Timing of Acute Stroke in COVID-19—A Health System Registry Study

Background and Purpose: The association between SARS-CoV-2 infection and stroke remains unknown. We aimed to compare the characteristics of stroke patients who were hospitalized with Coronavirus Disease 2019 (COVID-19) based on the timing of stroke diagnosis. Methods: We performed a retrospective analysis of adult patients in a health system registry of COVID-19 who were hospitalized and had imaging-confirmed acute stroke during hospitalization. Baseline characteristics and hospital outcomes were collected and analyzed. Results: Out of 882 COVID-19 patients who were hospitalized between March 9 to May 17, 2020, 14 patients (2% of all COVID-19 patients and 21% of those who underwent imaging) presented with stroke or developed stroke during hospitalization. Eleven had acute ischemic stroke (AIS) and 3 had acute hemorrhagic stroke. Six patients (43%) presented to the hospital with acute stroke symptoms and were found to have SARS-CoV-2. Compared to patients who presented with AIS, more patients with AIS during hospitalization were male, of older age, had pneumonia and acute respiratory distress syndrome, were severely ill, and had high inflammatory and thrombotic markers (including C reactive protein, D dimer, ferritin, and fibrinogen). Among all patients, hospital mortality was high (50%) and the majority of patients who were discharged had poor neurological outcome. Conclusions: A distinction should be made between patients who present with acute stroke with concurrent SARS-CoV-2 infection and those who develop stroke as a complication of severe COVID-19. It is likely that a subset of stroke patients will incidentally test positive for the virus given the widespread pandemic.

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Abstract TP180: Markedly Elevated High-sensitive C-reactive protein (hsCRP) Predicts Early Mortality Among Stroke Patients

Stroke ◽

10.1161/str.44.suppl_1.atp180 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Ahmed Itrat ◽

Shazia Alam ◽

Esteban Walker ◽

Irene Katzan

Keyword(s):

Acute Stroke ◽

Early Mortality ◽

Mortality Data ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein ◽

Risk Of Death ◽

Social Security Death Index ◽

All Cause Mortality ◽

Very High

Background: High-sensitive C-Reactive Protein (hsCRP) levels are correlated with risk of vascular disease and cardiovascular mortality. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood as they are often excluded from studies. Objective: To determine the association of very high admission hsCRP levels (> 10mg/L) on all-cause mortality in patients with acute stroke Methods: We performed a retrospective cohort study of patients admitted to our institution with acute stroke (8/2003- 11/2011) who had at least one hsCRP assay drawn < 7 days of stroke diagnosis. Mortality data was obtained using Social Security Death Index. Differences in survival were determined using Kaplan-Meier curves. Cox proportional analysis was used to determine hazard ratios of death among patients with hsCRP values > 10 mg/L after adjusting for age, sex, race and the following co-morbid conditions: cancer, atrial fibrillation, diabetes, hypertension, myocardial infarction Results: There were 293 stroke patients identified with hsCRP levels drawn < 7 days of stroke admission. Median age was 65.7 years (SD 15.3), and 55% were male. All-cause mortality was 18% (n=53) with a median follow-up of 2.2 years. Median hsCRP level was 5.5 mg/L, [IQR 1.8 - 14.6] with 31.7% patients having hsCRP > 10 mg/L. Patients with hsCRP > 10 mg/L had a 2.7 times higher risk of mortality than those with hsCRP < 10 mg/L (p=0.004). The increased risk was steepest in the first months after stroke (Figure). The only other significant variable affecting hazard for death was age; each year increased the hazard ratio by 3.3%. Of the cases in which cause of death was known (n=31), stroke was the most common cause (71%) Conclusion: Very high level of hsCRP (>10 mg/L) at the time of admission is associated with increased early mortality among patients presenting with acute strokes. This finding may help stratify risk of death in stroke.

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Abstract WP465: Effect of Chocolate Containing 86% Cacao and Much Polyphenol to Improve Level of Alertness in Acute Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.wp465 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Takahisa Mori ◽

Kazuhiro Yoshioka ◽

Nozomi Chiba

Keyword(s):

Nutritional Status ◽

Acute Stroke ◽

High Sensitivity ◽

Dark Chocolate ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein ◽

Level Of Consciousness ◽

Hs Crp ◽

Gcs Score

Introduction: Level of alertness in acute stroke patients is often deteriorated during hospitalization, even though they can orally eat food on admission and their stroke is not severe. Then, it is difficult to improve their level of alertness. If their level of alertness is not improved, their nutritional status is probably deteriorated. Hypothesis: Dark chocolate 5g tablet containing 86% cacao and 147mg polyphenol can improve level of alertness and prevent deterioration of nutritional status. Methods: We included acute stroke patients for retrospective analysis who 1) were admitted between August 2017 and July 2018, 2) presented alert consciousness on admission and orally eat food then, 3) underwent blood examination on admission, the 3rd day and 7th day, 4) presented mild deterioration of level of alertness during hospitalization and 5) took dark chocolate 5g containing 86% cacao and 147mg polyphenol twice a day. We evaluated patients’ features, Glasgow Coma Scale (GCS) as level of consciousness, albumin (Alb), prealbumin (PreAlb), high-sensitivity C-reactive protein (hs-CRP) on admission, on the initial chocolate day and on the 7th day. Results: Eighteen patients met our inclusive criteria and were analyzed. The median age, GCS score, body mass index, blood glucose (BG), hs-CRP, Alb and PreAlb were 85 years, 14, 21.8 kg/m2, 119 mg/dl, 0.1165 mg/dl, 3.9 g/dl and 20.4 mg/dl, respectively. They started to eat 86% cacao chocolate 5g supplementation twice a day median on the 3rd day. On the 3rd day when chocolate was started, their median GCS score, Alb and PreAlb decreased to13 (p<0.0001), 3.45 mg/dl (p<0.0001) and 19.1 mg/dl (p<0.001), respectively, and their median hs-CRP increased to 0.4325 mg/dl (p<0.05). On the 7th day, their median GCS increased to 14 (0.0001), median Alb, PreAlb and hs-CRP levels were 3.45 mg/dl (ns), 16.5 g/dl (ns) and 0.506 mg/dl (ns). Conclusion: Dark chocolate containing 86% cacao and 147mg polyphenol probably improved level of alertness and prevented further deterioration of nutritional status in patients who could orally eat food.

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Hochuekkito can Prevent the Colonization of Methicillin-Resistant Staphylococcus aureus in Upper Respiratory Tract of Acute Stroke Patients

Frontiers in Pharmacology ◽

10.3389/fphar.2021.683171 ◽

2021 ◽

Vol 12 ◽

Author(s):

Masakazu Kitahara ◽

Shin Takayama ◽

Tetsuya Akaishi ◽

Akiko Kikuchi ◽

Tadashi Ishii

Keyword(s):

Acute Stroke ◽

Modified Rankin Scale ◽

Upper Respiratory Tract ◽

C Reactive Protein ◽

Blood Cell Count ◽

Stroke Patients ◽

Protein Levels ◽

Reactive Protein ◽

Upper Respiratory ◽

Mrsa Colonization

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization can lead to MRSA pneumonia or other infections in compromised hosts, and invasive MRSA infections lead to significant morbidity and mortality. The present observational study elucidated whether administration of hochuekkito (HET) can prevent MRSA colonization in the upper respiratory tract and support recovery in acute stroke patients.Methods: In this retrospective, observational study, 73 acute stroke patients admitted to Kenwakai Hospital between April 2007 and December 2019 who did not require emergency surgery during this period were enrolled. Conventional treatment was provided to all patients, depending on their condition, and 7.5 g/day of HET was administered to the patients who could take the medicine via nasogastric tube or orally in three divided doses for three months. Bacterial cultures from laryngeal swabs and sputum were evaluated every week. We evaluated the presence of MRSA infection or another infectious disease within 30 days of admission; modified Rankin Scale scores, which assesses the independent living skills after stroke at three months after admission; and blood biomarkers (white blood cell count, albumin levels, C-reactive protein levels, and hemoglobin levels).Results: In total, 73 patients (HET group, n = 41; non-HET group, n = 32) were enrolled in the study. MRSA detection was significantly less likely in the HET group than in the non-HET group (p = 0.0497). The incidence of infectious diseases was significantly lower in the HET group than in the non-HET group (p = 0.0096), and the modified Rankin Scale score at three months was also significantly lower in the HET group than in the non-HET group (p = 0.033). The white blood cell count, and serum C-reactive protein levels did not differ between those who were treated with HET and those who were not. However, serum albumin and hemoglobin levels improved slightly between month one and month three after admission only in those who were treated with HET.Conclusion: Our results indicate that the administration of HET may contribute to the prevention of MRSA colonization and promote rehabilitation in stroke patients.

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C-Reactive Protein and Fibrinogen in Acute Stroke Patients with and without Sleep Apnea

Cerebrovascular Diseases ◽

10.1159/000108430 ◽

2007 ◽

Vol 24 (5) ◽

pp. 412-417 ◽

Cited By ~ 8

Author(s):

Rainer Dziewas ◽

Martin Ritter ◽

Linn Krüger ◽

Stefanie Berger ◽

Claus Langer ◽

...

Keyword(s):

Sleep Apnea ◽

Acute Stroke ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein

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Differences in C-Reactive Protein (CRP) between depression levels in ischaemic stroke patients

Stem Cell Oncology ◽

10.1201/9781351190152-18 ◽

2018 ◽

pp. 81-85

Author(s):

S.N. Lubis ◽

W.H. Lubis ◽

I. Nasution

Keyword(s):

Ischaemic Stroke ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein

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MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN: DIAGNOSTIC MARKERS AND FEATURES OF PHARMACOTHERAPY

Medical Science of Ukraine (MSU) ◽

10.32345/2664-4738.1.2021.03 ◽

2021 ◽

Vol 17 (1) ◽

pp. 24-28

Author(s):

M.V. Кhaitovych ◽

L.M. Voroniuk ◽

G.Yu. Borisova ◽

N.V. Diudenko ◽

N.M. Miagka

Keyword(s):

Distress Syndrome ◽

The United States ◽

C Reactive Protein ◽

Reactive Protein ◽

Markers Of Inflammation ◽

Laboratory Markers ◽

Mucous Membranes ◽

Coronavirus Infection ◽

Polymerase Chain ◽

Inflammatory Syndrome

Relevance. In 2020, children were hospitalized with fever and multisystem inflammation throughout the world during the COVID-19 pandemic. In the United States, this condition is called MIS-C (Multisystem Inflammatory Syndrome in Children). This syndrome is thought to be similar to the severe course of COVID-19 in adults (cytokine storm). The objective of the work is to evaluate the features of the course and pharmacotherapy of multisystem inflammatory syndrome in children. Materials and methods. The study included 17 children (10 boys and 7 girls) aged 3-16 years (on average – 9.5±3.4 years). Diagnosis of coronavirus infection was performed by polymerase chain reaction with real-time detection, determined the level of immunoglobulins M and G before coronavirus infection. Results. The duration of fever in patients was 5-21 days (average 8.1±4.0 days), the duration of inpatient treatment – 7-35 days (average 15.7±7.0 days). Blood albumin levels were reduced in 53.8% of children; the level of fibrinogen was increased in 88.2% of children, the level of C-reactive protein, ferritin, and D-dimer – in all patients. 15 (88.2%) children had pathology of the digestive system, 13 (76.5%) – cardiovascular system (7 children were diagnosed with carditis, 2 – dilation of coronary arteries, 7 – cardiac arrhythmia). Acute respiratory distress -syndrome was found in a 13-year-old girl, shock - in an 11-year-old boy, 11 children (64.7%) were diagnosed with the pathology of the respiratory system (pleurisy, pneumonia), skin and mucous membranes, and 4 children (23.5%) there were manifestations of central nervous system disorders (meningism, decreased reflexes, ataxia), in 2 (11.8%) – renal failure. On average, each patient had lesions of 3.9 ±1.2 systems. Conclusions. MIS-C was manifested by prolonged fever, high levels of laboratory markers of inflammation, hypoalbuminemia, hypercoagulation, often – pathological manifestations of the cardiovascular, digestive, respiratory systems, skin, and mucous membranes. The treatment included intravenous immunoglobulin, steroids, anticoagulant, and antibacterial therapy and was effective.

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Admission blood glucose and in-hospital clinical outcome among patients with acute stroke in Inner Mongolia, China

Clinical & Investigative Medicine ◽

10.25011/cim.v32i2.6033 ◽

2009 ◽

Vol 32 (2) ◽

pp. 151 ◽

Cited By ~ 2

Author(s):

Ning Wang ◽

Dawei Qiao ◽

Weijun Tong ◽

Fengshan Zhang ◽

Zhong Ju ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Acute Stroke ◽

Inner Mongolia ◽

Odds Ratio ◽

Logistic Model ◽

Hemorrhagic Stroke ◽

Blood Glucose Concentration ◽

Hospital Death ◽

Stroke Patients

Purpose: There is still controversy about the association between admission blood glucose concentration and outcome of acute stroke. We studied the association between admission blood glucose and in-hospital death / dependency among acute stroke patients in Inner Mongolia, China. Methods: 2,178 acute ischemic and 1,760 hemorrhagic stroke patients in six hospitals were included in the study. Blood glucose and other study variables were collected within the first 24-hr of hospital admission. Clinical outcomes were evaluated by neurologists during hospitalization. The associations between admission blood glucose and the risk of in-hospital death/dependency were analyzed using a multiple logistic model. Results: There were associations between admission blood glucose and in-hospital death/dependency among patients with acute ischemic or hemorrhagic stroke. Compared with patients with blood glucose < 6.1mmol/L, multivariate-adjusted odds ratio (95% confidence interval) of death/dependency were 0.53 (0.23, 1.27), 2.22 (1.21, 4.11), 1.92 (1.12, 3.33) and 1.91 (1.00, 3.64) for ischemic stroke patients, and 0.93 (0.44, 1.96), 1.42 (0.65, 3.10), 1.98 (1.10, 3.55) and 2.93 (1.40, 6.11) for hemorrhagic stroke patients, with blood glucose 6.1-6.9, 7.0-7.7, 7.8-11.0 and ?11.1mmol/L, respectively. Conclusion: Increased admission blood glucose was associated with death/dependency among patients with acute hemorrhagic and ischemic stroke.

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Abstract P855: Importance of Compliance in Dysphagia Screening in Acute Stroke Care

Stroke ◽

10.1161/str.52.suppl_1.p855 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Patty Noah ◽

Melanie Henderson ◽

Rebekah Heintz ◽

Russell Cerejo ◽

Christopher T Hackett ◽

...

Keyword(s):

Acute Stroke ◽

Aspiration Pneumonia ◽

Hemorrhagic Stroke ◽

Oral Intake ◽

Stroke Care ◽

Stroke Severity ◽

Stroke Patients ◽

Acute Stroke Care ◽

Chi Square ◽

Stroke Center

Introduction: Dysphagia occurs in up to two thirds of stroke patients and can lead to serious complications such as aspiration pneumonia, which is also linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia assessment before oral intake in stroke patients regardless of initial stroke severity. Several studies have described registered nurses’ competency in terms of knowledge and skills regarding dysphagia screening. We aimed to examine the rate of aspiration pneumonia compared to the rate of dysphagia screening. Methods: A retrospective analysis of prospectively collected data at a single tertiary stroke center was carried out between January 2017 and June 2020. Data comparison was completed utilizing ICD-10 diagnosis codes to identify aspiration pneumonia in ischemic and hemorrhagic stroke patients. The data was reviewed to compare the compliance of a completed dysphagia screen prior to any oral intake to rate of aspiration pneumonia. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of aspiration pneumonia diagnosis in the ischemic and hemorrhagic stroke patients. Results: We identified 3320 patient that met inclusion criteria. 67% were ischemic strokes, 22% were intracerebral hemorrhages and 11% were subarachnoid hemorrhages. Compliance with dysphagia screening decreased from 94.2% (n=1555/1650) in 2017-2018 to 74.0% (n=1236/1670) in 2019-2020, OR=0.17 (95%CI 0.14 - 0.22), p < 0.0001. Aspiration pneumonias increased from 58 (3.5%) in 2017-2018 to 77 (4.6%) in 2019-2020, but this difference was not statistically significant, OR=0.75 (95%CI 0.53 - 1.07), p = 0.11. Conclusion: We noted that the decrease in compliance with completing a dysphagia screen in patients with acute stroke prior to any oral intake was associated with a higher trend of aspiration pneumonia.

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