scholarly journals Prognostic significance of serum cortisol and serum albumin in patients of ischemic stroke

2020 ◽  
Vol 7 (4) ◽  
pp. 650
Author(s):  
Saman Fatima ◽  
Ruhi Khan

Background: Stroke is the second most common cause of mortality worldwide and a major contributor to morbidity and chronic adult disability. To study the prognostic significance of serum cortisol and serum albumin in patients of ischemic stroke was the objective.Methods: This hospital based observational cohort prospective study was undertaken in the Department of Medicine in collaboration with the Departments of Radio diagnosis and Pathology, Jawahar Lal Nehru Medical College and Hospital, AMU, Aligarh from January 2017 to November 2018. By convenience method for sampling, 102 patients who were admitted with the diagnosis of acute ischemic stroke to IPD of JNMCH, Aligarh, on clinical as well as radiological grounds were taken into study.Results: Mean cortisol was 450.84±190.35 nmol/L. The (mean±SD) of serum cortisol was 258.10±77.91 ng/ml in patients with good outcome and 585.77±113.34ng/ml in patients with poor outcome. (p<0.05, r= 0.812). Mean serum albumin was 2.83±0.76 gm/dl. The (mean±SD) of serum albumin was 3.47±0.64mg/dl in patients with good outcome and it was comparatively lower in patients with poor outcome (2.38±0.45mg/dl).  (p <0.01, r=-0.659).Conclusions: Serum albumin, serum cortisol are prognostic indicators of functional outcome at 3 months in patients of ischemic stroke.

Author(s):  
Konstantinos Makris ◽  
Katerina Koniari ◽  
Loukia Spanou ◽  
Eleni Gialouri ◽  
Efimia Evodia ◽  
...  

AbstractAnimal studies have shown a neuroprotective effect of human serum albumin (sAlb) in ischemic stroke (IS). Previous studies have shown an association of high sAlb with better outcome. Our aim is to investigate the kinetics of sAlb in acute IS and its possible correlation with outcome taking into account the analytical and biological variation of sAlb measurement.In a prospective observational study, we enrolled 105 patients with acute IS. sAlb was measured upon admission, at 24 h, 48 h, 72 h and Day 7 thereafter. Stroke severity was assessed upon admission and at 72 h, and functional outcome on Day 7. Patients were divided into two groups according to functional outcome on discharge. Calculation of reference change value was used to assess the clinical significance of sAlb changes and multiple logistic regression to assess the independent association between variables and outcome.Fifty-one patients (48.6%) had poor outcome. Their sAlb levels exhibit a significant daily decrease until 72 h (35.9 g/L) compared to baseline (41.1 g/L) and remained low until Day 7 (36.0 g/L). These changes were clinically significant only from 72 h on. Among non-poor outcome patients a significant daily decrease until 72 h (40.9 g/L) was followed by recovery on Day 7 (41.2 g/L), but these changes were not clinically significant. sAlb was not independently associated with the functional outcome at any time-point.This study shows that sAlb levels might change during the first days after an acute IS, but these changes although statistically significant are not clinically significant if we take into account the analytical and biological variation of sAlb.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takuya Kanamaru ◽  
Satoshi Suda ◽  
Junya Aoki ◽  
Kentaro Suzuki ◽  
Yuki Sakamoto ◽  
...  

Background: It is reported that pre-stroke cognitive impairment is associated with poor functional outcome after stroke associated with small vessel disease. However, it is not clear that pre-stroke cognitive impairment is associated with poor outcome in patients treated with mechanical thrombectomy. Method: We enrolled 127 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke from December 2016 to November 2018. Pre-stroke cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We retrospectively compared poor outcome (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=75) with good outcome (a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=52) and examined that IQCODE could be the predictor of PO. Result: IQCODE was significantly higher in poor outcome group than in good outcome group (89 vs. 82, P=0.0012). Moreover, age (77.2 years old vs. 71.6 years old, P= 0.0009), the percentage of female (42.7% vs. 17.3%, P= 0.0021), complication of hypertension (HT, 68.0% vs. 44.2%, P=0.0076), National Institutes of Health Stroke Scale (NIHSS) at admission (20 vs. 11, P<0.0001), the percentage of postoperative intracerebral hemorrhage (ICH, 33.3% vs. 15.4%, P=0.0233) were higher in poor outcome group than in good outcome group, too. However, there was no significant difference between poor outcome and good outcome groups in occlusion site (P= 0.1229), DWI-ASPECTS (P= 0.2839), the duration from onset to recanalization (P=0.4871) and other risk factors. Multivariable logistic regression analysis demonstrated that IQCODE, HT and NIHSS at admission were associated with poor outcome (P= 0.0128, P=0.0061 and P<0.0001, respectively). Conclusion: Cognitive impairment could be associated with poor outcome in patients treated with mechanical thrombectomy.


Author(s):  
Amy K Starosciak ◽  
Italo Linfante ◽  
Gail Walker ◽  
Osama O Zaidat ◽  
Alicia C Castonguay ◽  
...  

Background: Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. Methods: The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power. Results: Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80). Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.


2014 ◽  
pp. 168-176
Author(s):  
Vu Xuan Loc Doan ◽  
Thanh Thao Nguyen ◽  
Minh Loi Hoang ◽  
Trong Hao Vo

Background and Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) scale semiquantitatively assesses extent and location of ischemic changes within the middle cerebral artery (MCA) territory using a 10-point grading system. ASPECTS measured at baseline using noncontrast computed tomography (CT) scan. The aim of this study was to assess early prediction of clinical outcome after acute ischemic stroke by ASPECTS scale. Methods: The study based on convenience sample which included 82 first-ever acute ischemic stroke patients, admitted to Hue Central Hospital within 72 hours of stroke onset, from October 2013 to October 2014. Ischemic territory changes were defined as parenchymal CT hypoattenuation. We assessed all baseline CT scans, dichotomized ASPECTS at ≤ 7 and >7, defined good outcome (0 to 2) and poor outcome (3 to 6) as modified Rankin Scale (mRS) score at discharge. Univariate analysis and multivariable logistic regression analysis were performed to define the independent predictors for stroke outcome. Results: Mean age was 68.35 ± 13.93 years, proportion of male (51.2%) and female (48.8%) are approximately the same. ASPECTS score > 7 in 57 patients and ≤ 7 in 25 patients. Mean ASPECTS was 7.51 ± 2.25. Mean mRS at discharge was 2.28 ± 1.33. Good outcome (mRS ≤ 2) and poor outcome (mRS > 2) at discharge were 63.4% and 36.6% respectively. There is a negative correlation between ASPECTS and mRS (r = -0.86, p < 0.001). In the univariate analysis, atrial fibrillation, Glasgow Coma Scale (GCS) score at admisison, ASPECT score and infarct volume were significantly associated with stroke outcome. All of aforementioned variables underwent multivariate analysis, but none of them was proven to be an independent predictor of early outcome. Conclusion: In patients with first-ever acute ischemic stroke, ASPECT score which bases on conventional computed tomography scan is not independent predictor for clinical outcome at discharge. Key words: ischemic stroke, ASPECTS, outcome


2021 ◽  
Vol 15 (6) ◽  
pp. 1335-1339
Author(s):  
E. U Haq ◽  
A. Qayyum ◽  
H. A. Qayyum ◽  
M. Anam ◽  
A. R. Khan ◽  
...  

Background: Stroke is a serious public health issue and third leading cause of death worldwide. Hypoalbuminemia is commonly found factor in patients of stroke and is also associated with severe disease as well as pro inflammatory patterns of serum protein electrophoresis. Therefore, further research for understanding the role of Hypoalbuminemia in stroke is important to devise strategies for better management of stroke. Aim : To determine the frequency of hypoalbuminemia in acute ischemic stroke patients based on stroke severity. Methods: This descriptive cross- sectional study was conducted in Shifa International hospital stroke unit for 6 months from May 15, 2018 till Nov 15, 2018. Data was collected from 100 patients using purposive sampling. After taking consent from patient or attendant, the demographic data was collected on a structured proforma. Baseline serum albumin and stroke severity using the NIHSS score was also assessed. All data was entered and analysed using SPSS 21. After descriptive analysis, post stratified Chi Square test was applied for gender and age categories. Results: The mean age of patients was 63.60 ± 11.87 years with 57(57%) male and 43(43%) female cases. The mean serum albumin level was 4.03 ± 0.94 with minimum and maximum values as 1.50 and 5.5. Among cases with minor, moderately severe and with severe stroke, 6(37.5%) cases, 18(25.7%) cases and 6(42.9%) cases had Hypoalbuminemia. The frequency of hypoalbuminemia was statistically same with respect to severity of stroke, p-value > 0.05. Conclusion: This study concludes that the frequency of hypoalbuminemia in acute ischemic stroke patients was diagnosed in almost one third cases, however, no statistical association could be found. Hence, screening for hypoalbuminemia should be done for better management of stroke patients. Keywords: Storke, NIHSS score, serum albumin, hypoalbuminemia, mortality


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Taha Nisar ◽  
Toluwalase Tofade ◽  
Ava Liberman ◽  
Priyank Khandelwal

Introduction: Elevation of blood pressure (BP) post mechanical thrombectomy (MT) can theoretically restore cerebral perfusion to the ischemic brain tissue, but it comes at a risk of causing reperfusion injury. The ideal BP in the 24-hour range after MT has been understudied. We investigated the association of different BP parameters post-MT with the functional outcome at discharge at a tertiary care center. Methods: We performed a retrospective chart review of adult patients who underwent MT for an anterior circulation large vessel occlusion at a comprehensive stroke center from July 2014 to March 2018. We recorded the BP values over a period of 24-hours post-MT. A binary logistic regression analysis was performed, controlling for age, pre-thrombectomy NIHSS-scores, thrombolysis in cerebral infarction (TICI)-scores, duration to thrombectomy, with the BP parameters as the predictors. The primary outcome was the functional outcome at discharge. Good outcome was defined as a modified rankin scale (mRS) of 0-2 and a poor outcome as mRS of 3-6, upon discharge. Results: 69 patients met our inclusion criteria. 39 (56.52%) patients were male. The mean age was 64.80±14 years. The mean pre-treatment NIHSS was 16.18±5. 22 (31.88%) patients had a good outcome (mRS≤2) at discharge. In the logistic regression model, the parameters of higher mean arterial pressure (MAP) variability like coefficient variation (CV) MAP (7.04±6 vs.3.13±5.; OR, 1.13; 95% CI,1.01-1.27; P 0.038) and standard deviation (SD) MAP (6.4±6 vs.2.75±4; OR, 1.15; 95% CI,1.02-1.31; P 0.032) were significantly associated with a poor outcome at discharge. The parameters of average systolic BP, average diastolic BP, and average MAP over 24-hours post-MT were not significantly associated with poor outcomes at discharge. Conclusions: Our study demonstrates a significant association between 24-hours-post-MT parameters of higher MAP variability like CV MAP and SD MAP and poor functional outcomes at discharge.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Saad El-Din Mahmud ◽  
Hala Mahmoud EL-Khawas ◽  
Hossam El Din Mahmoud Afify ◽  
Mohamed Mohamed Tawfik

Abstract Objectives We aimed to Detect if there is association between serum albumin level in acute ischemic stroke patients and its short term neurological and functional outcome in a tertiary care hospital in Cairo. Methods The study was carried out as descriptive (cross-sectional) study conducted on 50 cases first-ever acute ischemic stroke patients were enrolled between June 2018 to December 2018 with follow up after 30 days of discharge from hospital. Inclusion and exclusion criteria were strictly exercised. National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) score was noted. Serum albumin (SA) was estimated from blood Clinical, functional, and radiological evaluation was done for the patients. Statistical SPSS 20.0 software and Microsoft excel were used for statistical analysis (P ≤ 0.05).Relationship between serum albumin and stroke outcome was determined. Results A total of 50 stroke cases were thus included in the study comprising 34 males and 16 females. The mean age of patients was 40-65 [59.26±6.25] years, we found the most prevalent risk factors in the present study results were hypertension 36 (72.0%). The mean serum level of albumin were (3.73±0.63) on day o of onset and (3.72±0.63) after 30 days of discharge from hospital. Bivariate analysis shows serum albumin was inversely associated with NIHS score and mRS on day o of onset and after 30 days of discharge from hospital which were NIHSS(r= -0.264, P = 0.044) (r= -0.645, P = &lt;0.001) and mrs (r= -0.321, P = 0.031) (r= -0.587, P = &lt;0.001) respectively. Conclusion Hypoalbuminemia had influence to degree of stroke severity, degree of disability and functional outcome. Serum albumin levels had a negatively correlation with NIHSS score and modified Rankin scale. Low serum albumin levels associated with poor prognosis in acute ischemic stroke patients.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9524-9524 ◽  
Author(s):  
M. D. Norris ◽  
J. Smith ◽  
A. Kwek ◽  
C. Flemming ◽  
S. L. Cohn ◽  
...  

9524 Background: We have previously shown, both retrospectively and prospectively, that high-level expression of the multidrug transporter gene ABCC1/MRP1, is strongly predictive of poor outcome in the childhood cancer neuroblastoma (NEJM, 334:231–8, 1996; JCO, 24:1546–53, 2006), and that ABCC1/MRP1 can be regulated by the MYCN oncogene. The contribution of other ABCC family genes to clinical outcome in this disease has now been examined. Methods: Real-time quantitative PCR was used to determine ABCC gene expression in a large prospectively accrued cohort (n=209) of primary untreated neuroblastomas from patients enrolled on POG biology protocol 9047. Results: Older age, advanced stage, and MYCN amplification were all predictive of poor outcome in the cohort. Amongst the ABCC family, high levels of ABCC1 and ABCC4, but low levels of ABCC3, were strongly associated with reduced survival and event-free survival (P<0.005) in the overall study population, and also in subgroups of patients lacking MYCN amplification. Following adjustment for the effect of MYCN gene amplification and other prognostic indicators by multivariate analysis, expression of ABCC1 (HR=2.3; p=0.03), ABCC3 (HR=2.7; p=0.0141), ABCC4 (HR=3.4; p=0.002) retained significant prognostic value for outcome, whereas age and MYCN amplification lost all prognostic significance. By combining the expression of these three transporter genes, patients could be stratified into groups having excellent, intermediate or poor outcome (EFS=84%, 59%, 17%, respectively). Conclusions: These data, suggest that ABCC1, 3 and 4 are amongst the most powerful prognostic markers yet identified for childhood neuroblastoma and as such represent important targets for potential therapeutic intervention. No significant financial relationships to disclose.


2021 ◽  
Vol 12 ◽  
Author(s):  
Xuan Wu ◽  
Zuowei Duan ◽  
Yihui Liu ◽  
Changwu Zhou ◽  
Zhiyun Jiao ◽  
...  

Background: This study was to examine the patients with acute cerebral infarction (ACI) treated at a single center over 9 years and who underwent Unruptured intracranial aneurysm (UIA) screening by three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA), and to explore the factors associated with outcomes.Methods: The outcome was the modified Rankin scale (mRS) score at 90 days after stroke onset. The outcome was classified into a good outcome (mRS score of 0–2 points) and poor outcome (mRS score of 3–6 points).Results: UIAs were found in 260 (6.5%) of 4,033 patients with ACI; 2,543 (63.1%) had a good outcome, and 1,490 (36.9%) had a poor outcome. There was no difference in outcomes between the two groups (P = 0.785). The multivariable analysis showed that age (OR = 1.009, 95%CI: 1.003–1.014, P = 0.003), diabetes (OR = 1.179, 95%CI: 1.035–1.342, P = 0.013), ischemic stroke history (OR = 1.451, 95%CI: 1.256–1.677, P &lt; 0.001), and baseline NIHSS score (OR = 1.034, 95%CI: 1.018–1.050, P &lt; 0.001) were independently associated with the 90-day outcomes in patients with ACI. The presence of incidental UIA was not associated with outcomes after ACI.Conclusions: Age, diabetes, ischemic stroke history, and baseline NIHSS score were independently associated with the early outcomes of patients with ACI.


2019 ◽  
Vol 26 (02) ◽  
Author(s):  
Omperkash ◽  
Arshad ◽  
Suresh ◽  
Nathumal Maheshwari ◽  
Rewachand ◽  
...  

Objectives: Analysis of Clinical and Prognostic significance of Serum Albumin in Acute Ischemic Stroke and its correlation with National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). Study Design: Case control study. Setting & Period: Department of Medicine, Liaquat University of Medical and Health Sciences Hospital Hyderabad/Jamshoro from March 2016 to June 2017. Subjects & Methods: A sample of 100 cases of acute ischemic brain stroke (AIS) and 100 controls were selected according to inclusion and exclusion criteria. Clinical criteria of NIHSS and mRS were calculated. Blood samples were taken for biochemical analysis. Albumin was analyzed between 2 groups and its correlation with NIHSS and mRS was estimated by Pearson`s correlation. Data was analyzed on Statistical Package SPSS 22.0 software and Microsoft excel sheet (P ≤ 0.05). Results: Serum albumin was found low in AIS cases 3.86±0.68 g/dl compared to controls 5.16±0.34 g/dl (P=0.0001). Of 100 AIS cases, 23% patients died and 77.0% survived. Bivariate analysis shows serum albumin was inversely associated with NIHS score and mRS (r= -0.596, P=0.0001) (r= -0.720, P=0.0001) respectively. Conclusion: Low serum albumin adversely affects the prognosis of acute ischemic stroke patients.


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