A Simple Hospital Mobility Scale for Acute Ischemic Stroke Patients Predicts Long-term Functional Outcome

Background. Stroke patients present restriction of mobility in the acute phase, and the use of a simple and specific scale can be useful to guide rehabilitation. Objective. To validate and propose a Hospital Mobility Scale (HMS) for ischemic stroke patients as well as to evaluate the HMS as a prognostic indicator. Methods. This study was performed in 2 phases: in the first, we developed the HMS content, and in the second, we defined its score and evaluated its psychometric properties. We performed a longitudinal prospective study consisting of 2 cohorts (derivation and validation cohorts). The data were collected in a stroke unit, and the following scales were applied during hospitalization: National Institutes of Health Stroke Scale to quantify stroke severity and the HMS to verify the degree of mobility. The primary outcome was the proportion of unfavorable functional outcomes, defined as a modified Barthel Index of <95. Results. We defined 3 tasks for HMS: sitting, standing, and gait. In the derivation cohort, the HMS presented an accuracy of 84.5% measured using the area under the receiver operating characteristic curve (95% CI = 78.3-90.7; P < .001), whereas in the validation cohort the accuracy was 87.8% (95% CI = 81.9%-93.7%; P < .001). The HMS presented a large standardized effect size (1.41) and excellent interexaminer agreement (intraclass correlation coefficient = 0.962; 95% CI = 0.917-0.983; P < .001). Conclusion. The HMS was able to predict accurately the functional outcome of poststroke patients, presented excellent interexaminer agreement, and was sensitive in detecting changes.

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Predicting Early Mortality of Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.118.022863 ◽

2019 ◽

Vol 50 (2) ◽

pp. 349-356 ◽

Cited By ~ 11

Author(s):

Thomas Gattringer ◽

Alexandra Posekany ◽

Kurt Niederkorn ◽

Michael Knoflach ◽

Birgit Poltrum ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Unit ◽

Functional Disability ◽

Area Under The Curve ◽

Early Mortality ◽

Stroke Severity ◽

Stroke Patients ◽

Derivation Cohort ◽

Temporal Validation

Background and Purpose— Several risk factors are known to increase mid- and long-term mortality of ischemic stroke patients. Information on predictors of early stroke mortality is scarce but often requested in clinical practice. We therefore aimed to develop a rapidly applicable tool for predicting early mortality at the stroke unit. Methods— We used data from the nationwide Austrian Stroke Unit Registry and multivariate regularized logistic regression analysis to identify demographic and clinical variables associated with early (≤7 days poststroke) mortality of patients admitted with ischemic stroke. These variables were then used to develop the Predicting Early Mortality of Ischemic Stroke score that was validated both by bootstrapping and temporal validation. Results— In total, 77 653 ischemic stroke patients were included in the analysis (median age: 74 years, 47% women). The mortality rate at the stroke unit was 2% and median stay of deceased patients was 3 days. Age, stroke severity measured by the National Institutes of Health Stroke Scale, prestroke functional disability (modified Rankin Scale >0), preexisting heart disease, diabetes mellitus, posterior circulation stroke syndrome, and nonlacunar stroke cause were associated with mortality and served to build the Predicting Early Mortality of Ischemic Stroke score ranging from 0 to 12 points. The area under the curve of the score was 0.879 (95% CI, 0.871–0.886) in the derivation cohort and 0.884 (95% CI, 0.863–0.905) in the validation sample. Patients with a score ≥10 had a 35% (95% CI, 28%–43%) risk to die within the first days at the stroke unit. Conclusions— We developed a simple score to estimate early mortality of ischemic stroke patients treated at a stroke unit. This score could help clinicians in short-term prognostication for management decisions and counseling.

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Predictors of the functional outcome after thrombolysis in an Egyptian patients’ sample

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00261-5 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

H. M. Eldeeb ◽

D. H. Elsalamawy ◽

A. M. Elabd ◽

H. S. Abdelraheem

Keyword(s):

Ischemic Stroke ◽

Hospital Stay ◽

Functional Outcome ◽

Arterial Occlusion ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Predicting Factors ◽

Egyptian Patients ◽

Cerebrovascular Stroke

Abstract Background About 6.2 million individuals worldwide and approximately 200 Egyptians/100,000 citizens have cerebrovascular stroke annually, and only less than 1% of stroke patients received intravenous (IV) thrombolysis in 2014. Outcome of the ischemic stroke after IV thrombolysis varies, and there is lack of data about the predicting factors that contributes to the outcome of ischemic strokes after IV thrombolysis in Egypt. Objective The aim of this work is to study the predictors of the functional outcome of ischemic cerebrovascular stroke after IV thrombolysis in Egyptian patients. Patients and methods This is a prospective study that includes acute ischemic stroke patients who received IV thrombolysis at the Alexandria University Hospital during the year from February 2017 to February 2018, and they were evaluated initially by Rapid Arterial Occlusion Evaluation (RACE) scale and followed-up serially for 6 months after thrombolysis using the National Institutes of Health Stroke Scale (NIHSS) and modified ranking score (mRS). Results Forty-five patients are included; 56% had favorable functional outcome (mRS 0–2) after 6 months, 68% had ≥ 4 points improvement in NIHSS after 6 months, and 13% had hemorrhagic conversion with 18% mortality rate. High initial RACE scale and long hospital stay are associated with poor functional outcome 6 months after thrombolysis. Conclusion Stroke severity demonstrated by high initial RACE and the duration of hospital stay are the two most significant predictors with an impact on the functional outcome of ischemic cerebrovascular stroke after thrombolysis.

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Abstract TP19: Charlson Comorbidity Index Predicts Mortality and Functional Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽

10.1161/str.47.suppl_1.tp19 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Daniela Samaniego ◽

Maria Hernandez-Perez ◽

Anna Planas ◽

Lorena Martin ◽

Laura Dorado ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Charlson Comorbidity Index ◽

Mechanical Thrombectomy ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Arterial Revascularization ◽

Comorbidity Index ◽

High Comorbidity

Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy. Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was <2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days. Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p <0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3). Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.

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Plasma Osteoprotegerin Correlates with Stroke Severity and the Occurrence of Microembolic Signals in Patients with Acute Ischemic Stroke

Disease Markers ◽

10.1155/2019/3090364 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Yanyan Cao ◽

Congxian Cui ◽

Hongqin Zhao ◽

Xudong Pan ◽

Wenjian Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Operating Characteristic ◽

Characteristic Curve ◽

National Institutes Of Health ◽

Atherosclerotic Plaques ◽

Stroke Severity ◽

Large Artery ◽

Unstable Plaque ◽

Cutoff Value ◽

Operating Characteristic Curve

Background. Instability of atherosclerotic plaques is associated with the occurrence of stroke. Microembolic signals (MESs) are an indicator of unstable plaque. A relationship between plasma osteoprotegerin (OPG) and ischemic stroke has already been identified. The aim of this study was to investigate whether plasma OPG levels have a relationship with MESs and to evaluate the feasibility of OPG as a biomarker of stroke severity and occurrence of MESs. Methods. Our study consisted of 127 patients with large artery atherosclerosis stroke and 56 controls. Patients were classified into subgroups based on stroke severity and the occurrence of MESs. MES-monitoring was performed for 60 min using transcranial Doppler within 72 h of stroke onset. Stroke severity at admission was assessed by the National Institutes of Health Stroke Scale. Results. Plasma OPG levels were significantly associated with stroke, MESs, and stroke severity at admission (adjusted OR [95% CI]: 1.002 [1.001–1.003] p<0.001; 1.002 [1.001–1.003] p=0.001; 1.001 [1.000–1.002] p=0.028). When plasma OPG levels were used to determine the stroke severity, the area under the receiver-operating characteristic curve (AUC) was 0.734 (95% CI: 0.625-0.843) based on a cutoff value of 1998.44 pg/ml; the sensitivity and specificity of this test were 80.6% and 65.6%, respectively. Furthermore, when the levels of OPG were used to distinguish the presence of MESs, the AUC was 0.766 (95% CI: 0.672-0.860); the cutoff value was 2107.91 pg/ml. The sensitivity of this cutoff value was 68.8% and the specificity was 73.7%. Conclusions. Plasma OPG levels correlate with stroke severity and the occurrence of MESs.

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Effects of SSRI exposure on hemorrhagic complications and outcome following thrombolysis in ischemic stroke

International Journal of Stroke ◽

10.1177/1747493017743055 ◽

2017 ◽

Vol 13 (5) ◽

pp. 511-517 ◽

Cited By ~ 5

Author(s):

Christoph Schellen ◽

Julia Ferrari ◽

Wilfried Lang ◽

Marek Sykora

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Selective Serotonin Reuptake Inhibitors ◽

Ad Hoc ◽

Binary Logistic Regression ◽

Tissue Type ◽

Bleeding Complications ◽

Stroke Severity ◽

Stroke Patients ◽

Hemorrhagic Complications

Background Selective serotonin reuptake inhibitors (SSRI) may interfere with platelet function, and pre-stroke SSRI treatment has been associated with increased hematoma volumes and mortality in hemorrhagic stroke patients. The effects of SSRI on the risk of hemorrhagic complications after thrombolysis in ischemic stroke patients are unclear. Aims To examine the effects of pre-stroke SSRI exposure on bleeding complications, functional outcome, and mortality following thrombolysis in ischemic stroke. Methods Data including standard demographic and clinical variables as well as baseline and follow-up stroke severity (measured by National Institutes of Health Stroke Score), functional outcome (measured by modified Rankin Scale) at 3 months, and mortality at 7 and 90 days were extracted from the Virtual International Stroke Trials Archive. Multivariable binary logistic regression was used for statistical analyses. Results Out of 1114 ischemic stroke patients treated with recombinant tissue-type plasminogen activator, 135 (12.1%) had previous SSRI exposure. Symptomatic intracranial hemorrhage occurred in 30 (2.7%) patients. Of those, 2 (1.5%, n = 135) were in the SSRI pretreatment group and 28 (2.9%, n = 979) were SSRI naive patients. Pre-stroke SSRI exposure in thrombolysed patients showed association with neither bleeding complications ( P = .58) nor functional outcome ( P = .38) nor mortality ( P = .65). Conclusions Results from this large retrospective ad hoc database cohort study indicate that pre-stroke SSRI exposure in ischemic stroke patients who receive thrombolytic treatment is not associated with bleeding complications, functional outcome, or mortality.

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HUBUNGAN ANTARA RIWAYAT PENYAKIT JANTUNG DENGAN TINGKAT KEPARAHAN STROKE ISKEMIK AKUT PERTAMA KALI

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v37i1.101 ◽

2019 ◽

Vol 37 (1) ◽

Author(s):

Ignatius Ivan ◽

Budi Riyanto Wreksoatmodjo ◽

Octavianus Darmawan

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischemic Stroke ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Severe Stroke ◽

History Of

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords: Atrial fibrillation, heart failure, ischemic stroke, myocardial infarction, National Institutes of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik

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Abstract WMP120: Pre-stroke Statin Enhancement of Collateralization in Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wmp120 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mengmeng Ma ◽

Jiaying Zhu ◽

Li He

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Cerebral Artery ◽

Collateral Circulation ◽

Stroke Onset ◽

Stroke Severity ◽

Stroke Patients ◽

Statin Use

Background: Recent studies suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcome in case of stroke onset. It was speculated that pre-stroke statin may enhance collateral circulation and result in favorable functional outcome. This study aimed to investigate the association of pre-stroke statin use with leptomeningeal collaterals in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 hours from May 2011 to April 2017. CTA imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; admission NIHSS was used to measure stroke severity; modified Rankin scale (mRS) at 90 day was used to measure outcome. Univariate and multivariate analyses were performed. Results: 239 patients met inclusion criteria. 54 patients use statin before stroke onset. Pre-stroke statin use was independently associated with good collateral circulations (rLMCS>10) (OR, 4.786; 95% CI, 1.195 - 19.171; P = 0.027). Pre-stroke statin use was not independently associated with lower stroke severity (NIHSS≤14) (OR, 1.955; 95%CI, 0.657- 5.816; P = 0.228), but pre-stroke statin use was independently associated with good outcome (mRS≤2) (OR, 3.868; 95%CI, 1.325 - 11.289; P = 0.013). Conclusion: Pre-stroke statin use seems enhance collateralization and improve clinical outcomes in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.

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WMH and long-term outcomes in ischemic stroke

Neurology ◽

10.1212/wnl.0000000000007142 ◽

2019 ◽

Vol 92 (12) ◽

pp. e1298-e1308 ◽

Cited By ~ 24

Author(s):

Marios K. Georgakis ◽

Marco Duering ◽

Joanna M. Wardlaw ◽

Martin Dichgans

Keyword(s):

Ischemic Stroke ◽

Functional Impairment ◽

Recurrent Stroke ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Stroke Recurrence ◽

Stroke Severity ◽

Stroke Patients ◽

Increased Risk

ObjectiveTo investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality.MethodsFollowing the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle–Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models.ResultsWe included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72–2.73), cognitive impairment (RR 2.29, 95% CI 1.48–3.54), functional impairment (RR 2.21, 95% CI 1.83–2.67), any recurrent stroke (RR 1.65, 95% CI 1.36–2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26–2.88), all-cause mortality (RR 1.72, 95% CI 1.47–2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44–2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias.ConclusionsPresence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.

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Serum YKL-40 Levels Correlate with Infarct Volume, Stroke Severity, and Functional Outcome in Acute Ischemic Stroke Patients

PLoS ONE ◽

10.1371/journal.pone.0051722 ◽

2012 ◽

Vol 7 (12) ◽

pp. e51722 ◽

Cited By ~ 14

Author(s):

Hyun Young Park ◽

Chang-Duk Jun ◽

Se-Jeong Jeon ◽

See-Sung Choi ◽

Hak-Ryul Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Infarct Volume ◽

Stroke Severity ◽

Stroke Patients

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Plasma Translocator Protein Levels and Outcomes of Acute Ischemic Stroke: A Pilot Study

Disease Markers ◽

10.1155/2018/9831079 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Wen-Hung Chen ◽

Hsu-Ling Yeh ◽

Chiung-Wen Tsao ◽

Li-Ming Lien ◽

Arthur Chiwaya ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Neurological Diseases ◽

Severe Disability ◽

National Institutes Of Health ◽

Translocator Protein ◽

Stroke Severity ◽

Stroke Patients ◽

Protein Levels

Translocator protein 18 kDa (TSPO) has been used as a biomarker of brain injury and inflammation in various neurological diseases. In this study, we measured the level of TSPO in acute ischemic stroke patients and determined its association with the degree of stroke severity and its ability to predict stroke functional outcomes. In total, 38 patients with moderate to severe acute ischemic stroke were enrolled. Demographic information, cerebral risk factors, and stroke severity were examined at the baseline. The National Institutes of Health Stroke Scale, modified Rankin Scale, and Barthal Index were assessed at discharge as measures of poor functional outcomes and severe disability. The baseline fasting plasma TSPO level was assessed within 24 h after the incident stroke and during hospitalization (on days 8–10). The proportion of patients with poor functional outcomes was significantly higher in the higher-TSPO group (compared to the lower group) in terms of clinical worsening (odds ratio (OR) = 11.69, 95% confidence interval (CI) = 2.08–65.6), poor functional outcomes (OR = 10.5, 95% CI = 1.14–96.57), and severe disability (OR = 4.8, 95% CI = 1.20–19.13). Plasma TSPO may be intimately linked with disease progression and worse functional outcomes in acute ischemic stroke patients.

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