Abstract TP348: Extraventricular Drain Placement is Associated With Improved Outcome After Intracerebral Hemorrhage With Intraventricular Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Andrew D Warren ◽  
Qi Li ◽  
Kristin Schwab ◽  
Steven M Greenberg ◽  
Anand Viswanathan ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Medical Center ◽  
Obstructive Hydrocephalus ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Neurologic Outcome ◽  
Lower Mortality ◽  
Poor Outcome

Background and Aims: Many patients with intracerebral hemorrhage (ICH) develop intraventricular hemorrhage (IVH). External ventricular drains (EVDs) are commonly placed to treat obstructive hydrocephalus, but there is little data on how much patients benefit. We explored the use of EVD in ICH patients and any association with clinical outcome. Methods: We analyzed patients with primary ICH presenting to one academic medical center between 2000-2019. Patients with ICH secondary to trauma, aneurysm, and stroke were excluded. 3 month telephone interviews were used to assess clinical outcome. Good outcome was defined as 90 day modified Rankin score (mRS) of 0-3. Results: During this period 2,486 patients presented with primary ICH. Overall, patients were 73 (+/- 13) years old; 54% were male, 46% had IVH. Factors associated with IVH presence included ICH volume (29 cm 3 vs 9 cm 3 , p < 0.001), deep location (48% vs 37%, p < 0.001), and lower median Glasgow Coma Scale (GCS) score (9 vs 15, p < 0.001). IVH presence was associated with higher 90 day mortality (57% vs. 19%, p < 0.001) and poor outcome (86% vs 47%, p < 0.001). An EVD was placed in 29% of patients with IVH and 4% of those without. IVH patients with EVD were younger (67 +/- 13 vs 74 +/- 13, p < 0.001), had larger IVH volumes (17 cm 3 vs 8 cm 3 , p < 0.001), and had lower GCS scores (7 vs 10, p < 0.001) compared to other IVH patients. In univariate analysis, EVD placement was associated with poor outcome (88% vs 85%, p < 0.001) but lower 90 day mortality (53% vs 59%, p = 0.048). In multivariate analysis controlling for age, ICH and IVH volumes, and Comfort Measures Only (CMO) status, EVD placement was associated with lower 90 day mortality (OR 0.68, 95% CI 0.47 - 0.98, p = 0.041), and was associated with lower chance of poor outcome (OR 0.43, 95% CI 0.25 - 0.72, p = 0.002). However, when controlling for intubation, these associations were no longer seen with 90-day mortality (OR 1.07, 95% CI 0.72 - 1.60, p = 0.737) or with poor outcome (OR 0.68, 95% CI 0.38 - 1.23, p = 0.202). Conclusion: IVH is relatively common after ICH. In univariate analysis, EVD placement is associated with lower mortality but worse neurologic outcome. However, after controlling for potential confounding factors, EVD is associated with lower mortality and better neurologic outcome.

Nosocomial Infections in Patients With Spontaneous Intracerebral Hemorrhage

2015 ◽  
Vol 24 (3) ◽  
pp. 227-231 ◽  
Author(s):  
Archana Hinduja ◽  
Jamil Dibu ◽  
Eugene Achi ◽  
Anand Patel ◽  
Rohan Samant ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Intracerebral Hemorrhage ◽  
Nosocomial Infections ◽  
Odds Ratio ◽  
Intraventricular Hemorrhage ◽  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Percutaneous Gastrostomy ◽  
Poor Outcome

Background Nosocomial infections are frequent complications in patients with intracerebral hemorrhage. Objectives To determine the prevalence, risk factors, and outcomes of nosocomial infections in patients with intracerebral hemorrhage. Methods Prospectively collected data on patients with spontaneous intracerebral hemorrhage between January 2009 and June 2012 were retrospectively reviewed. Patients who had nosocomial infection during the hospital stay were compared with patients who did not. Poor outcome was defined as death or discharge to a long-term nursing facility. Results At least 1 nosocomial infection developed in 26% of 202 patients with intracerebral hemorrhage. The most common infections were pneumonia (18%), urinary tract infection (12%), meningitis or ventriculitis (3%), and bacteremia (1%). On univariate analysis, independent predictors of nosocomial infection were intraventricular hemorrhage, hydrocephalus, low score on the Glasgow Coma Scale at admission, hyperglycemia at admission, and treatment with mechanical ventilation. On multivariate regression analysis, the only significant predictor of nosocomial infection was intraventricular hemorrhage (odds ratio, 5.4; 95% CI, 1.2–11.4; P = .02). Patients with nosocomial infection were more likely than those without to require a percutaneous gastrostomy tube (odds ratio, 33.1, 95% CI, 23.3–604.4; P &lt; .001) and to have a longer stay in the intensive care unit or hospital without a significant increase in mortality. Patients with nosocomial pneumonia were also more likely to have a poor outcome (P &lt; .001). Conclusion Pneumonia was the most common infection among patients with intracerebral hemorrhage.

Evaluation of intraventricular hemorrhage assessment methods for predicting outcome following intracerebral hemorrhage

2012 ◽  
Vol 116 (1) ◽  
pp. 185-192 ◽  
Author(s):  
Brian Y. Hwang ◽  
Samuel S. Bruce ◽  
Geoffrey Appelboom ◽  
Matthew A. Piazza ◽  
Amanda M. Carpenter ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Receiver Operating Characteristic ◽  
Intraventricular Hemorrhage ◽  
Operating Characteristic ◽  
Medical Center ◽  
External Ventricular Drain ◽  
Characteristic Analysis ◽  
Poor Outcome ◽  
The Impact ◽  
Receiver Operating

Object Intraventricular hemorrhage (IVH) associated with intracerebral hemorrhage (ICH) is an independent predictor of poor outcome. Clinical methods for evaluating IVH, however, are not well established. This study sought to determine the best IVH grading scale by evaluating the predictive accuracies of IVH, Graeb, and LeRoux scores in an independent cohort of ICH patients with IVH. Subacute IVH dynamics as well as the impact of external ventricular drain (EVD) placement on IVH and outcome were also investigated. Methods A consecutive cohort of 142 primary ICH patients with IVH was admitted to Columbia University Medical Center between February 2009 and February 2011. Baseline demographics, clinical presentation, and hospital course were prospectively recorded. Admission CT scans performed within 24 hours of onset were reviewed for ICH location, hematoma volume, and presence of IVH. Intraventricular hemorrhage was categorized according to IVH, Graeb, and LeRoux scores. For each patient, the last scan performed within 6 days of ictus was similarly evaluated. Outcomes at discharge were assessed using the modified Rankin Scale (mRS). Receiver operating characteristic analysis was used to determine the predictive accuracies of the grading scales for poor outcome (mRS score ≥ 3). Results Seventy-three primary ICH patients (51%) had IVH. Median admission IVH, Graeb, and LeRoux scores were 13, 6, and 8, respectively. Median IVH, Graeb and LeRoux scores decreased to 9 (p = 0.005), 4 (p = 0.002), and 4 (p = 0.003), respectively, within 6 days of ictus. Poor outcome was noted in 55 patients (75%). Areas under the receiver operating characteristic curve were similar among the IVH, Graeb, and LeRoux scores (0.745, 0.743, and 0.744, respectively) and within 6 days postictus (0.765, 0.722, 0.723, respectively). Moreover, the IVH, Graeb, and LeRoux scores had similar maximum Youden Indices both at admission (0.515 vs 0.477 vs 0.440, respectively) and within 6 days postictus (0.515 vs 0.339 vs 0.365, respectively). Patients who received EVDs had higher mean IVH volumes (23 ± 26 ml vs 9 ± 11 ml, p = 0.003) and increased incidence of Glasgow Coma Scale scores < 8 (67% vs 38%, p = 0.015) and hydrocephalus (82% vs 50%, p = 0.004) at admission but had similar outcome as those who did not receive an EVD. Conclusions The IVH, Graeb, and LeRoux scores predict outcome well with similarly good accuracy in ICH patients with IVH when assessed at admission and within 6 days after hemorrhage. Therefore, any of one of the scores would be equally useful for assessing IVH severity and risk-stratifying ICH patients with regard to outcome. These results suggest that EVD placement may be beneficial for patients with severe IVH, who have particularly poor prognosis at admission, but a randomized clinical trial is needed to conclusively demonstrate its therapeutic value.

scholarly journals Predicting Poor Outcome of COVID-19 Patients on the Day of Admission with the COVID-19 Score

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Luke Tseng ◽  
Erin Hittesdorf ◽  
Mitchell F. Berman ◽  
Desmond A. Jordan ◽  
Nina Yoh ◽  
...  
Keyword(s):  
At Risk ◽  
Primary Endpoint ◽  
Laboratory Tests ◽  
Medical Center ◽  
Multiorgan Failure ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Binary Logistic Regression Model ◽  
Poor Outcome ◽  
Patients At Risk

Background. COVID-19 may result in multiorgan failure and death. Early detection of patients at risk may allow triage and more intense monitoring. The aim of this study was to develop a simple, objective admission score, based on laboratory tests, that identifies patients who are likely going to deteriorate. Methods. This is a retrospective cohort study of all COVID-19 patients admitted to a tertiary academic medical center in New York City during the COVID-19 crisis in spring 2020. The primary combined endpoint included intubation, stage 3 acute kidney injury (AKI), or death. Laboratory tests available on admission in at least 70% of patients (and age) were included for univariate analysis. Tests that were statistically or clinically significant were then included in a multivariate binary logistic regression model using stepwise exclusion. 70% of all patients were used to train the model, and 30% were used as an internal validation cohort. The aim of this study was to develop and validate a model for COVID-19 severity based on biomarkers. Results. Out of 2545 patients, 833 (32.7%) experienced the primary endpoint. 53 laboratory tests were analyzed, and of these, 47 tests (and age) were significantly different between patients with and without the endpoint. The final multivariate model included age, albumin, creatinine, C-reactive protein, and lactate dehydrogenase. The area under the ROC curve was 0.850 (CI [95%]: 0.813, 0.889), with a sensitivity of 0.800 and specificity of 0.761. The probability of experiencing the primary endpoint can be calculated as p = e − 2.4475 + 0.02492 age − 0.6503 albumin + 0.81926 creat + 0.00388 CRP + 0.00143 LDH / 1 + e − 2.4475 +   0.02492 age − 0.6503 albumin + 0.81926 creat + 0.00388 CRP + 0.00143 LDH . Conclusions. Our study demonstrated that poor outcome in COVID-19 patients can be predicted with good sensitivity and specificity using a few laboratory tests. This is useful for identifying patients at risk during admission.

Abstract WP361: Sex Differences in Intracerebral Hemorrhage Severity and Mortality

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sandro Marini ◽  
Andrea Morotti ◽  
Alison M Ayres ◽  
Katherine Crawford ◽  
Nicolette H Friedman ◽  
...  
Keyword(s):  
Sex Differences ◽  
Intracerebral Hemorrhage ◽  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Case Fatality ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
One Year

Background and objective: Due to conflicting results in multiple studies, uncertainty remains regarding sex differences in incidence, pathophysiology, and outcome after intracerebral hemorrhage (ICH). We investigated the differential impact of sex on ICH severity and mortality. Methods: We analyzed prospectively collected ICH patients ascertained between 1994 and 2015 at a single tertiary care academic medical center. Clinical variables including past medical history, medications, hemorrhage characteristics, and case-fatality rate at 90 days and one year were assessed. Categorical and continuous characteristics were compared between sexes using chi-square test and t-test, respectively. Multivariable logistic regression was used to examine associations between sex and ICH severity as well as outcome. Results: A total of 2403 patients were investigated: 1292 (53.8 %) male and 1111 female (46.2%). Men with ICH were younger (72 vs. 77 years), had greater smoking and alcohol use, and were more likely to have hypertension, diabetes, hypercholesterolemia and coronary artery disease (all p< 0.05), consistent with previous studies. Lobar hemorrhages frequency was higher in women compared to men (46.5% lobar hemorrhages in women vs 37.1% lobar hemorrhages in men, p<0.001). Hematoma expansion was more frequent in men (19% vs. 12.5%, p=0.001) in univariate analysis, and after controlling for admission INR, time from onset to CT, baseline hematoma volume, spot sign and blood pressure values, men continued to demonstrate a higher risk of hematoma expansion (Odds Ratio [OR] 1.98, 95% confidence interval [CI] 1.11 - 3.52, p=0.020). The overall case fatality at 90 days was 37.4%. Controlling for univariate differences and known predictors of mortality, male sex was independently associated with both 90-day (OR 1.53, CI 1.05 - 2.23, p=0.025) and one year mortality (OR 1.80, CI 1.20 - 2.69, p=0.005). Conclusions: Sex independently affects early ICH expansion and outcome after ICH, with men experiencing a higher risk of both expansion as well as early and late mortality. Further research is needed to explore the biological mechanisms mediating these observed differences.

scholarly journals Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

2018 ◽  
Vol 128 (4) ◽  
pp. 1032-1036 ◽  
Author(s):  
Ha Son Nguyen ◽  
Luyuan Li ◽  
Mohit Patel ◽  
Shekar Kurpad ◽  
Wade Mueller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Intraventricular Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Ventricular System ◽  
Fisher Grade ◽  
Gcs Score

OBJECTIVEThe presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores.METHODSThe authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1–3 and 4–5 subgroups for analysis.RESULTSOn univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895–0.979), GCS score (OR 3.422, 95% CI 1.9–6.164), and ventricular density (OR 0.937, 95% CI 0.878–0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1–3 and 4–5.CONCLUSIONSThis study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

EARLY PREDICTION OF ACUTE ISCHEMIC STROKE OUTCOME BY USING ALBERTA STROKE PROGRAM EARLY CT SCORE (ASPECTS)

2014 ◽  
pp. 168-176
Author(s):  
Vu Xuan Loc Doan ◽  
Thanh Thao Nguyen ◽  
Minh Loi Hoang ◽  
Trong Hao Vo
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Early Prediction ◽  
Stroke Outcome ◽  
Good Outcome ◽  
Poor Outcome

Background and Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) scale semiquantitatively assesses extent and location of ischemic changes within the middle cerebral artery (MCA) territory using a 10-point grading system. ASPECTS measured at baseline using noncontrast computed tomography (CT) scan. The aim of this study was to assess early prediction of clinical outcome after acute ischemic stroke by ASPECTS scale. Methods: The study based on convenience sample which included 82 first-ever acute ischemic stroke patients, admitted to Hue Central Hospital within 72 hours of stroke onset, from October 2013 to October 2014. Ischemic territory changes were defined as parenchymal CT hypoattenuation. We assessed all baseline CT scans, dichotomized ASPECTS at ≤ 7 and >7, defined good outcome (0 to 2) and poor outcome (3 to 6) as modified Rankin Scale (mRS) score at discharge. Univariate analysis and multivariable logistic regression analysis were performed to define the independent predictors for stroke outcome. Results: Mean age was 68.35 ± 13.93 years, proportion of male (51.2%) and female (48.8%) are approximately the same. ASPECTS score > 7 in 57 patients and ≤ 7 in 25 patients. Mean ASPECTS was 7.51 ± 2.25. Mean mRS at discharge was 2.28 ± 1.33. Good outcome (mRS ≤ 2) and poor outcome (mRS > 2) at discharge were 63.4% and 36.6% respectively. There is a negative correlation between ASPECTS and mRS (r = -0.86, p < 0.001). In the univariate analysis, atrial fibrillation, Glasgow Coma Scale (GCS) score at admisison, ASPECT score and infarct volume were significantly associated with stroke outcome. All of aforementioned variables underwent multivariate analysis, but none of them was proven to be an independent predictor of early outcome. Conclusion: In patients with first-ever acute ischemic stroke, ASPECT score which bases on conventional computed tomography scan is not independent predictor for clinical outcome at discharge. Key words: ischemic stroke, ASPECTS, outcome

scholarly journals Readmission Rates and Medication Selection for Patients with Heart Failure Preserved Ejection Fraction

2020 ◽  
Author(s):  
Troy Kramer ◽  
Carrie Vogler ◽  
Robert Robinson ◽  
Mukul Bhattarai
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Prescribing Patterns ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression ◽  
Readmission Rates

Purpose Heart failure with preserved ejection fraction (HFpEF) has less guideline driven treatment options due to a lack of trials demonstrating medications with improved clinical outcomes for this patient population. The primary objective of this study is to determine which medications and dosages are related to high readmission rates for HFpEF patients. Methods A retrospective, single center, chart review was performed on patients with HFpEF at an academic medical center. Heart failure patients ages between 18-89 with an ejection fraction ≥45% from a transthoracic echocardiogram (TTE) were included. Primary outcomes include 30-day all cause readmission rates, prescribing patterns, and avoidance of potentially harmful medications. Descriptive statistics and multivariate logistic regression were used to assess potential risk factors. Results This study analyzed 455 patient admissions. Univariate analysis shows patients who were not readmitted were more likely to be on furosemide (54% vs 42%; p = 0.019). Conversely, readmitted patients were more likely to be taking bumetanide (4% vs 1%; p = 0.039). Lisinopril was the only angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) associated with lower readmission rates (p = 0.036). Multivariate logistic regression showed bumetanide on admission (OR 14.6, p = 0.001), discharged on rosuvastatin (OR 6.29, p = 0.003) and meloxicam therapy (OR 6.33, p = 0.003) to be independent predictors of hospital readmission. Conclusion Three independent pharmacologic predictors for 30-day readmissions for patients with HFpEF were therapy with bumetanide, meloxicam, or rosuvastatin. Further research is needed to clarify the significance of these results.

Lack of tumour pigmentation in conjunctival melanoma is associated with light iris colour and worse prognosis

2018 ◽  
Vol 103 (3) ◽  
pp. 332-337 ◽  
Author(s):  
Niels J Brouwer ◽  
Marina Marinkovic ◽  
Gregorius P M Luyten ◽  
Carol L Shields ◽  
Martine J Jager
Keyword(s):  
Clinical Outcome ◽  
Medical Center ◽  
Univariate Analysis ◽  
Skin Colour ◽  
Metastasis Formation ◽  
Conjunctival Melanoma ◽  
Dark Colour ◽  
Colour Skin ◽  
Worse Prognosis ◽  
Iris Colour

AimTo investigate whether differences in iris colour, skin colour and tumour pigmentation are related to clinical outcome in conjunctival melanoma.MethodsData of 70 patients with conjunctival melanoma from the Leiden University Medical Center (Leiden, The Netherlands) and 374 patients from the Wills Eye Hospital (Philadephia, USA) were reviewed. The relation between iris colour, skin colour and tumour pigmentation versus clinical parameters and outcome was investigated using univariate and multivariate regression analyses.Results A light iris colour (blue, grey, green) was present in 261 (59%) patients and a dark colour (hazel, brown) in 183 (41%). A low tumour pigmentation was detected in 130 (40%) and a high pigmentation in 197 (60%) patients. Low tumour pigmentation was associated with light iris colour (p=0.021) but not related to skin colour (p=0.92). In univariate analysis, neither iris nor skin colour was related to clinical outcome, while a low tumour pigmentation was related to metastasis formation (HR 2.37, p=0.004) and death (HR 2.42, p=0.020). In multivariate analysis, low tumour pigmentation was related to the development of recurrences (HR 1.63, p=0.043), metastasis formation (HR 2.48, p=0.004) and death (HR 2.60, p=0.014).Conclusion Lightly pigmented tumours occurred especially in individuals with lightly coloured irises. While iris colour or skin colour was not significantly related to clinical outcome, a low tumour pigmentation was related to a worse outcome in patients with conjunctival melanoma. The amount and type of melanin in conjunctival melanocytes may be involved in the pathogenesis and behaviour of selected conjunctival melanoma.

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