute ischemic stroke. This suggests that NLR could be a useful and reliable prognostic biomarker following acute ischemic stroke.

scholarly journals Fibrinogen Level Predicts Prognosis of Patients with Acute Ischemic Stroke or TIA

2020 ◽  
Author(s):  
Huiqing Hou ◽  
Xianglong Xiang ◽  
Yuesong Pan ◽  
Hao Li ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Fibrinogen Level ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Poor Functional Outcome ◽  
Stroke Registry

Abstract Background: Fibrinogen is involved in acute stroke. This study aimed to investigate the association between fibrinogen and prognosis in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Using data from the CNSR-Ⅲ (Third China National Stroke Registry), this sub-study included 10 518 (69%) consecutive patients who had fibrinogen levels measured. The primary outcome was a poor functional outcome defined as modified Rankin Scale score of 3 to 6 within 90 days. The secondary outcomes were stroke recurrence, ischemic stroke recurrence, composite vascular events, and poor functional outcome during the 1-year follow-up and a new vascular event at 90 days. Multivariate logistic regression and Cox regression analyses were used to assess the associations between fibrinogen and prognosis of patients. Results: In total, 1446 (13.9%) patients had a poor functional outcome at 90 days. High fibrinogen levels were associated with poor functional outcome (adjusted odds ratio [OR], 1.35; 95% confidence interval [CI], 1.12-1.64) at 90 days after adjustment for confounding risk factors. High fibrinogen levels also independently predicted poor functional outcome during the 1-year follow-up. Stroke recurrence occurred in 657 (6.3%) patients at 90 days. High fibrinogen levels were associated with stroke recurrence, ischemic stroke recurrence, and composite vascular events in the crude model, but further adjustment eliminated these associations in the multivariate models. Conclusion: Our study showed that high fibrinogen level was independently associated with poor functional outcome but not with stroke recurrence in patients with acute ischemic stroke or TIA.

scholarly journals Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Stroke Severity and Short-Term Prognosis in Acute Ischemic Stroke With Intracranial Atherosclerotic Stenosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yuanlin Ying ◽  
Fang Yu ◽  
Yunfang Luo ◽  
Xianjing Feng ◽  
Di Liao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stroke Severity ◽  
Short Term ◽  
Severe Stroke ◽  
Lymphocyte Ratio ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis

Background: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of poor prognosis in acute ischemic stroke (AIS), but associations between NLR with stroke severity and prognosis of intracranial atherosclerotic stenosis (ICAS)-related ischemic events have not been well-elucidated; therefore, we aimed to evaluate whether admission NLR levels correlate with the early stroke severity and short-term functional prognosis in patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods: This retrospective study enrolled 899 consecutive patients with AIS attributed to ICAS at Xiangya Hospital stroke center between May 2016 and September 2020. The initial stroke severity was rated by the admission National Institutes of Health Stroke Scale (NIHSS) scores, and the short-term prognosis was evaluated using the 14-day modified Rankin Scale (mRS) scores after stroke onset. A severe stroke was defined as NIHSS &gt;8; an unfavorable functional outcome was defined as mRS scores of 3–6. Admission NLR was determined based on circulating neutrophil and lymphocyte counts.Results: The median admission NLR of all patients was 2.80 [interquartile range (IQR), 2.00–4.00]. In univariate analysis, admission NLR was significantly elevated in patients with severe stroke and poor short-term prognosis. After multivariate adjustment, admission NLR levels were significantly correlated with severe stroke [odds ratio (OR), 1.132; 95% confidence interval (95% CI), 1.038–1.234; P = 0.005] and unfavorable short-term prognosis (OR, 1.102; 95% CI, 1.017–1.195; P = 0.018) in Model 1. In Model 2, the highest NLR tertile (≥3.533) remained an independent predictor of severe stroke (OR, 2.736; 95% CI, 1.590–4.708; P &lt; 0.001) and unfavorable functional outcome (OR, 2.165; 95% CI, 1.416–3.311; P &lt; 0.001) compared with the lowest NLR tertile (&lt;2.231). The receiver operating characteristic (ROC) curves showed the predictability of NLR regarding the stroke severity [area under the curve (AUC), 0.659; 95% CI, 0.615–0.703; P &lt; 0.001] and short-term prognosis (AUC, 0.613; 95% CI, 0.575–0.650; P &lt; 0.001). The nomograms were constructed to create the predictive models of the severity and short-term outcome of sICAS.Conclusions: Elevated admission NLR levels were independently associated with the initial stroke severity and could be an early predictor of severity and poor short-term prognosis in AIS patients with ICAS, which might help us identify a target group timely for preventive therapies.

scholarly journals Elevated plasma D-dimer level is associated with short-term poor outcome in patients with acute ischemic stroke: a prospective, observational study

2019 ◽  
Author(s):  
Tao Yao ◽  
Bo-Lin Tian ◽  
Gang Li ◽  
QIN CUI ◽  
Cui-fang Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Laboratory ◽  
Chinese Patients ◽  
Stroke Severity ◽  
Elevated Plasma ◽  
Short Term ◽  
Poor Outcome ◽  
D Dimer

Abstract Background: Elevated level of plasma D-dimer increases the risk of ischemic stroke, stroke severity and progression of stroke status, but the association between plasma D-dimer level and functional outcome is unclear. The aim of this study is to investigate whether Plasma D-dimer level is a determinant of short-term poor functional outcome in patients with acute ischemic stroke (AIS). Methods: This prospective study included 877 Chinese patients with AIS admitted to Renmin Hospital of Wuhan University within 72 hours of symptom onset. Patients were categorized per plasma D-dimer level: Quartile 1(0.24 mg /L), Quartile 2 (0.25–0.56 mg /L), Quartile 3 (0.57–1.78 mg /L), and Quartile 4 (1.78mg /L). Each patient’s medical record was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted. Functional outcome at 90 days was assessed with the modified Rankin Scale (mRS). Results: Of 877 patients were included (mean age, 64 years; male, 68.5%), poor outcome was present in 302 (34.4%) patients. After adjustment for potential confounding variables, higher plasma D-dimer level on admission was associated with poor outcome (adjusted odds ratio [aOR] 2.257, 95% CI1.349-3.777 for Q4:Q1; P trend = 0.004). According to receiver operating characteristic (ROC) analysis, the best discriminating factor was a plasma D-dimer level 0.315 mg/L for pour outcome [area under the ROC curve (AUC) 0.657; sensitivity 83.8%; specificity 41.4%]. Conclusion: Elevated plasma D-dimer level on admission was significantly associated with increased poor outcome after admission for AIS, suggesting the potential role of plasma D-dimer as a predictive marker for short-term poor outcome in patients with AIS.

Adverse Influence of Pre-Stroke Dementia on Short-Term Functional Outcomes in Patients with Acute Ischemic Stroke: The Fukuoka Stroke Registry

2016 ◽  
Vol 43 (1-2) ◽  
pp. 82-89 ◽  
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Jun Hata ◽  
Junya Kuroda ◽  
Takanari Kitazono ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neurological Deterioration ◽  
Stroke Onset ◽  
Matched Cohort ◽  
Poor Functional Outcome ◽  
Stroke Registry

Background: Dementia and stroke are major causes of disability in the elderly. However, the association between pre-stroke dementia and functional outcome after stoke remains unresolved. We aimed to determine this association in patients with acute ischemic stroke. Methods: Among patients registered in the Fukuoka Stroke Registry from June 2007 to May 2015, 4,237 patients with ischemic stroke within 24 h of onset, who were functionally independent before the onset, were enrolled in this study. Pre-stroke dementia was defined as any type of dementia that was present prior to the index stroke. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale 3-6) at 3 months after the stroke onset and neurological deterioration (≥2-point increases on the National Institutes of Health Stroke Scale score during hospitalization), respectively. For propensity score (PS)-matched cohort study to control confounding variables for pre-stroke dementia, 318 pairs of patients with and without pre-stroke dementia were also selected on the basis of 1:1 matching. Multivariable logistic regression models and conditional logistic regression analysis were used to quantify associations between pre-stroke dementia and study outcomes. Results: Of all 4,237 participants, 347 (8.2%) had pre-stroke dementia. The frequencies of neurological deterioration and poor functional outcome were significantly higher in patients with pre-stroke dementia than in those without pre-stroke dementia (neurological deterioration, 16.1 vs. 7.1%, p < 0.01; poor functional outcome, 63.7 vs. 27.1%, p < 0.01). Multivariable analysis showed that pre-stroke dementia was significantly associated with neurological deterioration (OR 1.67; 95% CI 1.14-2.41; p < 0.01) and poor functional outcome (OR 2.91; 95% CI 2.17-3.91; p < 0.01). In the PS-matched cohort study, the same trends were observed between the pre-stroke dementia and neurological deterioration (OR 2.60; 95% CI 1.17-5.78; p < 0.01) and between the dementia and poor functional outcome (OR 3.62; 95% CI 1.89-6.95; p < 0.01). Conclusions: Pre-stroke dementia was significantly associated with higher risks for poor functional outcome at 3 months after stroke onset as well as for neurological deterioration during hospitalization in patients with acute ischemic stroke.

Insulin resistance and clinical outcomes after acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 90 (17) ◽  
pp. e1470-e1477 ◽  
Author(s):  
Tetsuro Ago ◽  
Ryu Matsuo ◽  
Jun Hata ◽  
Yoshinobu Wakisaka ◽  
Junya Kuroda ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Scale Score ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Model Assessment ◽  
Poor Functional Outcome

ObjectiveIn this study, we aimed to determine whether insulin resistance is associated with clinical outcomes after acute ischemic stroke.MethodsWe enrolled 4,655 patients with acute ischemic stroke (aged 70.3 ± 12.5 years, 63.5% men) who had been independent before admission; were hospitalized in 7 stroke centers in Fukuoka, Japan, from April 2009 to March 2015; and received no insulin therapy during hospitalization. The homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated using fasting blood glucose and insulin levels measured 8.3 ± 7.8 days after onset. Study outcomes were neurologic improvement (≥4-point decrease in NIH Stroke Scale score or 0 at discharge), poor functional outcome (modified Rankin Scale score of ≥3 at 3 months), and 3-month prognosis (stroke recurrence and all-cause mortality). Logistic regression analysis was used to evaluate the association of the HOMA-IR score with clinical outcomes.ResultsThe HOMA-IR score was associated with neurologic improvement (odds ratio, 0.68 [95% confidence interval, 0.56–0.83], top vs bottom quintile) and with poor functional outcome (2.02 [1.52–2.68], top vs bottom quintile) after adjusting for potential confounding factors, including diabetes and body mass index. HOMA-IR was not associated with stroke recurrence or mortality within 3 months of onset. The associations were maintained in nondiabetic or nonobese patients. No heterogeneity was observed according to age, sex, stroke subtype, or stroke severity.ConclusionsThese findings suggest that insulin resistance is independently associated with poor functional outcome after acute ischemic stroke apart from the risk of short-term stroke recurrence or mortality.

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