Clinical Response to Hypertensive Hypervolemic Therapy and Outcome After Subarachnoid Hemorrhage

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Jennifer A. Frontera ◽  
Andres Fernandez ◽  
J. Michael Schmidt ◽  
Jan Claassen ◽  
Katja E. Wartenberg ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
High Risk ◽  
Clinical Response ◽  
Clinical Improvement ◽  
Odds Ratio ◽  
Volume Expansion ◽  
Adjusted Odds Ratio ◽  
High Risk Patient ◽  
Modified Rankin Scale ◽  
Symptomatic Vasospasm

Abstract OBJECTIVE Hypertensive hypervolemic therapy is widely used to treat symptomatic vasospasm after subarachnoid hemorrhage. Few data exist to support a relationship between early clinical response and mortality or functional outcome. METHODS In a prospective cohort of 580 subarachnoid hemorrhage patients, we studied 95 patients with acute symptomatic vasospasm who received stepwise volume expansion with crystalloid and/or 5% albumin solution followed by intravenous pressors to maintain systolic blood pressure between 180 and 220 mm Hg. We separately assessed the effects of volume expansion and induced hypertension on the neurological examination during the first 2 hours of each intervention. We used multivariate logistic regression analysis to calculate adjusted odds ratios assessing the relationship between clinical response to hypertensive hypervolemic therapy and 3-month outcome, as measured by the modified Rankin Scale. RESULTS Of 95 patients with symptomatic vasospasm, volume expansion was used in 94% (n = 89), of whom 43% had a clinical response; 85% of the patients (n = 81) received pressors, of whom 68% responded. Early clinical improvement attributable to either volume expansion or pressors was not related to the development of infarction on computed tomography, but response to either modality within 2 hours was independently protective against death (adjusted odds ratio, 0.03; P < 0.05) and death-or-severe-disability (modified Rankin Scale score, 4–6; adjusted odds ratio, 0.1; P < 0.05) after adjusting for age, Hunt-Hess grade, angioplasty, and aneurysm size. CONCLUSION Subarachnoid hemorrhage patients with symptomatic vasospasm who fail to demonstrate early clinical improvement in response to volume or pressor therapy are at high risk for death or disability. Urgent endovascular intervention in this high-risk patient cohort may be justified.

scholarly journals Intra-Arterial Nimodipine Infusion for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

2011 ◽  
Vol 17 (2) ◽  
pp. 169-178 ◽  
Author(s):  
W-S. Cho ◽  
H-S. Kang ◽  
J.E. Kim ◽  
O-K. Kwon ◽  
C.W. Oh ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Clinical Response ◽  
Clinical Improvement ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Related Complication ◽  
Improvement Rate ◽  
Deterioration Rate ◽  
Symptomatic Vasospasm ◽  
Favorable Clinical Outcome

This study evaluated the efficacy of intra-arterial nimodipine infusion for symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Clinical data collected from 42 consecutive patients with symptomatic vasospasm after aSAH were retrospectively reviewed. Forty-two patients underwent 101 sessions of intra-arterial nimodipine infusion. Angiographic response, immediate clinical response, and clinical outcome were evaluated at discharge and six months later. Angiographic improvement was achieved in 82.2% of patients. The immediate clinical improvement rate was 68.3%, while the deterioration rate was 5.0%. A favorable clinical outcome was achieved in 76.2% at discharge and 84.6% six months. Vasospasm-related infarction occurred in 21.4%. There was no drug-related complication. The nimodipine group showed satisfactory outcomes. Nimodipine can be recommended as an effective and safe intra-arterial agent for the treatment of symptomatic vasospasm after aSAH.

Comprehensive assessment of disability post-stroke using the newly developed miFUNCTION scale

2019 ◽  
Vol 15 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Charlotte Zerna ◽  
Tyler Burley ◽  
Theresa L Green ◽  
Sean P Dukelow ◽  
Andrew M Demchuk ◽  
...  
Keyword(s):  
Pilot Study ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Outcome Measure ◽  
Observer Agreement ◽  
International Classification Of Functioning ◽  
Modified Rankin Scale ◽  
Escape Trial

Background and Purpose The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial interobserver variability impairs outcome assessment as well as reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health, we developed a comprehensive, hierarchical assessment tool (miFUNCTION) to address the shortcomings of the modified Rankin Scale and deliver a more thorough understanding of disability following stroke. Methods The initial construct validity of miFUNCTION was established in a pilot study of patients at an outpatient stroke prevention clinic that had been diagnosed with stroke within 60 days. To further assess criterion validity, miFUNCTION was compared against the modified Rankin Scale and other outcome measures within the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial. Logistic regression analysis with miFUNCTION as an outcome was used to demonstrate the beneficial effect of endovascular treatment. Results The pilot study showed moderate inter-observer agreement (k = 0.585, p < 0.005) but near perfect correlation between miFUNCTION and modified Rankin Scale (ρ = 0.821, p < 0.05). The correlation of miFUNCTION and modified Rankin Scale was near perfect again in the ESCAPE trial (ρ = 0.944). Effect size of the multivariable models using modified Rankin Scale (adjusted odds ratio: 3.45, 95% confidence interval: 2.05–5.78) and miFUNCTION (adjusted odds ratio: 3.32, 95% confidence interval: 1.99–5.55) as an outcome measure for the ESCAPE trial patients was similar. Conclusions miFUNCTION is strongly associated with the degree of disability following stroke both in an outpatient setting and a clinical trial. Further work remains to assess sensitivity to change and to improve the inter-observer reliability of the scale.

scholarly journals APOL1 Risk Variants and Acute Kidney Injury in Black Americans with COVID-19

2021 ◽  
Vol 16 (12) ◽  
pp. 1790-1796
Author(s):  
Christopher P. Larsen ◽  
Terrance J. Wickman ◽  
Juarez R. Braga ◽  
Luis A. Matute-Trochez ◽  
Anna E. Hasty ◽  
...  
Keyword(s):  
High Risk ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Enzyme Inhibitor ◽  
African Ancestry ◽  
Black Americans ◽  
Content Type ◽  
Risk Alleles ◽  
Risk Variants

Background and objectivesBlack Americans have a higher incidence of kidney disease compared with populations that do not have recent African ancestry. Two risk variants in the APOL1 are responsible for a portion of this higher risk. We sought to assess the odds of AKI conferred by APOL1 risk alleles in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Design, setting, participants, & measurementsBlack Americans who tested positive for coronavirus disease 2019 (COVID-19) were genotyped to determine APOL1 risk allele status. We assessed the incidence of AKI, persistent AKI, and AKI requiring KRT within 21 days of the PCR-based diagnosis. Outcomes were adjusted for age, sex, body mass index, hypertension, eGFR, and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker.ResultsIn total, 126 cases of SARS-CoV-2 infection were included within a 5-month period, with 16 (13%) and 110 (87%) cases with two and zero/one APOL1 high-risk alleles, respectively. AKI occurred in 11 (69%) patients with two APOL1 high-risk alleles and 39 (35%) patients with zero/one high-risk alleles (adjusted odds ratio, 4.41; 95% confidence interval, 1.11 to 17.52; P=0.04). Persistent AKI occurred in eight (50%) patients with two APOL1 high-risk alleles and 21 (19%) of those with zero/one high-risk alleles (adjusted odds ratio, 3.53; 95% confidence interval, 1.8 to 11.57; P=0.04). AKI KRT occurred in four (25%) of those with two APOL1 high-risk alleles and eight (7%) of those with zero/one high-risk alleles (adjusted odds ratio, 4.99; 95% confidence interval, 1.02 to 24.4, P=0.05).ConclusionsAPOL1 high-risk alleles are associated with greater odds of AKI in Black American patients with COVID-19.

scholarly journals Treatment and Outcome in Stroke Patients With Acute M2 Occlusion and Minor Neurological Deficits

Stroke ◽  
2021 ◽  
Author(s):  
Tomas Dobrocky ◽  
Eike I. Piechowiak ◽  
Bastian Volbers ◽  
Nedelina Slavova ◽  
Johannes Kaesmacher ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Scale Score ◽  
Cerebral Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
National Institutes Of Health ◽  
Neurological Deficits ◽  
Minor Stroke ◽  
Modified Rankin Scale ◽  
Stroke Patients

Background and Purpose: Treatment in stroke patients with M2 segment occlusion of the middle cerebral artery presenting with mild neurological deficits is a matter of debate. The main purpose was to compare the outcome in patients with a minor stroke and a M2 occlusion. Methods: Consecutive intravenous thrombolysis (IVT) eligible patients admitted to the Bernese stroke center between January 2005 and January 2020 with acute occlusion of the M2 segment and National Institutes of Health Stroke Scale score ≤5 were included. Outcome was compared between IVT only versus endovascular therapy (EVT) including intra-arterial thrombolysis and mechanical thrombectomy (MT; ±IVT) and between IVT only versus MT only. Results: Among 169 patients (38.5% women, median age 70.2 years), 84 (49.7%) received IVT only and 85 (50.3%) EVT (±IVT), the latter including 39 (45.9%) treated with MT only. Groups were similar in sex, age, vascular risk factors, event cause, or preevent independency. Compared with IVT only, there was no difference in favorable outcome (modified Rankin Scale score, 0−2) for EVT (adjusted odds ratio, 0.96; adjusted P =0.935) or for MT only (adjusted odds ratio, 1.12; adjusted P =0.547) groups. Considering only patients treated after 2015, there was a significantly better 3-month modified Rankin Scale shift (adjusted P =0.032) in the EVT compared with the IVT only group. Conclusions: Our study demonstrates similar effectiveness of IVT only versus EVT (±IVT), and of IVT only versus MT only in patients with peripheral middle cerebral artery occlusions and minor neurological deficits and indicates a possible benefit of EVT considering only patients treated after 2015. There is an unmet need for randomized controlled trials in this stroke field, including imaging parameters, and more sophisticated evaluation of National Institutes of Health Stroke Scale score subitems, neurocognition, and quality of life neglected by the standard outcome scales such as modified Rankin Scale and National Institutes of Health Stroke Scale score.

scholarly journals Ibuprofen and NSAIDs use in COVID-19 infected patients is Not Associated with Worse Outcomes

2020 ◽  
Author(s):  
Laila Carolina Abu Esba ◽  
Rahaf Ali Alqahtani ◽  
Abin Thomas ◽  
Nour Shamas ◽  
Lolowa Alswaidan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Clinical Improvement ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Oxygen Requirement ◽  
Disease Outcomes ◽  
Risk Of Mortality ◽  
Chronic Use ◽  
Telephone Questionnaire

Abstract Background: Ibuprofen disappeared off the pharmacy shelves during the COVID-19 pandemic. However, a while later circulating information was that ibuprofen should be avoided as it could worsen COVID-19 symptoms. The aim of our study was to assess the association of NSAID acute and chronic use with worse COVID-19 outcomes.Methods: We did a prospective cohort study between April 12 and June 1, 2020. Adults consecutively diagnosed with COVID-19 were included. Information on NSAID use was collected through a telephone questionnaire and patients were followed up for COVID-19 infection outcomes, including death, admission, severity, time to clinical improvement, oxygen requirement, and length of stay.Findings: Ibuprofen acute use was not associated with a greater risk of mortality relative to nonusers (adjusted hazard ratio (HR) 0·632 [95% CI, 0·073- 5·441; P=0·6758]). NSIAD chronic use was also not associated with greater risk of mortality (adjusted HR, 0·492 [95% CI, 0·178 - 1·362; P= 0·1721]). Ibuprofen acute use was not associated with a higher risk of admission compared to non-NSAID users (adjusted odds ratio OR, 1·271; 95% CI, 0·548 - 2·953). NSAID users did not have a significantly longer time to clinical improvement, or length of stay.Interpretation: Ibuprofen and other NSAID acute or chronic use were not associated with worse COVID-19 disease outcomes.

scholarly journals Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3205-3214
Author(s):  
Sophie A. van den Berg ◽  
Simone M. Uniken Venema ◽  
Maxim J.H.L. Mulder ◽  
Kilian M. Treurniet ◽  
Noor Samuels ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Lower Probability ◽  
Modified Rankin Scale ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT. Methods: We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP. Results: We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04–1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03–1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94–0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99–1.13]). Results for DBP were largely similar. Conclusions: In patients with acute ischemic stroke treated with EVT, higher admission BP is associated with lower probability of successful reperfusion and with poor clinical outcomes. Further research is needed to investigate whether these patients benefit from BP reduction before EVT.

Post-treatment Antiplatelet Therapy Reduces Risk for Delayed Cerebral Ischemia due to Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2018 ◽  
Vol 85 (6) ◽  
pp. 827-833 ◽  
Author(s):  
Marvin Darkwah Oppong ◽  
Oliver Gembruch ◽  
Daniela Pierscianek ◽  
Martin Köhrmann ◽  
Christoph Kleinschnitz ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Confidence Interval ◽  
Antiplatelet Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Minor Bleeding ◽  
Bleeding Events

ABSTRACT BACKGROUND Delayed cerebral ischemia (DCI) has a strong impact on outcome of patients with aneurysmal subarachnoid hemorrhage (SAH). Positive effect of antiplatelet therapy on DCI rates has been supposed upon smaller SAH series. OBJECTIVE To analyze the benefit/risk profile of antiplatelet use in SAH patients. METHODS This retrospective case–control study was based on institutional observational cohort with 994 SAH patients treated between January 2003 and June 2016. The individuals with postcoiling antiplatelet therapy (aspirin with/without clopidogrel) were compared to a control group without antiplatelet therapy. Occurrence of DCI, major/minor bleeding events in the follow-up computed tomography scans, and favorable outcome at 6 mo after SAH (modified Rankin scale < 3) were compared in both groups. RESULTS Of 580 patients in the final analysis, 329 patients received post-treatment antiplatelet medication. There were no significant differences between the compared groups with regard to basic outcome confounders. Aspirin use was independently associated with reduced DCI risk (P < .001, adjusted odds ratio = 0.41, 95% confidence interval 0.24-0.65) and favorable outcome (P = .02, adjusted odds ratio = 1.78, 95% confidence interval 1.06-2.98). Regarding bleeding complications, aspirin was associated only with minor bleeding events (P = .02 vs P = .51 for major bleeding events). CONCLUSION Regular administration of aspirin might have a positive impact on DCI risk and outcome of SAH patients, without increasing the risk for clinically relevant bleeding events. In our SAH cohort, dual antiplatelet therapy showed no additional benefit on DCI risk, but increased the likelihood of major bleeding events.

SUBARACHNOID HEMORRHAGE AND INTRACEREBRAL HEMATOMA

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1088-1094 ◽  
Author(s):  
Erdem Güresir ◽  
Jürgen Beck ◽  
Hartmut Vatter ◽  
Matthias Setzer ◽  
Rüdiger Gerlach ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Odds Ratio ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Favorable Outcome ◽  
Intracerebral Hematoma ◽  
Modified Rankin Scale ◽  
Poor Grade ◽  
Hematoma Evacuation ◽  
Number Of Patients ◽  
Good Grade

Abstract OBJECTIVE To analyze the incidence and impact of an intracerebral hematoma (ICH) on treatment and outcome in patients with aneurysmal subarachnoid hemorrhage. METHODS Data of 585 consecutive patients with subarachnoid hemorrhage from June 1999 to December 2005 were prospectively entered in a database. ICH was diagnosed and size was measured by computed tomographic scan before aneurysm occlusion. Fifty patients (8.5%) presented with an ICH larger than 50 cm3. The treatment decision (coil, clip, or hematoma evacuation) was based on an interdisciplinary approach. Patients were stratified into good (Hunt and Hess Grades I–III) versus poor (Hunt and Hess Grades IV and V) grade, and outcome was assessed according to the modified Rankin Scale at 6 months. RESULTS Overall, 358 patients presented in good grade, with 4 of them having ICH (1.1%); and 227 patients presented in poor grade, with 46 of them having ICH (20.3%, P &lt; 0.01). In good-grade patients with an ICH (n = 4), a favorable outcome (modified Rankin Scale score of 0–2) was achieved in 1 patient (25%), and in 246 patients (75%) without an ICH (P = 0.053; odds ratio, 0.11). A favorable outcome was achieved in 5 poor-grade patients (12.8%) with an ICH and in 40 patients (23.7%) without an ICH (P = 0.19; odds ratio, 0.47). Time to treatment was significantly shorter in patients with an ICH than without an ICH (median, 7 versus 26 h; P &lt; 0.001) and shortest in patients with favorable outcome (3.5 hours; P &lt; 0.01). CONCLUSION The current data confirm that the presence of an ICH is a predictor of unfavorable outcome. However, despite large ICHs, a significant number of patients have a good outcome. To achieve a favorable outcome, ultra-early treatment with hematoma evacuation and aneurysm obliteration seems to be mandatory.

scholarly journals High Prevalence of Anal and Oral High-Risk Human Papillomavirus in Human Immunodeficiency Virus–Uninfected French Men Who Have Sex With Men and Use Preexposure Prophylaxis

2019 ◽  
Vol 6 (9) ◽  
Author(s):  
Ralph-Sydney Mboumba Bouassa ◽  
Laurent Bélec ◽  
Camelia Gubavu ◽  
Hélène Péré ◽  
Mathieu Matta ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Human Papillomavirus ◽  
High Risk ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hpv Infection ◽  
Preexposure Prophylaxis ◽  
Immunodeficiency Virus ◽  
Oral Hpv ◽  
Sex With Men

Abstract Background We assessed the prevalence and risk factors of anal and oral high-risk (HR) human papillomavirus (HPV) infection in human immunodeficiency virus–uninfected men who have sex with men (MSM) and take preexposure prophylaxis (PrEP) in France. Methods Anal and oral samples were screened by multiplex real-time polymerase chain reaction (Anyplex II HPV 28; Seegene) for HPV DNA. Results A total of 61 unvaccinated MSM (mean age, 36.1 years) were enrolled. Anal HPV and HR-HPV prevalences were 93.4% and 81.9%, respectively, and oral HPV and HR-HPV prevalences, 33.9% and 19.6%, respectively. HR-HPV type 33 was the most detected genotype, in both anal and oral samples. Among MSM, 68.8% carried ≥1 anal HPV type targeted by the 9-valent Gardasil-9 vaccine; all oral HPV-positive samples carried ≥1 strain included in the vaccine. Condomless receptive anal intercourse and history of anal gonorrhea were the main factors associated with increased risk for anal HPV infection (adjusted odds ratio, 10.4) and anal infection with multiple HR-HPV genotypes (5.77), respectively. Conversely, having had &lt;10 partners in the last 12 months was associated with decreased risk for anal carriage of both multiple HPV (adjusted odds ratio, 0.19) and HR-HPV (0.17) types. Conclusion French MSM using PrEP are at high risk for both anal and oral carriage of HR-HPV that could lead to HPV-related cancers.

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