Level of IL-6 in cerebrospinal fluid is a preoperative predictor of short - term outcome in acquired hydrocephalus

Abstract Background: Acquired hydrocephalus (AH) is a common complication in patients with severe brain injury. Brain tissue injury has been proposed to induce a neuroinflammatory reaction reflected by cytokines release, particularly interleukin-6 (IL-6), which associates with early brain damage. The present study measured IL-6 in the cerebrospinal fluid (CSF) of AH patients and determined its relationship to functional outcome following shunt operation.Methods: The study included a total of 32 patients with a shunt operation due to hydrocephalus. CSF samples from 26 AH subjects and 6 iNPH patients were collected via lumbar puncture before surgery. IL-6 level was measured using the micro ELISA immunoassay method. AH subjects were dichotomized into good versus poor outcomes based on modified Rankin Scale (mRS) at 3 months after shunting.Results: CSF analysis demonstrated that IL-6 was significantly elevated in the CSF of the AH group compared to controls (p = 0.023). Within the AH group, eighteen (69.2%) had a good outcome while eight (30.8%) patients had a poor outcome. Mean IL-6 level in the good outcome group was approximately four-times higher than the poor outcome group (p = 0.004). Glasgow Coma Scale (GCS) on admission was significantly different between the two groups (p = 0.014). IL-6 level and admission GCS were significantly correlated with improvement of mRS score (r = 0.473, p = 0.015 and r = 0.691, p＜0.0001, respectively). Receiver operating characteristic curve analysis showed that both factors can accurately differentiate between patients with good versus poor functional outcome (AUC = 0.861, p = 0.0039 and AUC = 0.823, p = 0.0098, respectively). Conclusions: The CSF level of IL-6 is elevated in AH patients and higher levels correlate with improvement of post-shunt functional outcome. Therefore, IL-6 CSF level might serve as a complementary surrogate parameter for operative indication. A possible IL-6 threshold in clinical routine might be a 6.98-pg/ml cutoff value to rule out unresponsive and poor outcome AH patients that are under the 6.98-pg/ml threshold.

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Comparison of Prognostic Performance between Neuron-Specific Enolase and S100 Calcium-Binding Protein B Obtained from the Cerebrospinal Fluid of Out-Of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

Journal of Clinical Medicine ◽

10.3390/jcm10071531 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1531

Author(s):

Changshin Kang ◽

Wonjoon Jeong ◽

Jung Soo Park ◽

Yeonho You ◽

Jin Hong Min ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Cardiac Arrest ◽

Calcium Binding ◽

Neuron Specific Enolase ◽

Poor Outcome ◽

The Poor ◽

S100 Calcium Binding Protein ◽

Poor Outcome Group ◽

Outcome Group ◽

Hospital Cardiac Arrest

We compared the prognostic performances of serum neuron-specific enolase (sNSE), cerebrospinal fluid (CSF) NSE (cNSE), and CSF S100 calcium-binding protein B (cS100B) in out-of-hospital cardiac arrest (OHCA) survivors. This prospective observational study enrolled 45 patients. All samples were obtained immediately and at 24 h intervals until 72 h after the return of spontaneous circulation. The inter- and intragroup differences in biomarker levels, categorized by 3 month neurological outcome, were analyzed. The prognostic performances were evaluated with receiver operating characteristic curves. Twenty-two patients (48.9%) showed poor outcome. At all-time points, sNSE, cNSE, and cS100B were significantly higher in the poor outcome group than in the good outcome group. cNSE and cS100B significantly increased over time (baseline vs. 24, 48, and 72 h) in the poor outcome group than in the good outcome group. sNSE at 24, 48, and 72 h showed significantly lower sensitivity than cNSE or cS100B. The sensitivities associated with 0 false-positive rate (FPR) for cNSE and cS100B were 66.6% vs. 45.5% at baseline, 80.0% vs. 80.0% at 24 h, 84.2% vs. 94.7% at 48 h, and 88.2% (FPR, 5.0%) vs. 94.1% at 72 h. High cNSE and cS100B are strong predictors of poor neurological outcome in OHCA survivors. Multicenter prospective studies may determine the generalizability of these results.

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Abstract TP195: Pre-Stroke Cognitive Impairment is Associated With Poor Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽

10.1161/str.51.suppl_1.tp195 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Takuya Kanamaru ◽

Satoshi Suda ◽

Junya Aoki ◽

Kentaro Suzuki ◽

Yuki Sakamoto ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Modified Rankin Scale ◽

Good Outcome ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group ◽

Significant Difference

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.

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Abstract 150: Multicenter Validation of SPOT, an Artificial Intelligence Based Tool, to Optimize Selection of Elderly Stroke Patients for Mechanical Thrombectomy - Insights From the STAR Collaboration

Stroke ◽

10.1161/str.51.suppl_1.150 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ali M Alawieh ◽

Mohamed Baker Alawieh ◽

Fadi Zaraket ◽

Reda M Chalhoub ◽

Mohammad Anadani ◽

...

Keyword(s):

Elderly Patients ◽

Negative Predictive Value ◽

Predictive Value ◽

Mechanical Thrombectomy ◽

Characteristic Curve ◽

Linear Regression Models ◽

Good Outcome ◽

Poor Outcome ◽

Multicenter Validation ◽

Selection Of

Introduction: Mechanical thrombectomy for acute ischemic stroke (AIS) is the current standard of care based on level 1 evidence from multiple randomized controlled trials. Recently, real-world indications for mechanical thrombectomy (MT) has extended beyond the inclusion criteria used in the majority of trials including elderly patients. We have recently developed a machine-learning based tool, SPOT, to optimize selection of elderly patients for MT based on single-center data. Here, we use a large cohort of international multicenter patients who underwent MT for AIS to externally validate SPOT. Methods: Patients who underwent MT for AIS at 12 comprehensive stroke centers in the US and Europe between 01/2013 and 12/2018 were reviewed. Patients age 80 years or older were included for validation of SPOT. SPOT is designed based on a combination of decision trees and linear regression models to provide binary output of predicted good (mRS 0-2) or poor outcome (mRS 3-6) after MT. SPOT uses admission variables: age, gender, comorbidities, admission NIHSS, baseline mRS score, ASPECT score and whether IV-tPA was administered. Predicted outcome was compared to actual outcome recorded at 90-days after treatment. A receiver operating characteristic curve was used to evaluate the accuracy of SPOT, and the negative predictive value was computed. The rate of post-procedural hemorrhage and mortality were compared between patients predicted by SPOT to have good versus poor outcome. Results: A total of 3,228 patients underwent MT for AIS during the study duration, of which 647 patients were at least 80 years of age or older and were included in the study. The average age was 85±5 years, and 65% were females. The median mRS score at 90 days was 4, and 21.3% had a good outcome (mRS 0-2). Of patients predicted by SPOT to have a poor outcome, 90% had a poor outcome. The area under the ROC curve was 0.7. The mortality rate in patients predicted by SPOT to have poor outcome had twice higher mortality than those predicted to have good outcome (55% vs 27%, p<0.001). Conclusions: Based on multicenter validation, SPOT presents a clinical decision in aid in assisting for exclusion of elderly patients unlikely to benefit from MT for AIS with a 90% negative predictive value.

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Decreased Time to Evacuation Improves Long Term Functional Outcome in Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Neurosurgery ◽

10.1093/neuros/nyz310_304 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Christopher P Kellner ◽

Rui Song ◽

Dominic A Nistal ◽

Ian T McNeill ◽

Hasitha M Samarage ◽

...

Keyword(s):

Minimally Invasive ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

National Institutes Of Health ◽

Term Outcome ◽

Long Term Outcome ◽

Clinical Criteria ◽

Poor Outcome ◽

Deep Location

Abstract INTRODUCTION Preclinical and preliminary clinical data suggests that early minimally invasive intracerebral hemorrhage evacuation may convey a functional outcome benefit. Ongoing clinical trials permit an operative window extending out to 72 h. Here we present long term functional outcome after MIS endoscopic ICH evacuation with a focus on time to evacuation. METHODS Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit previously published clinical criteria including age = 18, National Institutes of Health Stroke Scale (NIHSS) = 6, hematoma volume = 15, and baseline modified Rankin Score (mRS) = 3 with a CTA negative for vascular malformation. Retrospective review was performed on patients who were treated in a single health system from December 2015 to August 2018. Demographic, clinical and radiographic previously demonstrated to impact ICH outcome were included in a multivariate logistic regression to identify factors predicting poor outcome (modified Rankin scale (mRS) 4-6) at 6 mo. RESULTS A total of 97 patients underwent minimally invasive endoscopic ICH evacuation. In a multivariate analysis, factors that predicted poor outcome included age (OR 1.81 (CI 1.15-3.08) P = .016), deep location (OR 11.1 (2.41-67.8) P = .004), presence of intraventricular hemorrhage (OR 5.81 (1.765-22.39) P = .006) and increased time to evacuation measured in hours (OR 1.048 (CI 1.017-1.084) P = .004). CONCLUSION Time to evacuation significantly impacts long term outcome in minimally invasive endoscopic ICH evacuation. Every minute counts.

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Abstract WP58: Correlating Stroke Volume with National Institute of Health Stroke Scale as a Means of Determining Patient Prognosis

Stroke ◽

10.1161/str.48.suppl_1.wp58 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Pamela J Zelnick ◽

Liang Zhu ◽

Louise D McCullough ◽

Amrou Sarraj

Keyword(s):

Patient Outcomes ◽

Infarct Volume ◽

Strong Predictor ◽

Ratio Test ◽

Vessel Occlusion ◽

Good Outcome ◽

Poor Outcome ◽

The Poor ◽

Poor Outcome Group ◽

Outcome Group

Introduction: The NIH Stroke Scale (SS) is a widely used tool for directing treatment and predicting outcomes in Acute Ischemic Stroke (AIS). Severe strokes with high admission SS often correlate with long term disability, and as such, SS serves as a strong predictor of outcome. Final infarct volume (FIV) is also a pivotal predictor of stroke outcome. We aimed to evaluate the relationship between SS, FIV and outcome, and hypothesize that a combined approach evaluating both FIV and SS may more accurately correlate with patient outcomes. Methods: A single center, retrospective cohort study, examined AIS patients with large vessel occlusion (LVO) affecting the anterior circulation, between July 2004 and April 2013. Patients were stratified by treatment to 1) intra-arterial therapy, 2) IV tPA, 3) both or 4) neither. Primary outcomes measured were mRS at discharge and 90 days (good outcome mRS 0-2, poor 4-6). FIV was manually calculated from DWI obtained within the first 7 days of presentation. SS and FIV were compared against good and poor mRS outcomes using Wilcoxon rank sum test. Logistic regression analysis was used to evaluate the association between SS, FIV and mRS. Finally, likelihood ratio test was used to compare model fit between a model including SS alone and model including both SS and FIV. Results: In 332 patients, SS was significantly higher in the poor outcome group (17.3 ± 5.4) when compared to the good outcome group (13.0 ± 6.1) (p=0.0002). In the same analysis, FIVs were also larger in the poor outcome group (110.3 ± 113 cm3) when compared to the good outcome group (37.2 ± 68.3 cm3) (p<0.0001). A combined SS and FIV model correlated significantly better with discharge outcome than did SS alone (p=0.0015). Analysis of 182 patient outcomes at 90 days maintained similar findings, with SS (18 ± 5.9) and FIVs (115.4 ± 121.0 cm3) significantly higher in poor outcomes than in good outcomes; (13.0 ± 5.4) and (35.7 ± 38.2 cm3) respectively (p<0.0001). Combined SS and FIV model, again, was significantly better at modeling outcome at 90 days than was a model including SS alone (p=0.0044). Conclusions: A combined model including FIV and SS better correlates with clinical outcomes at discharge and 90 days in patients with AIS due to LVO, than does a model using SS alone.

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Higher Baseline Cortical Score Predicts Good Outcome in Patients With Low Alberta Stroke Program Early Computed Tomography Score Treated with Endovascular Treatment

Neurosurgery ◽

10.1093/neuros/nyaa472 ◽

2020 ◽

Author(s):

Peng-fei Xing ◽

Yong-wei Zhang ◽

Lei Zhang ◽

Zi-fu Li ◽

Hong-jian Shen ◽

...

Keyword(s):

Computed Tomography ◽

Endovascular Treatment ◽

Receiver Operating Characteristics ◽

Operating Characteristics ◽

Good Outcome ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group ◽

Receiver Operating Characteristics Curve ◽

Receiver Operating

Abstract BACKGROUND Patients with large vessel occlusion and noncontrast computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) <6 may benefit from endovascular treatment (EVT). There is uncertainty about who will benefit from it. OBJECTIVE To explore the predicting factors for good outcome in patients with ASPECTS <6 treated with EVT. METHODS We retrospectively reviewed 60 patients with ASPECTS <6 treated with EVT in our center between March 2018 and June 2019. Patients were divided into 2 groups because of the modified Rankin Score (mRS) at 90 d: good outcome group (mRS 0-2) and poor outcome group (mRS ≥3). Baseline and procedural characteristics were collected for unilateral variate and multivariate regression analyses to explore the influent variates for good outcome. RESULTS Good outcome (mRS 0-2) was achieved in 24 (40%) patients after EVT and mortality was 20% for 90 d. Compared with the poor outcome group, higher baseline cortical ASPECTS (c-ASPECTS), lower intracranial hemorrhage, and malignant brain edema after thrombectomy were noted in the good outcome group (all P < .01). Multivariate logistic regression showed that only baseline c-ASPECTS (≥3) was positive factor for good outcome (odds ratio = 4.29; 95% CI, 1.21-15.20; P = .024). The receiver operating characteristics curve indicated a moderate value of c-ASPECTS for predicting good outcome, with the area under receiver operating characteristics curve 0.70 (95% CI, 0.56-0.83; P = .011). CONCLUSION Higher baseline c-ASPECTS was a predictor for good clinical outcome in patients with ASPECTS <6 treated with EVT, which could be helpful to treatment decision.

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Increased glycemic variability associated with a poor 30-day functional outcome in acute intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/2017.4.jns162238 ◽

2018 ◽

Vol 129 (4) ◽

pp. 861-869 ◽

Cited By ~ 2

Author(s):

Yan-Chun Wu ◽

Zan Ding ◽

Jiang Wu ◽

Yuan-Yuan Wang ◽

Sheng-Chao Zhang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Poor Prognosis ◽

Characteristic Curve ◽

Fasting Blood Glucose ◽

Glycemic Variability ◽

Acute Onset ◽

Stress Hyperglycemia ◽

Poor Outcome ◽

Normal Glucose

OBJECTIVEIntracerebral hemorrhage (ICH) is associated with a poor prognosis and high mortality, but no study has elucidated the association between glycemic variability (GV) and functional outcome in ICH. The authors of this study aimed to determine whether GV is a predictor of 30-day functional outcome in ICH patients.METHODSThe study recruited 366 patients with first-ever acute-onset ICH in the period during 2014 and 2015. Fasting blood glucose was assessed on admission and with 7-day continuous monitoring. Glycemic variability was calculated and expressed by the standard deviation (GluSD) and coefficient of variation (GluCV). Patients were divided into groups of those with diabetes mellitus (DM), stress hyperglycemia (SHG), and normal glucose (NG). Functional outcome was measured using the modified Rankin Scale.RESULTSThe numbers of patients with DM, SHG, and NG were 108 (29.5%), 127 (34.7%), and 131 (35.8%), respectively. As compared with the DM patients, those with SHG had higher mortality (29.9% vs 15.7%, p < 0.05) and a poorer prognosis (64.6% vs 52.8%, p < 0.05). Poor prognosis was associated with both high GluSD (OR 1.54, 95% CI 1.19–1.99) and high GluCV (1.05, 1.02–1.09), especially in the DM group. The area under the receiver operating characteristic curve was greater for the GluSD (OR 0.929, 95% CI 0.902–0.956) and the GluCV (0.932, 0.906–0.958) model than the original model (0.860, 0.823–0.898) in predicting a poor outcome.CONCLUSIONSStress hyperglycemia may be associated with increased mortality and a poor outcome in ICH, and increased GV may be independently associated with a poor outcome, particularly in ICH patients with DM.

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Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy

Pediatric Research ◽

10.1038/s41390-021-01626-z ◽

2021 ◽

Author(s):

Hajnalka Barta ◽

Agnes Jermendy ◽

Livia Kovacs ◽

Noemie Schiever ◽

Gabor Rudas ◽

...

Keyword(s):

Gestational Age ◽

Mr Spectroscopy ◽

Predictive Value ◽

Hypoxic Ischemic Encephalopathy ◽

List Type ◽

Proton Mr Spectroscopy ◽

Good Outcome ◽

Poor Outcome ◽

Outcome Group ◽

Ischemic Encephalopathy

Abstract Background Prognostic value of proton MR spectroscopy (H-MRS) in hypoxic–ischemic encephalopathy (HIE) is acknowledged; however, effects of gestational age (GA) and postnatal age (PA) on prediction and metabolite levels are unknown. Methods One hundred and sixty-nine newborns with moderate-to-severe HIE were studied, having ≥1 H-MRS scan during postnatal days 0–14 and known neurodevelopmental outcome (Bayley-II score/cerebral palsy/death). Initial scans were categorized by PA (day 1–3/4–6/≥7), and metabolite ratios were compared by predictive value. Metabolite dynamics were assessed in a total of 214 scans performed in the study population, using regression modeling, with predictors GA, PA, and outcome. Results N-acetyl-aspartate (NAA)/creatine (Cr) and myo-inositol (mI)/NAA height ratios were consistently associated with outcome throughout the first 14 days, with the highest predictive value in the late (≥7 days) period (AUC = 0.963 and 0.816, respectively). Neither GA nor PA had an overall effect on these metabolite ratios, which showed strongest association with outcome (p < 0.001). Assessed separately in patients with good outcome, GA became a significant covariate for metabolite ratios (p = 0.0058 and 0.0002, respectively). However, this association disappeared in the poor outcome group. Conclusions In HIE, NAA/Cr and mI/NAA give most accurate outcome prediction throughout postnatal days 0–14. GA only affected metabolite levels in the good outcome group. Impact Proton MR spectroscopy metabolite ratios N-acetyl-aspartate/creatine and myo-inositol/N-acetyl-aspartate have persistently high predictive value throughout postnatal days 0–14 in newborns with hypoxic–ischemic encephalopathy, with the highest predictive power between postnatal days 7 and 14. Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome. However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared. Proton MR spectroscopy provides valuable prognostic information in neonatal hypoxic–ischemic encephalopathy throughout the first 2 weeks of life, irrespective of the timing of MR scan.

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CSF Neurofilament-H Levels as a Potential Prognostic Marker in Patients of Guillain- Barré Syndrome- A Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/50049.15186 ◽

2021 ◽

Author(s):

Tanveer Hassan ◽

Rayees Ahmad Tarray ◽

Tanzeel Ahmad Wani ◽

Mushtaq Ahmad Wani ◽

Zaffar Amin Shah ◽

...

Keyword(s):

Cohort Study ◽

Guillain Barre Syndrome ◽

Control Group ◽

P Value ◽

Moderate Degree ◽

Good Outcome ◽

Poor Outcome ◽

Outcome Group ◽

Guillain Barré Syndrome ◽

Guillain Barré

Introduction: The prognosis of Guillain-Barré Syndrome (GBS) at an early stage with explicit biomarkers is critical to distinguish patients with possibility of poor recovery. Cerebrospinal Fluid (CSF) serves as an impending source for biomarkers that portrays the exact biochemical changes. Aim: To find out if there is any prognostic value of high CSF phosphorylated Neurofilament Heavy subunit (pNf-H) levels, measured during first two weeks of onset of GBS, as assessed by the level of disability at six months after the onset of GBS. Materials and Methods: The cohort study was conducted in the Department of Neurology and Department of Immunology and Molecular Medicine, at the Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India, over a period of two years from August 2015 to August 2017. Sixty two patients who satisfied the required diagnostic standards for GBS (study group) and 35 patients with tension-type headache (control group) were selected for the study. After clinical and electrophysiological assessment, CSF samples were collected. A commercially available sandwich enzyme immunoassay kit, manufactured by BioVendor-Laboratorní medicína (Czech Republic), was used for measuring human pNf-H quantitatively. Results: Mean CSF pNf-H level in patients with good outcome was 325.3 pg/mL whereas, in patients with poor outcome it was 3655.2 pg/mL. CSF pNf-H levels were found to be suggestively higher in GBS patients with poor outcome as compared to those with good outcome. Only eight patients in good outcome group had pathologically high CSF Nf-H levels whereas 10 patients in poor outcome group had CSF Nf-H levels ≤730 pg/mL. The odds ratio was 17.1 (95% Confidence Interval (CI) 3.83-76.29). Thus, high CSF Nf-H levels on admission predicted poor outcome in GBS (p-value <0.001). Moderate degree of positive correlation was found between CSF Nf-H levels and outcome (F score) at six months (R=0.684; p-value <0.001). Conclusion: It can be determined that higher values of CSF pNf-H in GBS (acute stage), could serve as a predictive marker indicative of poor prognosis.

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Abstract TP42: Association of 24-Hour Blood Pressure Parameters Post-Thrombectomy With Functional Outcomes at Discharge

Stroke ◽

10.1161/str.51.suppl_1.tp42 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Taha Nisar ◽

Toluwalase Tofade ◽

Ava Liberman ◽

Priyank Khandelwal

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Functional Outcome ◽

Functional Outcomes ◽

Care Center ◽

Tertiary Care ◽

Binary Logistic Regression Analysis ◽

Good Outcome ◽

Poor Outcome ◽

The Mean

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.

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