Abstract WP355: Recurrent Stroke is an Independent Risk Factor for Ischemic Stroke Prognosis

Introduction: Recurrent ischemic stroke is more likely to have a worse prognosis. However, it is little known whether recurrent stroke is an independent risk factor for poor prognosis. We aim to investigate the difference of mortality and recurrent rate of first ever and recurrent ischemic strokes, as well as to explore the potential reasons. Method: We analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008. Date including hypertension, diabetes mellitus, hyperlipidemia, heart disease, etc. were obtained from paper-based registry forms. Multivariable analysis using logistic regression was performed to assess the risk of worse prognosis of recurrent ischemic stroke compared to first-ever stroke. Result: A total of 8 181 patients with first-ever stroke and 4 234 patients with recurrent stroke were enrolled in the study. For patients with first-ever stroke, the mortality, recurrence, composite Events(modified Rankin Scale=3-6, which means death or disability) rate is 7.2%, 10.3%, 22.6%, respectively at 3-month; and 9.0%, 13.0%, 29.0% at 6-month; as well as 11.4%, 14.7%, 28.5% at 1 year, respectively. For patients with recurrent stroke, the mortality, recurrence, composite events rate is 10.5%, 16.1%, 30.8% respectively at 3-month, and 13.9%, 20.3%, 41.7% at 6-month, as well as 17.3%, 23.6%, 42.1% at 1 year, respectively. Multivariable analysis showed that patients with recurrent stroke had a higher risk of death, recurrence and disability at 3-month, 6 month and 1 year (table 1). Conclusion: After adjusting for multiple risk factors, recurrent stroke is still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke, and the specific causes need to be furtherly investigated.

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Stroke History is an Independent Risk Factor for Poor Prognosis in Ischemic Stroke Patients: Results from a Large Nationwide Stroke Registry

Current Neurovascular Research ◽

10.2174/1567202617666200817141837 ◽

2020 ◽

Vol 17 (4) ◽

pp. 487-494

Author(s):

Haiqiang Qin ◽

Penglian Wang ◽

Runhua Zhang ◽

Miaoxin Yu ◽

Guitao Zhang ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Poor Prognosis ◽

Independent Risk Factor ◽

Multivariable Analysis ◽

Stroke Patients ◽

Stroke Registry ◽

Risk Of Death ◽

History Of ◽

The Difference

Background: There is some controversy whether stroke history is an independent risk factor for poor prognosis of stroke or not. This study aimed to investigate the difference of mortality, disability and recurrent rate of ischemic stroke patients without and with stroke history, as well as to explore the effect of stroke history on stroke prognosis. Methods: We analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008. Multivariable logistic regression was performed to assess the risk of worse prognosis of stroke history in patients with ischemic stroke. Results: A total of 8181(65.9%) patients without stroke history and 4234(34.1%) patients with stroke history were enrolled in the study. The mortality, recurrence, modified Rankin Scale (mRS) 3-6 rate was 11.4%, 14.7% and 28.5% respectively at 1 year for patients without stroke history, which was significantly lower than that of 17.3%, 23.6%, 42.1% in patients with stroke history, respectively. Multivariable analysis showed that patients with stroke history had higher risk of death [odds ratio (OR) 1.34,95% confidence interval (CI) 1.17-1.54], recurrence (OR 1.47, 95 % CI 1.31-1.65) and mRS 3-6 (OR 1.49,95% CI 1.34-1.66) at 1 year. Conclusion: After adjusting for the potential confounders, stroke history was still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke. The specific causes of poor prognosis in patients with history of stroke need to be furtherly investigated.

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One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients

Cerebrovascular Diseases ◽

10.1159/000495418 ◽

2019 ◽

Vol 47 (1-2) ◽

pp. 40-47 ◽

Cited By ~ 3

Author(s):

Adnan I. Qureshi ◽

Mushtaq H. Qureshi ◽

Li-Ming Lien ◽

Jiunn-Tay Lee ◽

Jiann-Shing Jeng ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Recurrent Stroke ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Large Artery ◽

Stroke Registry ◽

Risk Of Death ◽

Vertebrobasilar Artery

Background: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. Methods: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0–49%; moderate to severe: 50–99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. Results: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01–1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99–2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72–2.83), among patients with VBA occlusion after adjustment of potential confounders. Conclusions: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.

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Overexpressed XRCC2 as an independent risk factor for poor prognosis in glioma patients

Molecular Medicine ◽

10.1186/s10020-021-00316-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Zhendong Liu ◽

Wang Zhang ◽

Xingbo Cheng ◽

Hongbo Wang ◽

Lu Bian ◽

...

Keyword(s):

Risk Factor ◽

Expression Pattern ◽

Poor Prognosis ◽

Independent Risk Factor ◽

Cox Regression ◽

Enrichment Analysis ◽

Gene Set Enrichment Analysis ◽

Cellular Mechanisms ◽

Molecular Features ◽

Meta Analyses

Abstract Background XRCC2, a homologous recombination-related gene, has been reported to be associated with a variety of cancers. However, its role in glioma has not been reported. This study aimed to find out the role of XRCC2 in glioma and reveal in which glioma-specific biological processes is XRCC2 involved based on thousands of glioma samples, thereby, providing a new perspective in the treatment and prognostic evaluation of glioma. Methods The expression characteristics of XRCC2 in thousands of glioma samples from CGGA and TCGA databases were comprehensively analyzed. Wilcox or Kruskal test was used to analyze the expression pattern of XRCC2 in gliomas with different clinical and molecular features. The effect of XRCC2 on the prognosis of glioma patients was explored by Kaplan–Meier and Cox regression. Gene set enrichment analysis (GSEA) revealed the possible cellular mechanisms involved in XRCC2 in glioma. Connectivity map (CMap) was used to screen small molecule drugs targeting XRCC2 and the expression levels of XRCC2 were verified in glioma cells and tissues by RT-qPCR and immunohistochemical staining. Results We found the overexpression of XRCC2 in glioma. Moreover, the overexpressed XRCC2 was associated with a variety of clinical features related to prognosis. Cox and meta-analyses showed that XRCC2 is an independent risk factor for the poor prognosis of glioma. Furthermore, the results of GSEA indicated that overexpressed XRCC2 could promote malignant progression through involved signaling pathways, such as in the cell cycle. Finally, doxazosin, quinostatin, canavanine, and chrysin were identified to exert anti-glioma effects by targeting XRCC2. Conclusions This study analyzed the expression pattern of XRCC2 in gliomas and its relationship with prognosis using multiple datasets. This is the first study to show that XRCC2, a novel oncogene, is significantly overexpressed in glioma and can lead to poor prognosis in glioma patients. XRCC2 could serve as a new biomarker for glioma diagnosis, treatment, and prognosis evaluation, thus bringing new insight into the management of glioma.

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Imipenem Resistance in Pseudomonas aeruginosa Emergence, Epidemiology, and Impact on Clinical and Economic Outcomes

Infection Control and Hospital Epidemiology ◽

10.1086/649021 ◽

2010 ◽

Vol 31 (1) ◽

pp. 47-53 ◽

Cited By ~ 69

Author(s):

Ebbing Lautenbach ◽

Marie Synnestvedt ◽

Mark G. Weiner ◽

Warren B. Bilker ◽

Lien Vo ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Risk Factor ◽

Hospital Stay ◽

Hospital Cost ◽

Independent Risk Factor ◽

Multivariable Analysis ◽

Economic Outcomes ◽

Imipenem Resistance ◽

Hospital Acquired ◽

Control Study

Background.Pseudomonas aeruginosa is one of the most common gram-negative hospital-acquired pathogens. Resistance of this organism to imipenem complicates treatment.Objective.To elucidate the risk factors for imipenem-resistant P. aeruginosa (IRPA) infection or colonization and to identify the effect of resistance on clinical and economic outcomes.Methods.Longitudinal trends in prevalence of IRPA from 2 centers were characterized during the period from 1989 through 2006. For P. aeruginosa isolates obtained during the period from 2001 through 2006, a case-control study was conducted to investigate the association between prior carbapenem use and IRPA infection or colonization, and a cohort study was performed to identify the effect of IRPA infection or colonization on mortality, length of stay after culture, and hospital cost after culture.Results.From 1989 through 2006, the proportion of P. aeruginosa isolates demonstrating resistance to imipenem increased from 13% to 20% (P< .001, trend). During the period from 2001 through 2006, there were 2,542 unique patients with P. aeruginosa isolates, and 253 (10.0%) had IRPA isolates. Prior carbapenem use was independently associated with IRPA infection or colonization (adjusted odds ratio [OR], 7.92 [95% confidence interval {CI}, 4.78-13.11]). Patients with an IRPA isolate recovered had higher in-hospital mortality than did patients with an imipenem-susceptible P. aeruginosa isolate (17.4% vs 13.4%; P = .01). IRPA infection or colonization was an independent risk factor for mortality among patients with isolates recovered from blood (adjusted OR, 5.43 [95% CI, 1.72-17.10]; P = .004) but not among patients with isolates recovered from other anatomic sites (adjusted OR, 0.78 [95% CI, 0.51-1.21]; P = .27). Isolation of IRPA was associated with longer hospital stay after culture (P<.001) and greater hospital cost after culture (P<.001) than was isolation of an imipenem-susceptible strain. In multivariable analysis, IRPA infection or colonization remained an independent risk factor for both longer hospital stay after culture (coefficient, 0.20 [95% CI, 0.04-0.36]; P = .02) and greater hospital cost after culture (coefficient, 0.30 [95% CI, 0.06-0.54]; P = .02).Conclusions.The prevalence of IRPA infection or colonization has increased significantly, with important implications for both clinical and economic outcomes. Interventions to curb this continued increase and strategies to optimize therapy are urgently needed.

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Abstract TP208: Sleep Disordered Breathing (SDB) - An Overlooked Modifiable Risk Factor in Acute Stroke Care

Stroke ◽

10.1161/str.48.suppl_1.tp208 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Vishal Shah ◽

Ashrai Gudlavalleti ◽

Julius G Latorre

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Modifiable Risk Factor ◽

Inclusion Criteria ◽

Risk Of Death ◽

Disordered Breathing

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.

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Abstract TP416: Comparative Effectiveness of Addition of Antiplatelet to Oral Anticoagulant in Acute Ischemic Stroke With Atrial Fibrillation

Stroke ◽

10.1161/str.51.suppl_1.tp416 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Joon-tae Kim ◽

Hee-Joon Bae ◽

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Oral Anticoagulant ◽

Recurrent Stroke ◽

Cox Proportional Hazards ◽

Large Artery ◽

Vascular Events ◽

Nihss Score ◽

Composite Events

Introduction: Atrial fibrillation (AF) and large artery diseases (LAD) share several risk factors and often coexist in the same patient. Optimal treatments for acute ischemic stroke (AIS) patients with concomitant AF and LAD have not been extensively studied so far. Objective: This study aimed to compare the effectiveness of the addition of antiplatelet (AP) to oral anticoagulant (OAC) with that of OAC alone in AIS with AF according to the LAD. Methods: Using a multicenter stroke registry, acute (within 48h of onset) and mild-to-moderate (NIHSS score ≤15) stroke patients with AF were identified. Propensity scores using IPTW were used to adjust baseline imbalances between the OAC+AP group and the OAC alone group in all patients and in each subgroup by LAD. The primary outcome was major vascular events, defined as the composite of recurrent stroke, MI, and all-cause mortality at up to 3 months after index stroke. Results: Among the 5469 patients (age, 72±10yrs; male, 54.9%; initial NIHSS score, 4 [2-9]), 79.0% (n=4323) received OAC alone, and 21.0% (n=1146) received OAC+AP. By weighted Cox proportional hazards analysis, a tendency of increasing the risk of 3-months primary composite events in the OAC+AP group vs the OAC alone (HR 1.36 [0.99-1.87], p=0.06), with significant interaction with treatments and LAD (Pint=0.048). Briefly, among patients with moderate-to-severe large artery stenosis, tendency of decrease in 3-months primary composite events of the OAC+AP group, compared with OAC alone group, was observed (HR 0.54 [0.17-1.70]), whereas among patients with complete occlusion, the OAC+AP group markedly increased the risk of 3-months composite events (HR 2.00 [1.27-3.15]), compared with the OAC alone group. No interaction between direct oral anticoagulant and warfarin on outcome was observed (Pint=0.35). Conclusion: In conclusion, treatment with addition of AP to OAC had a tendency to increase the risk of 3-months vascular events, compared with OAC alone in AIS with AF. However, the effects of antithrombotic treatment could be modified according to the LAD, with substantial benefits of OAC alone in subgroup of large artery occlusion. Our results address the need for the further study to tailor the optimal treatment in AIS with concomitant AF and LAD.

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Plasma Retinol Binding Protein 4 as a Biomarker for Detecting Progressive Stroke and Prediction of Early Prognosis in Patients with Acute Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202618666211122150730 ◽

2021 ◽

Vol 18 ◽

Author(s):

Shuqiong Liu ◽

Jiande Li ◽

Xiaoming Rong ◽

Yingmei Wei ◽

Ying Peng ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Independent Risk Factor ◽

Binding Protein ◽

Multivariate Logistic Regression Analysis ◽

Retinol Binding Protein ◽

Retinol Binding Protein 4 ◽

Treatment Measures ◽

Plasma Retinol

Aim and purpose: Progressive stroke (PS) lacks effective treatment measures and leads to serious disability or death. Retinol binding protein 4 (RBP4) could be closely associated with acute ischemic stroke(AIS). We aimed to explore plasma RBP4 as a biomarker for detecting the progression in patients with AIS. Methods: Participants of this retrospective study were 234 patients with AIS within the 48 h onset of disease. The primary endpoint was to ascertain if there was PS through the National Institute of Health stroke scale (NIHSS), early prognosis was confirmed through the modified Rankin scale score (mRS) at discharge or 14 days after the onset of stroke, and determine the significance of demographic characteristics and clinical data . Results: In this study, 43 of 234 patients demonstrated PS. . The level of plasma RBP4 in patients with progressive stroke was significantly lower (29 mg/L, 22.60－40.38 mg/L) than that without progression (38.70 mg/L, 27.28－46.40 mg/L, P = 0.003). In patients with lower plasma RBP4, he proportion of patients with progression (c2 = 9.63, P = 0.008) and with mRS scores ≥2 (c2 = 6.73, P = 0.035) were significantly higher Multivariate logistic regression analysis showed that a lower RBP4 level on admission was an independent risk factor for progressive stroke during hospitalization with an OR value of 2.70 (P = 0.03, 95% CI: 1.12－6.52). Conclusion: A low plasma RBP4 level on admission could be an independent risk factor of PS during hospitalization.

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Abstract P252: Discharge Antithrombotic Therapy for Ischemic Stroke Patients With Prior Aspirin Failure

Stroke ◽

10.1161/str.52.suppl_1.p252 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ying Xian ◽

Haolin Xu ◽

Deepak L Bhatt ◽

Gregg C Fonarow ◽

Eric E Smith ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Prevention ◽

Antithrombotic Therapy ◽

Recurrent Stroke ◽

Oral Anticoagulants ◽

The United States ◽

Future Research ◽

Large Artery ◽

Secondary Stroke Prevention ◽

Stroke Registry

Introduction: Aspirin is one of the most commonly used medications for cardiovascular disease and stroke prevention. Many older patients who present with a first or recurrent stroke are already on aspirin monotherapy, yet little evidence is available to guide antithrombotic strategies for these patients. Method: Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we described discharge antithrombotic treatment pattern among Medicare beneficiaries without atrial fibrillation who were discharged alive for acute ischemic stroke from 1734 hospitals in the United States between October 2012 and December 2017. Results: Of 261,634 ischemic stroke survivors, 100,016 (38.2%) were on prior aspirin monotherapy (median age 78 years; 53% women; 79.4% initial stroke and 20.6% recurrent stroke). The most common discharge antithrombotics (Figure) were 81 mg aspirin monotherapy (20.9%), 325 mg aspirin monotherapy (18.2%), clopidogrel monotherapy (17.8%), and dual antiplatelet therapy (DAPT) of 81 mg aspirin and clopidogrel (17.1%). Combined, aspirin monotherapy, clopidogrel monotherapy, and DAPT accounted for 86.8% of discharge antithrombotics. The rest of 13.2% were discharged on either aspirin/dipyridamole, warfarin or non-vitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotics at all. Among patients with documented stroke etiology (TOAST criteria), 81 mg aspirin monotherapy (21.2-24.0%) was the most commonly prescribed antithrombotic for secondary stroke prevention. The only exception was those with large-artery atherosclerosis, in which, 25.3% received DAPT of 81 mg aspirin and clopidogrel at discharge. Conclusion: Substantial variations exist in discharge antithrombotic therapy for secondary stroke prevention in ischemic stroke with prior aspirin failure. Future research is needed to identify best management strategies to care for this complex but common clinical scenario.

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