scholarly journals A Novel FAND Nomogram to Predict the Risk of Hospital-Acquired Pneumonia after Acute Ischemic Stroke with Mechanical Thrombectomy

2019 ◽  
Author(s):  
Belynda Owoya Ochete ◽  
Linda Nyame ◽  
Xiang Li ◽  
Yang Zou ◽  
XueMei Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Patient Outcomes ◽  
Mechanical Thrombectomy ◽  
Preventive Measure ◽  
Predictive Tool ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background: The timely prediction in the risk of Hospital-Acquired Pneumonia（HAP）in Acute Ischemic stroke (AIS) patients after Mechanical thrombectomy (MT) treatment is of high priority, given the rise in AIS mortality as a result. Although prior extensive research has been conducted in HAP preventive management and therapeutics, ischemic stroke patients are still at serious risk of contracting In-hospital pneumonia infections following certain medical procedures like Mechanical thrombectomy, a care standard for AIS patients. The predictive accuracy of patients with higher infection risk and adjusting therapeutic strategies accordingly will not only provide an enhanced preventive measure perspective but also significantly improve patient outcomes. Hence, our study was aimed at the validation and development of a novel predictive tool for risk stratification and individualized predictions of HAP occurrence in AIS patients after MT therapy. Method: A multicenter retrospective study was executed with 405 AIS patients after undergoing MT treatment and admitted to the three Chinese stroke units. The major measure of outcome was to estimate the risk of HAP after MT through the integration of the following four predictors FBG, Age, NHISS, and Diastolic blood pressure (FAND) into a nomogram. Assessed on the multivariate logistic model, a nomogram was constructed, using the area under the receiver-operating characteristic curve to evaluate the discriminative performance and the Hosmer–Lemeshow test for risk prediction model calibration. Results: Age(OR:1039; 95%Cl 1.017-1.062; p=0.001), NIHSS(National Institutes of Health Stroke Scale) score on admission(OR:1.066; 95%Cl: 1.030-1.103); p< 0.0001), diastolic blood pressure(OR 1.023; 95% Cl 1.006-1.040: p=0.008), Fasting blood glucose(OR 1.1444; 95% Cl 1.029-1.271; p=0.013) remained independent predictors of HAP integrated into the FAND nomogram after AIS Chinese patients received MT treatment. The Hosmer-Lemeshow goodness-of fit-test expressed good calibration(p-value: 0.496) and Area under the curve of 0.737 was exhibited for functional impairment prediction. Conclusion: The FAND nomogram is a novel prognostic model developed and validated in Chinese AIS patients after MT treatment may aid in preventive measure strategies and predict poor patient outcomes.

Abstract P246: Hospital Acquired Pneumonia and Dysphagia Screening in Patients With Acute Ischemic Stroke: Findings From Get With the Guidelines-Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Shihab Masrur ◽  
Eric E Smith ◽  
Mathew Reeves ◽  
Xin Zhao ◽  
DaiWai Olson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Intake ◽  
Stroke Patients ◽  
Chi Square ◽  
Hospital Acquired Pneumonia ◽  
Get With The Guidelines ◽  
Hospital Acquired ◽  
The Relationship ◽  
Hospital Characteristics

National guidelines recommend dysphagia screening (DS) before any oral intake in hospitalized stroke patients to reduce the risk of hospital-acquired pneumonia (HAP). We examined the relationship between DS and HAP in acute ischemic stroke patients in the Get With the Guidelines-Stroke (GWTG-S) program. Methods: Data from 1251 GWTG-S hospitals from 04/01/2003 to 03/01/2009 were analyzed. GWTG-S defines HAP as a clinical diagnosis of pneumonia requiring antibiotics. Use of a bedside, evidence-based swallow screen prior to any oral intake qualified as a DS. Univariate analyses (chi-square for categorical variables or Wilcoxon for continuous variables) and multivariate logistic regression analyses were performed to examine the relationship between DS and HAP, adjusting for patient and hospital characteristics Results: Among 365,726 ischemic stroke patients, 213097 (59.83%) underwent DS, and 25,166 (6.88%) developed HAP. When compared to patients without pneumonia ( Table 1 ), patients with HAP were older and more frequently had CAD/MI, diabetes, prior stroke/TIA, dyslipidemia, atrial fibrillation. They, underwent DS less often, and had increased length of stay, morbidity and in-hospital mortality. Among the subgroup who had NIHSS recorded (n=160,837, 44%), HAP patients had higher median NIHSS (13 vs. 5). Among patients with NIHSS<2, 3.3% developed HAP. In multivariate analysis, factors independently associated with a lower risk of HAP were DS (OR 0.86 [0.83-0.90]), female (OR 0.83 [0.81-0.85]), dyslipidemia (OR 0.84 [0.82-0.86]), and hypertension (OR 0.96 [0.94-0.98]). Discussion: Our data suggests that dysphagia screening is associated with a lower likelihood of HAP, but screening rates remain low. Strategies that increase the rate of dysphagia screening among all stroke patients, even those with mild strokes, should be more broadly implemented. Prospective validation of these findings is warranted. Table 1. Unadjusted associations between patient and hospital characteristics and clinical outcomes Overall(% or value) HAP(% or value) No HAP(% or value) Study Population 365726 (100%) 25166(6.9%) 340560(93.1%) Age (years) Median (IQR) 73(61, 82) 77(66, 85) 73(61,82) Female 52.5 49.2 52.8 Dysphagia Screen Performed 59.8 54.8 60.2 In Hospital Death 5.7 18.1 4.8 P-values are <.0001 for all comparisons and are based on Chi-square test (for dichotomous and nominal factors) or Wilcoxon test (for ordinal and continuous factors)

scholarly journals Effect of Prior Atorvastatin Treatment on the Frequency of Hospital Acquired Pneumonia and Evolution of Biomarkers in Patients with Acute Ischemic Stroke: A Multicenter Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Yuetian Yu ◽  
Cheng Zhu ◽  
Chunyan Liu ◽  
Yuan Gao
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Protective Factor ◽  
Prior Treatment ◽  
Clinical Trial Registry ◽  
Atorvastatin Treatment ◽  
Significant Difference ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP).Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n=268, PG) and no prior treatment group (n=224, NG). All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC), procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)] were tested.Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%,p>0.05) and 28-day mortality (50.72% versus 58.18%,p>0.05). However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP) (36.54% versus 58.14%,p=0.041) and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825,p=0.038). Concentrations of TNF-αand IL-6 in PG VAP cases were lower than those in NG VAP cases (p<0.01).Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-αand improved the outcome of VAP. This clinical study has been registered withChiCTR-ROC-17010633in Chinese Clinical Trial Registry.

scholarly journals Outcome of mechanical thrombectomy in the very elderly for the treatment of acute ischemic stroke: the real world experience

2015 ◽  
Vol 4 (9) ◽  
pp. 205846011559942 ◽  
Author(s):  
Chiu Yuen To ◽  
Sina Rajamand ◽  
Ratnesh Mehra ◽  
Stephanie Falatko ◽  
Yaser Badr ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Mechanical Thrombectomy ◽  
Very Elderly ◽  
Symptomatic Intracranial Hemorrhage ◽  
Viable Treatment

Background Although initial studies of neuroendovascular intervention did not review benefit over intravenous thrombolytics (iv r-tPA), recent studies have suggested otherwise. Elderly patients (age ≥80 years) are typically excluded from clinical trials. Purpose To examine the utility of mechanical thrombectomy based on patient outcomes. Material and Methods All stroke-alert activations at our health system from January 2011 to June 2014 were examined. All patients aged ≥80 years who had undergone mechanical thrombectomy were identified. Clinical characteristics included physiologic imaging findings, use of intravenous thrombolytics, baseline and postoperative National Institute of Health Stroke Scale (NIHSS), thrombolysis in cerebral infarction scores (TICI), and discharge destination. Results Mean NIHSS on presentation was 18.2 (range, 6–31), and 13.3 (range, 3–30) post thrombectomy. Three (16.6%) patients received iv r-tPA, two (11.1%) had symptomatic intracranial hemorrhage. Eight (44.4%) died, eight (44.4%) were discharged to nursing homes, and two (11.7%) were discharged to inpatient rehab and subsequently home. Favorable outcome was achieved in five (27.7%) patients. Fourteen (77.7%) patients had physiologic imaging prior to intervention. Three (75%) of four patients who did not have physiologic imaging prior to thrombectomy died. Thirteen (66.6%) patients had TICI 3 recanalization. Conclusion Our study showed that although there remains a role of mechanical thrombectomy in the treatment of acute ischemic stroke in very elderly patients, it is associated with significant higher morbidity and mortality compared to younger patients, but should remain a very viable treatment option when quality of life is the most important consideration.

scholarly journals Increased blood pressure variability after acute ischemic stroke increases the risk of death: A secondary analysis of the Virtual International Stroke Trial Archive

2019 ◽  
Vol 8 ◽  
pp. 204800401985649 ◽  
Author(s):  
Adam de Havenon ◽  
Greg Stoddard ◽  
Monica Saini ◽  
Ka-Ho Wong ◽  
David Tirschwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Risk Of Death ◽  
Study Enrollment ◽  
Systolic Blood Pressure Variability ◽  
Stroke Trial

Background Despite promising epidemiological data, it remains unclear if increased blood pressure variability is associated with death after acute ischemic stroke. Our objective was to examine this association in a large cohort of acute ischemic stroke patients. Methods We conducted a retrospective analysis of anonymized, pooled, participant data from the Virtual International Stroke Trial Archive. We included patients with a 90-day modified Rankin Scale and blood pressure readings in the 24 h after study enrollment. The exposure was blood pressure variability during the day after study enrollment, calculated for the systolic and diastolic blood pressure using six statistical methodologies. The primary outcome was death within 90 days of stroke onset. Results Our cohort comprised 1891 patients of whom 277 (14.7%) died within 90 days. All indices of blood pressure variability were higher in patients who died, but the difference was more pronounced for systolic than diastolic blood pressure variability (systolic standard deviation for alive versus dead patients = 13.4 versus 15.9 mmHg, p < 0.001). Similar results were found in logistic regression models fit to the outcome of death, but only systolic blood pressure variability remained significant in adjusted models (Odds Ratio for death when comparing highest to lowest tercile of systolic blood pressure variability = 1.41–1.89, p < 0.03 for all). Conclusions and relevance: These results reinforce prior studies that found increased blood pressure variability is associated with worse neurologic outcome after stroke. These data should help guide research on blood pressure variability after stroke and advocate for the inclusion of death as a clinical outcome in future studies that therapeutically reduce blood pressure variability.

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