The distribution indices of erythrocytes: which one for acute ischemic stroke?

2019 ◽  
Vol 45 (1) ◽  
pp. 65-75
Author(s):  
Nahide Ekici Günay ◽  
Nurullah Günay
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Linear Relationship ◽  
Survival Rates ◽  
Prognostic Significance ◽  
Fold Increase ◽  
Reference Intervals ◽  
Stroke Severity ◽  
Severity Scores ◽  
Poor Outcomes

Abstract Background The erythrocytes distribution indices are reported from same histogram but they have different reference intervals and calculated by distinct measurements. Objectives To explore whether the RDW-CV and RDW-SD values may predictive and prognostic significance in ischemic stroke patients and to clarify the relation each of these indices with stroke severity and 3-months survival. Materials and methods Cumulative survival rates were calculated with the Kaplan-Meier method, and life curves were compared to RDW-CV, RDW-SD quartiles. The risk factors were described with a multivariable cox proportional hazard model. Results In acute ischemic stroke, RDW-CV was more specific and RDW-SD was more sensitive (92% vs. 80%) (52% vs. 48%). RDW-CV values higher than 14.7% are associated with 11-fold increase in the risk of stroke; and the level of RDW-CV does show a linear relationship with the severity of stroke. However, when we evaluated RDW-SD, higher 43.55 fL RDW-SD values was have 16-fold increase in severity of stroke and have a relatively high linear relationship with stroke severity scores to RDW-CV. Conclusions RDW-CV and RDW-SD levels have different prognostic poor outcomes for interpreting in ischemic stroke events approach and these should be used alone and comparatively with the AIS predictive and prognostic approach.

Neutrophil extracellular traps are increased in patients with acute ischemic stroke: prognostic significance

2017 ◽  
Vol 117 (10) ◽  
pp. 1919-1929 ◽  
Author(s):  
Juana Vallés ◽  
María Teresa Santos ◽  
Ana María Latorre ◽  
José Tembl ◽  
Juan Salom ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Proteolytic Enzymes ◽  
Demographic Data ◽  
Prognostic Significance ◽  
Neutrophil Extracellular Traps ◽  
Stroke Severity ◽  
Specific Marker ◽  
Glucose Levels ◽  
Extracellular Traps

SummaryNeutrophil extracellular traps (NETs) are networks of DNA, histones, and proteolytic enzymes produced by activated neutrophils through different mechanisms. NET formation is promoted by activated platelets and can in turn activate platelets, thus favoring thrombotic processes. NETs have been detected in venous and arterial thrombosis, but data in stroke are scarce. The aim of this study was to evaluate NETs in the plasma of patients with acute ischemic stroke and their potential association with baseline clinical characteristics, stroke severity, and one-year clinical outcomes. The study included 243 patients with acute ischemic stroke. Clinical and demographic data and scores of stroke severity (NIHSS and mRs) at onset and discharge were recorded. Markers of NETs (cell-free DNA, nucleosomes, and citrullinated histone 3 (citH3)), were determined in plasma. Patients were followed-up for 12 months after the ischemic event. NETs were significantly elevated in the plasma of patients with acute ischemic stroke when compared to healthy subjects. NETs were increased in patients who were over 65 years of age and in those with a history of atrial fibrillation (AF), cardioembolic stroke, high glucose levels, and severe stroke scores at admission and discharge. In multivariate analysis, elevated levels of citH3, the most specific marker of NETs, at onset were independently associated with AF and all-cause mortality at oneyear follow-up. NETs play a role in the pathophysiology of stroke and are associated with severity and mortality. In conclusion, citH3 may constitute a useful prognostic marker and therapeutic target in patients with acute stroke.

The prognostic significance of white blood cell and platelet count for in-hospital mortality and pneumonia in acute ischemic stroke

2021 ◽  
Vol 18 ◽  
Author(s):  
Shoujiang You ◽  
Xin Sun ◽  
Yi Zhou ◽  
Chongke Zhong ◽  
Juping Chen ◽  
...  
Keyword(s):  
Platelet Count ◽  
Ischemic Stroke ◽  
Blood Cell ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
White Blood Cell ◽  
Prognostic Significance ◽  
Fold Increase ◽  
Combined Effect ◽  
Wbc Count

Background: We investigated the combined effect of white blood cell (WBC) and platelet count on in-hospital mortality and pneumonia in acute ischemic stroke (AIS) patients. Methods: A total of 3,265 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of WBC and platelet count: LWHP (low WBC and high platelet), LWLP (low WBC and low platelet), HWHP (high WBC and high platelet), and HWLP (high WBC and low platelet). A logistic regression model was used to estimate the combined effect of WBC and platelet counts on all-cause in-hospital mortality and pneumonia in AIS patients. Results : HWLP was associated with a 2.07-fold increase in the risk of in-hospital mortality in comparison to LWHP (adjusted odds ratio [OR] 2.07; 95% confidence interval [CI], 1.02-4.18; P-trend =0.020). The risk of pneumonia was significantly higher in patients with HWLP than those with LWHP (adjusted OR 2.29; 95% CI, 1.57-3.35; P-trend <0.001). The C-statistic for the combined WBC and platelet count was higher than WBC count or platelet count alone for the prediction of in-hospital mortality and pneumonia (all P < 0.01). Conclusion: High WBC count combined with a low platelet count level at admission was independently associated with in-hospital mortality and pneumonia in AIS patients. Moreover, the combination of WBC count and platelet count level appeared to be a better predictor than WBC count or platelet count alone.

National trends in outcomes of ischemic stroke and prognostic influence of stroke center capability in Japan, 2010–2016

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Akiko Kada ◽  
Kuniaki Ogasawara ◽  
Takanari Kitazono ◽  
Kunihiro Nishimura ◽  
Nobuyuki Sakai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Temporal Trends ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

scholarly journals P.066 Failing a dysphagia screen after acute ischemic stroke is highly predictive of poor outcomes

2016 ◽  
Vol 43 (S2) ◽  
pp. S36-S36
Author(s):  
RA Joundi ◽  
R Martino ◽  
G Saposnik ◽  
J Fang ◽  
V Giannakeas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Decubitus Ulcer ◽  
Stroke Severity ◽  
Term Care ◽  
Stroke Registry ◽  
Feeding Tubes ◽  
Multivariable Regression ◽  
Baseline Factors ◽  
Poor Outcomes

Background: Bedside dysphagia screening is recommended for all patients with acute ischemic stroke, in order to detect swallowing impairment early and prevent complications. However, limited data are available on outcomes associated with failing a dysphagia screen. Methods: We used the Ontario Stroke Registry to identify patients who were admitted to Regional Stroke Centres from 2010-2013 and received a dysphagia screen within 72 hours. We used multivariable regression to determine outcomes of patients who failed the dysphagia screen. Results: Among 5145 patients who underwent dysphagia screening, 2458 (47.8%) failed and 2687 (52.2%) passed. Patients who failed had more co-morbidities and presented with more severe strokes (mean NIHSS 11.0 vs. 5.4). Among those who failed, 9% required permanent feeding tubes, versus 0.1% among those who passed. After controlling for age, co-morbidities, and stroke severity, failing a bedside swallowing screen remained highly predictive of poor outcomes, including decubitus ulcer (adjusted odds ratio aOR 10.5), pneumonia (aOR 4.6), discharge to long-term care (aOR 4.1) and 30-day mortality (aOR 4.5; 16.6% vs. 2.2%). *All p <0.0001 Conclusions: Patients who failed a dysphagia screen on admission had dramatically worse outcomes after controlling for baseline factors. A bedside dysphagia screen provides immediate risk stratification for acute stroke patients and can be used to guide appropriate care.

scholarly journals Evaluation of serum ferritin as a prognostic marker in acute ischemic stroke: a prospective observational study

2020 ◽  
Vol 8 (12) ◽  
pp. 4282
Author(s):  
Ramesh Thanikachalam ◽  
Sathyan Elangovan ◽  
Appandraj Srivijayan
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Prognostic Marker ◽  
Serum Ferritin ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Stroke Severity ◽  
The Mean

Background: Stroke is an important health problem causing of morbidity and mortality globally. Serum ferritin has gained clinical significance as a prognostic factor that can aggravate the cytotoxicity of brain ischemia. The present study investigated the prognostic significance of serum ferritin levels with the severity of stroke using NIHSS scale.Methods: It was a prospective observational study conducted on 60 patients with acute ischemic stroke admitted in the general medicine department of a tertiary care teaching hospital. Serum ferritin levels were assessed on all participants using the instrument “immulite”. National institute of health stroke scale scoring was applied at the time of admission and on the seventh day to assess the impairment caused by a stroke. IBM SPSS version 22 was used for statistical analysis.Results: The mean serum ferritin levels at admission in patients with severe stroke, moderate stroke and mild and less stroke were 337.41±58.76, 285.56±49.37, and 197.91±111.01 ng/mL, respectively. The mean serum ferritin levels at admission were 178.76±114.70 ng/mL and 341.91±62.292 ng/mL in subjects who did not deteriorate and those who deteriorated, respectively. Whereas the mean serum ferritin levels on the sixth day were 198.34±106.88 and 348.10±57.34 ng/mL in subjects who did not deteriorate and those who deteriorated, respectively.Conclusions: Serum ferritin has a significant positive correlation with the severity of acute ischemic stroke severity on admission (p<0.001) and negative correlation with the severity of acute ischemic stroke severity on seventh day of admission (p<0.001). Thus, serum ferritin can be used as a prognostic marker in acute ischemic stroke.

scholarly journals Timing of Transfusion, not Hemoglobin Variability, Is Associated with 3-Month Outcomes in Acute Ischemic Stroke

2020 ◽  
Vol 9 (5) ◽  
pp. 1566 ◽  
Author(s):  
Chulho Kim ◽  
Sang-Hwa Lee ◽  
Jae-Sung Lim ◽  
Mi Sun Oh ◽  
Kyung-Ho Yu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
P Value ◽  
Stroke Severity ◽  
Operating Characteristics ◽  
Multivariable Logistic Regression Model ◽  
Absolute Deviation ◽  
Poor Outcome ◽  
Hemoglobin Variability ◽  
Poor Outcomes

Objectives: This study aimed to investigate whether transfusions and hemoglobin variability affects the outcome of stroke after an acute ischemic stroke (AIS). Methods: We studied consecutive patients with AIS admitted in three tertiary hospitals who received red blood cell (RBC) transfusion (RBCT) during admission. Hemoglobin variability was assessed by minimum, maximum, range, median absolute deviation, and mean absolute change in hemoglobin level. Timing of RBCT was grouped into two categories: admission to 48 h (early) or more than 48 h (late) after hospitalization. Late RBCT was entered into multivariable logistic regression model. Poor outcome at three months was defined as a modified Rankin Scale score ≥3. Results: Of 2698 patients, 132 patients (4.9%) received a median of 400 mL (interquartile range: 400–840 mL) of packed RBCs. One-hundred-and-two patients (77.3%) had poor outcomes. The most common cause of RBCT was gastrointestinal bleeding (27.3%). The type of anemia was not associated with the timing of RBCT. Late RBCT was associated with poor outcome (odd ratio (OR), 3.55; 95% confidence interval (CI), 1.43–8.79; p-value = 0.006) in the univariable model. After adjusting for age, sex, Charlson comorbidity index, and stroke severity, late RBCT was a significant predictor (OR, 3.37; 95% CI, 1.14–9.99; p-value = 0.028) of poor outcome at three months. In the area under the receiver operating characteristics curve comparison, addition of hemoglobin variability indices did not improve the performance of the multivariable logistic model. Conclusion: Late RBCT, rather than hemoglobin variability indices, is a predictor for poor outcome in patients with AIS.

Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients

2020 ◽  
Vol 132 (4) ◽  
pp. 1182-1187 ◽  
Author(s):  
Carrie E. Andrews ◽  
Nikolaos Mouchtouris ◽  
Evan M. Fitchett ◽  
Fadi Al Saiegh ◽  
Michael J. Lang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Multivariate Logistic Regression Analysis ◽  
Standard Of Care ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Younger Patients ◽  
Success Of Treatment

OBJECTIVEMechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients.METHODSThe authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old.RESULTSAll groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results.CONCLUSIONSOctogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.

Association of admission leukocyte count with clinical outcomes in acute ischemic stroke patients undergoing intravenous thrombolysis with recombinant tissue plasminogen activator

2020 ◽  
Vol 17 ◽  
Author(s):  
Jie Chen ◽  
Fu-Liang Zhang ◽  
Shan Lv ◽  
Hang Jin ◽  
Yun Luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Leukocyte Count ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Functional Independence ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Objective:: Increased leukocyte count are positively associated with poor outcomes and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association between admission leukocyte count before thrombolysis with recombinant tissue plasminogen activator (rt-PA) and 3-month outcomes in AIS patients. Methods:: This retrospective study included consecutive AIS patients who received intravenous (IV) rt-PA within 4.5 h of symptom onset between January 2016 and December 2018. We assessed outcomes including short-term hemorrhagic transformation (HT), 3-month mortality, and functional independence (modified Rankin Scale [mRS] score of 0–2 or 0–1). Results:: Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%) died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0–2). Multivariable logistic regression revealed admission leukocyte count as an independent predictor of good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased the odds of poor outcomes at 3 months by 7.6% (mRS score: 3–6, odds ratio (OR): 1.076, 95% confidence interval (CI): 1.003–1.154, p=0.041) and 7.8% (mRS score: 2–6, OR: 1.078, 95% CI: 1.006–1.154, p=0.033). Multivariable regression analysis revealed no association between HT and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3-month functional outcomes or 3-month mortality. Conclusion:: Lower admission leukocyte count independently predicts good and excellent outcomes at 3 months in AIS patients undergoing rt-PA treatment.

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