Association of homocysteine level with adverse outcomes in patients with acute ischemic stroke: A meta-analysis

2021 ◽  
Vol 28 ◽  
Author(s):  
Heng Zhang ◽  
Jiabin Huang ◽  
Yongjing Zhou ◽  
Yu Fan
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Homocysteine Level ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Poor Functional Outcome ◽  
Increased Risk ◽  
All Cause Mortality

Background and Objective: Studies on the prognostic value of homocysteine level have yielded controversial results in patients with acute ischemic stroke (AIS). The aim of this meta-analysis was to evaluate the prognostic utility of homocysteine among patients with AIS in terms of recurrent stroke, poor functional outcome or all-cause mortality. Methods: Two independent authors searched the articles published in PubMed and Embase databases prior to March 31, 2020. Original studies that investigated the value of homocysteine level in predicting recurrent stroke, poor functional outcome (modified Rankin Scale ≥ 3) or all-cause mortality in AIS patients were eligible. Results: Eleven articles (10 studies) that enrolled 19,435 patients with AIS were included. Meta-analysis indicated that the patients with the highest homocysteine level had an increased risk of all-cause mortality (risk ratio [RR] 1.40; 95% confidence interval [CI] 1.26–1.55). However, elevated homocysteine level was not significantly associated with recurrent stroke (RR 1.28; 95% CI 0.99–1.65) or poor functional outcome (RR 1.71; 95% CI 0.77–3.83). Conclusion: Elevated homocysteine level is independently associated with a higher risk of all-cause mortality but not recurrent stroke or poor functional outcome in patients with AIS. However, additional well-designed studies are required to confirm the findings of this meta-analysis.

scholarly journals Prognostic Value of Neutrophil To Lymphocyte Ratio In Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis: A Meta-Analysis

2021 ◽  
Author(s):  
Chengbing Wang ◽  
Qian Zhang ◽  
Mingwei Ji ◽  
Jing Mang ◽  
Zhongxin Xu
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Poor Functional Outcome ◽  
Lymphocyte Ratio ◽  
Increased Risk ◽  
The Relationship

Abstract Background: The neutrophil to lymphocyte ratio (NLR) has been shown to be an important independent inflammatory indicator in stroke. The relationship between NLR and poor prognostics in acute ischemic stroke (AIS) patients who received intravenous thrombolysis (IVT) still unclear. The purpose of this meta-analysis was to evaluate the association between NLR and poor prognosis after IVT. Furthermore, we aim to concluded whether admission NLR or post-IVT NLR play a role in AIS.Methods: Pubmed, Embase, Wed of Science and China National Knowledge Infrastructure were searched for relevant articles until October 7, 2020. Cohort and case-control studies were included if related to NLR in AIS patients treated with IVT. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were pooled to estimate the relationship between NLR and poor prognosis after IVT. A random effects model was used to calculate the pooled data.Results: Twelve studies, including 3641 patients met the predefined inclusion criteria. Higher NLR levels were associated with an increased risk of hemorrhagic transformation (HT) (OR=1.33,95%CI=1.14-1.56, P<0.001) and 3-month poor functional outcome (OR=1.64,95%CI=1.38-1.94, P<0.001) in AIS patients receiving IVT. Subgroup analysis of HT suggested that admission NLR levels rather than post-IVT NLR levels was associated with higher risk of HT (OR=1.33,95%CI=1.01-1.75, P=0.039). But There had no statistically significant difference between higher NLR levels and 3-month mortality (OR=1.14, 95%CI=0.97-1.35, P=0.120).Conclusions: High NLR can predict HT and 3-month poor functional outcome in AIS patients received IVT. Admission NLR rather than post-IVT NLR was independent risk factor of increased risk of HT.

Predictive Value of Insulin Resistance as Determined by Homeostasis Model Assessment in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 53 (11) ◽  
pp. 746-751
Author(s):  
An Wu ◽  
Yunping Li ◽  
Rongcai Liu ◽  
Dongjing Qi ◽  
Guofeng Yu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Stroke Recurrence ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Poor Functional Outcome ◽  
All Cause Mortality

AbstractStudies on association between homeostasis model assessment of insulin resistance (HOMA-IR) and adverse outcomes have yielded conflicting results in patients with acute ischemic stroke (AIS). This meta-analysis aimed to assess the predictive value of HOMA-IR in AIS patients. Two authors comprehensively searched PubMed and Embase databases until February 28, 2021. All observational studies investigating the association between HOMA-IR and adverse outcomes in AIS patients were included. Outcome measures were poor functional outcome (Modified Rankin Scale≥3), all-cause mortality, stroke recurrence, and neurologic worsening. Seven studies (eight articles) involving 8330 AIS patients were identified. For the highest versus lowest HOMA-IR, the pooled risk ratio (RR) of poor functional outcome was 2.55 (95% CI 1.76–3.70) after adjustment of conventional confounding factors. In addition, elevated HOMA-IR was associated with higher risk of neurologic worsening (RR 1.93; 95% CI 1.15–3.26). However, there were conflicting findings on the association of HOMA-IR with stroke recurrence and all-cause mortality. This meta-analysis confirms that HOMA-IR is significantly associated with an increased risk of poor functional outcome in patients with AIS. However, interpretation of the results of mortality, stroke recurrence, and neurologic worsening should be done with caution due to small number of studies available.

scholarly journals Associations of Aminotransferases with Adverse Outcomes after Acute Ischemic Stroke: Results from China National Stroke Registry

2020 ◽  
Author(s):  
Lixia Zong ◽  
Xianwei Wang ◽  
Zixiao Li ◽  
Xingquan Zhao ◽  
Liping Liu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Recurrent Stroke ◽  
Composite Endpoint ◽  
Stroke Recurrence ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
All Cause Mortality ◽  
One Year

Abstract Background The relationship between aminotransferases and cardiovascular outcomes has been inconsistent in previous studies. We aimed to investigate the association of aminotransferases with clinical outcomes after acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods 17,178 AIS or TIA patients with serum alanine aminotransferase (ALT) levels < 120 U/L were included from the China National Stroke Registry (CNSR) for current analysis. Composite endpoint is comprised of recurrent stroke and all-cause mortality. Poor functional outcome is defined as modified Rankin scale of 3-6. Multivariable logistic regression was used to evaluate the risks of one-year all-cause mortality, recurrent stroke, composite endpoint and poor functional outcome according to increasing sex-specific quintiles of ALT/ aspartate aminotransferase (AST) respectively. Results One-year incidences of all-cause mortality, recurrent stroke, composite endpoint and poor functional outcome were 11.9%, 6.0%, 13.7% and 28.2% respectively in patients with the lowest quintile of ALT, and 7.4%, 3.6%, 9.0% and 17.9% respectively in the highest quintile. Compared with the lowest ALT quintile, the adjusted odds ratios with 95% confidence interval of the highest quintile were 0.55 (0.43-0.70) for all-cause mortality, 0.61 (0.45-0.83) for stroke recurrence, 0.62 (0.49-0.77) for composite endpoint, and 0.67 (0.56-0.80) for poor functional outcome. There was no significant interaction of ALT with age, sex, diabetes, dyslipidemia and alcohol consumption for all outcomes (p for interaction ≥ 0.10). Conclusions Low serum ALT may serve as an independent predictor for all-cause mortality, stroke recurrence, composite endpoint and poor functional outcome after stroke.

scholarly journals Serum Phosphate and 1-Year Outcome in Patients With Acute Ischemic Stroke and Transient Ischemic Attack

2021 ◽  
Vol 12 ◽  
Author(s):  
Jun-Fang Zhang ◽  
Jing Jing ◽  
Xia Meng ◽  
Yuesong Pan ◽  
Yi-Long Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Serum Phosphate ◽  
Poor Functional Outcome ◽  
End Point ◽  
All Cause Mortality ◽  
Ischemic Attack

Objective: To determine the association between serum phosphate level and 1-year clinical outcomes in patients with acute ischemic stroke and transient ischemic attack.Methods: We included 7,353 patients with acute ischemic stroke and transient ischemic attack from the China National Stroke Registry III for analysis. Participants were divided into 4 groups according to serum phosphate quartiles. Composite end point included recurrent stroke, myocardial infarction, other ischemic vascular events, and all-cause mortality. Poor functional outcome is defined as modified Rankin Scale score of 3 to 6. Multivariable Cox regression or logistic regression was used to evaluate the independent association of serum phosphate with 1-year all-cause mortality, recurrent stroke, composite end point and poor functional outcome.Results: The mean age of the included 7,353 patients was 62.5 years, and 68.6% of them were men. Plotting hazard ratios over phosphate levels suggested a U-shaped association especially for recurrent stroke and composite end point, and therefore the third quartile group was set as reference group. Compared with the third quartile of phosphate (1.06–1.20 mmol/L), the adjusted hazard ratios/odds ratios (95% CI) of the lowest quartile (&lt;0.94 mmol/L) were 0.98 (0.67–1.42) for all-cause mortality, 1.31 (1.05–1.64) for stroke recurrence, 1.26 (1.02–1.57) for composite end point, and 1.27 (1.01–1.61) for poor functional outcome, and the adjusted odds ratio of the highest quartile (≥1.2 mmol/L) was 1.40 (1.11–1.77) for poor functional outcome.Conclusions: Serum phosphate may be an independent predictor of stroke recurrence, composite end point and poor functional outcome after ischemic stroke.

scholarly journals C-reactive protein for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis

2019 ◽  
Vol 39 (2) ◽  
Author(s):  
Bo Yu ◽  
Ping Yang ◽  
Xuebi Xu ◽  
Lufei Shao
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Observational Studies ◽  
Meta Analysis ◽  
C Reactive Protein ◽  
Stroke Patients ◽  
Reactive Protein ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Unit Increase

Abstract Studies on the association of C-reactive protein (CRP) with all-cause mortality in acute ischemic stroke patients have yielded conflicting results. The objective of this meta-analysis was to evaluate the prognostic value of CRP elevation in predicting all-cause mortality amongst patients with acute ischemic stroke. We searched the original observational studies that evaluated the association of CRP elevation with all-cause mortality in patients with acute ischemic stroke using PubMed and Embase databases until 20 January 2018. Pooled multivariate-adjusted hazard ratio (HR) with 95% confidence intervals (CI) of all-cause mortality was obtained for the highest compared with the lowest CRP level or per unit increment CRP level. A total of 3604 patients with acute ischemic stroke from eight studies were identified. Acute ischemic stroke patients with the highest CRP level were independently associated with an increased risk of all-cause mortality (HR: 2.07; 95% CI: 1.60–2.68) compared with the lowest CRP category. The pooled HR of all-cause mortality was 2.40 (95% CI: 1.10–5.21) for per unit increase in log-transformed CRP. Elevated circulating CRP level is associated with the increased risk of all-cause mortality in acute ischemic stroke patients. This meta-analysis supports the routine use of CRP for the death risk stratification in such patients.

scholarly journals Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis

2018 ◽  
Vol 38 (2) ◽  
Author(s):  
Yu Fan ◽  
Menglin Jiang ◽  
Dandan Gong ◽  
Changfeng Man ◽  
Yuehua Chen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mortality Risk ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Stroke Patients ◽  
Troponin Elevation ◽  
Increased Risk ◽  
All Cause Mortality

Cardiac troponins are specific biomarkers of cardiac injury. However, the prognostic usefulness of cardiac troponin in patients with acute ischemic stroke is still controversial. The objective of this meta-analysis was to investigate the association of cardiac troponin elevation with all-cause mortality in patients with acute ischemic stroke. PubMed and Embase databases were searched for relevant studies up to April 31, 2017. All observational studies reporting an association of baseline cardiac troponin-T (cTnT) or troponin-I (cTnI) elevation with all-cause mortality risk in patients with acute ischemic stroke were included. Pooled adjusted risk ratio (RR) and corresponding 95% confidence interval (CI) were obtained using a random effect model. Twelve studies involving 7905 acute ischemic stroke patients met our inclusion criteria. From the overall pooled analysis, patients with elevated cardiac troponin were significantly associated with increased risk of all-cause mortality (RR: 2.53; 95% CI: 1.83–3.50). The prognostic value of cardiac troponin elevation on all-cause mortality risk was stronger (RR: 3.54; 95% CI: 2.09–5.98) during in-hospital stay. Further stratified analysis showed elevated cTnT (RR: 2.36; 95% CI: 1.47–3.77) and cTnI (RR: 2.79; 95% CI: 1.68–4.64) level conferred the similar prognostic value of all-cause mortality. Acute ischemic stroke patients with elevated cTnT or cTnI at baseline independently predicted an increased risk of all-cause mortality. Determination of cardiac troponin on admission may aid in the early death risk stratification in these patients.

scholarly journals Residual Inflammatory Risk Predicts Poor Prognosis in Acute Ischemic Stroke or Transient Ischemic Attack Patients

Stroke ◽  
2021 ◽  
Author(s):  
Jiejie Li ◽  
Yuesong Pan ◽  
Jie Xu ◽  
Shiyu Li ◽  
Mengxing Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Large Artery ◽  
Poor Functional Outcome ◽  
Ischemic Attack

Background and Purpose: It is still unclear whether the residual cholesterol and inflammatory risk in the acute phase is associated with prognosis of stroke. We aimed to investigate the proportion and relative contribution of residual cholesterol and inflammatory risk, determined by baseline low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) levels, to the risk of recurrent stroke and poor functional outcome at 1 year. Methods: In this prospective multicenter cohort study, 10 499 consecutive acute ischemic stroke and transient ischemic attack patients with levels of LDL-C and hsCRP were enrolled. Patients were divided into 4 groups: residual cholesterol risk only (LDL-C ≥2.6 mmol/L and hsCRP <3 mg/L), residual inflammatory risk (RIR) only (LDL-C <2.6 mmol/L and hsCRP ≥3 mg/L), both risk (LDL-C ≥2.6 mmol/L and hsCRP ≥3 mg/L), and neither risk (LDL-C <2.6 mmol/L and hsCRP <3 mg/L). The primary outcomes consisted of stroke recurrence and a modified Rankin Scale score of 2 to 6 within 1 year. Results: The relative proportions of patients with RIR only, residual cholesterol risk only, both risk, and neither were 21.3%, 23.7%, 14.4%, and 40.6%, respectively. RIR only was independently associated with recurrent stroke (adjusted hazard ratio, 1.18 [95% CI, 1.00–1.40]; P =0.05). The association was slightly attenuated after further adjusting for usage of antiplatelet agent and statin during 1-year follow-up in addition to the traditional risk factors (hazard ratio, 1.31 [95% CI, 0.99–1.76]; P =0.07). When applying the LDL-C cutoff value of 1.8 mmol/L in the sensitivity analyses, such association in large-artery atherosclerosis subtype was more significant (adjusted hazard ratio, 1.69 [95% CI, 1.06–2.67]; P =0.03). Patients with RIR only also had increased risk of poor functional outcome (adjusted odds ratio, 1.43 [95% CI, 1.24–1.64]; P <0.0001). Conclusions: In the patients with acute ischemic stroke or transient ischemic attack, RIR only could be predictive for recurrent stroke, especially for those with large-artery atherosclerosis, and poor functional outcome.

scholarly journals Prognostic value of neutrophil to lymphocyte ratio in acute ischemic stroke after reperfusion therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying Bi ◽  
Jing Shen ◽  
Sheng-Cai Chen ◽  
Ji-Xiang Chen ◽  
Yuan-Peng Xia
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Credible Interval ◽  
Reperfusion Therapy ◽  
Neutrophil To Lymphocyte Ratio ◽  
Categorical Variables ◽  
Poor Functional Outcome ◽  
Lymphocyte Ratio

AbstractThe purpose of this study was to investigate whether baseline neutrophil to lymphocyte ratio (NLR) was an independent predictor for early symptomatic intracranial hemorrhage (sICH), poor functional outcome and mortality at 3 months after reperfusion therapy in acute ischemic stroke (AIS) patients. Using PubMed and EMBASE, we searched for literature published before January 19th, 2019. Two reviewers independently confirmed each study’s eligibility, assessed risk of bias, and extracted data. One reviewer combined studies using random effects meta-analysis. 9 studies with 3651 patients were pooled in the meta-analysis. Overall, baseline NLR levels were greater in patients with poor outcome. The standardized mean difference (SMD) in the NLR levels between patients with poor functional outcome (mRS > 2) and good functional outcome (mRS ≤ 2) was 0.54 units (95% credible interval [CI] [0.38, 0.70]). Heterogeneity test showed that there were significant differences between individual studies (p = 0.02; I2 = 72.8%). The NLR levels were associated with sICH in four included studies (n = 2003, SMD = 0.78, 95% [CI] [0.18, 1.38], I2 = 73.9%). Higher NLR levels were positively correlated with 3-month mortality (n = 1389, ES = 1.71, 95% CI [1.01,2.42], p < 0.01, I2 = 0%) when data were used as categorical variables. Our meta-analysis suggests that increased NLR levels are positively associated with greater risk of sICH, 3-month poor functional outcome and 3-month mortality in AIS patients undergoing reperfusion treatments. Although there are some deficits in this study, it may be feasible to predict the prognosis of reperfusion therapy in AIS patients with NLR levels.

scholarly journals Low Toe–Brachial Index Is Associated With Stroke Outcome Despite Normal Ankle–Brachial Index

2021 ◽  
Vol 12 ◽  
Author(s):  
Minho Han ◽  
Young Dae Kim ◽  
Ilhyung Lee ◽  
Hyungwoo Lee ◽  
Joonnyung Heo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
All Cause Mortality ◽  
Toe Brachial Index

Introduction: We investigated whether the toe–brachial index (TBI) is associated with stroke prognosis and evaluated this association in patients with normal ankle–brachial index (ABI).Methods: Acute ischemic stroke patients who underwent TBI measurements were enrolled. Poor functional outcome was defined as modified Rankin Scale score ≥3. Major adverse cardiovascular event (MACE) was defined as stroke recurrence, myocardial infarction, or death. Normal ABI was defined as 0.9 ≤ ABI ≤ 1.4.Results: A total of 1,697 patients were enrolled and followed up for a median 39.7 (interquartile range, 25.7–54.6) months. During the period, 305 patients suffered MACE (18.0%), including 171 (10.1%) stroke recurrences. TBI was associated with hypertension, diabetes, atrial fibrillation, aortic plaque score, ABI, and brachial–ankle pulse wave velocity (all p &lt; 0.05). In multivariable logistic regression, TBI was inversely associated with poor functional outcome in all patients [odds ratio (OR) 0.294, 95% confidence interval (CI) 0.114–0.759], even in patients with normal ABI (OR 0.293, 95% CI 0.095–0.906). In multivariable Cox regression, TBI &lt; 0.6 was associated with stroke recurrence [hazard ratio (HR) 1.651, 95% CI 1.135–2.400], all-cause mortality (HR 2.105, 95% CI 1.343–3.298), and MACE (HR 1.838, 95% CI 1.396–2.419) in all patients. TBI &lt; 0.6 was also associated with stroke recurrence (HR 1.681, 95% CI 1.080–2.618), all-cause mortality (HR 2.075, 95% CI 1.180–3.651), and MACE (HR 1.619, 95% CI 1.149–2.281) in patients with normal ABI.Conclusions: Low TBI is independently associated with poor short- and long-term outcomes in acute ischemic stroke patients despite normal ABI.

scholarly journals Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis

Neurology ◽  
2017 ◽  
Vol 88 (7) ◽  
pp. 638-645 ◽  
Author(s):  
Kannikar Kongbunkiat ◽  
Duncan Wilson ◽  
Narongrit Kasemsap ◽  
Somsak Tiamkao ◽  
Fatima Jichi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Rating Scale ◽  
Poor Functional Outcome ◽  
Total N ◽  
Increased Risk ◽  
Statistical Heterogeneity ◽  
Arterial Thrombolysis

Objective:To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome.Methods:We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI). We used random-effects models to calculate pooled relative risks (RR) of sICH and poor functional outcome (mRS ≥ 2) for any vs no leukoaraiosis (using any rating scale) and for no to mild vs moderate to severe leukoaraiosis (using the Van Swieten or Fazekas Schmidt scale).Results:We identified 15 studies (total n = 6,967). For sICH outcome, the RR was 1.65 (n = 5,551; 95% confidence interval [CI] 1.26–2.16, p = 0.001) with an absolute risk (AR) increase of 2.5% for any leukoaraiosis vs none. The RR was 2.4 (n = 4,192; 95% CI 1.83–3.14, p = 0.001) with an AR increase of 6.2% for moderate to severe vs no to mild leukoaraiosis. For poor functional outcome; the RR was 1.30 (n = 3,401; 95% CI 1.19–1.42, p = 0.001) with an AR increase of 15.4% for any leukoaraiosis vs none. The RR was 1.31 (n = 3,659; 95% CI 1.22–1.42, p = 0.001) with an AR increase of 17.5% for moderate to severe vs no to mild leukoaraiosis. No statistical heterogeneity was noted for any of the analyses.Conclusions:Leukoaraiosis presence and severity are consistently associated with an increased risk of sICH and poor functional outcome after IV or intra-arterial thrombolysis for acute ischemic stroke.

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