Prognostic significance of serum neurofilament light chain in acute ischemic stroke: a retrospective cohort study (Preprint)

2020 ◽  
Author(s):  
Zhongchen Mao ◽  
Zhixin Fu ◽  
Jinhua Zhang ◽  
Yan Zhao ◽  
Yong Sun ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Cognitive Function ◽  
Acute Ischemic Stroke ◽  
Daily Activity ◽  
Prognostic Significance ◽  
Neurofilament Light ◽  
Baseline Serum ◽  
Increased Risk

BACKGROUND Acute ischemic stroke affects a large number of people each year around the world. However, accurately predicting clinical outcome is still difficult. OBJECTIVE The aim of this cohort study was to explore the relationship between serum neurofilament light (NfL) concentration and clinical outcomes in these patients. METHODS A total of 820 patients with acute ischemic stroke were retrospectively enrolled between January 2012 and June 2017. Changes in patients' conditions, imaging data and other necessary information were obtained from their medical records. Blood samples were collected several times during the first two weeks of admission. Serum NfL levels were measured using a commercial Simoa NfL assay. In 6-month follow-up period, daily activity and cognitive function were assessed using modified Rankin Scale and Mini-mental State Examination. RESULTS Serum NfL levels gradually increased after the disease onset and peaked on the 7th day of admission. The elevated levels of peak NfL were roughly associated with the increased risk of poor daily activity function (OR: 2.92, 95%CI: 1.66 - 5.13), poor cognitive function (OR: 1.54, 95%CI: 1.03 - 2.29; OR: 1.66, 95%CI: 1.11 - 2.47; OR: 1.55, 95%CI: 1.03 - 2.37) and greater cognitive decline during the follow-up period (OR: 2.38, 95%CI: 1.07 - 5.26; OR: 1.99, 95%CI: 1.01 - 3.97). However, baseline serum NfL levels did not have similar prognostic significance. CONCLUSIONS Elevated peak concentration of NfL in serum predicts poor daily activity performance and cognitive function decline, and might be a prognostic biomarker for acute ischemic stroke. CLINICALTRIAL None.

Abstract P25: Safety of Ticagrelor in Moderate to Severe Acute Ischemic Stroke: A Single-Center Retrospective Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Stephen W English ◽  
David Landzberg ◽  
Nirav Bhatt ◽  
Michael Frankel ◽  
Digvijaya Navalkele
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Major Bleeding ◽  
Mechanical Thrombectomy ◽  
Categorical Variables ◽  
Severe Bleeding ◽  
Large Artery ◽  
Inpatient Stay ◽  
Increased Risk

Introduction: Ticagrelor with aspirin has been recently shown to reduce the risk of stroke or death compared to aspirin alone in patients with high risk TIAs and mild strokes. However, this benefit is offset by increased risk of severe bleeding. We sought to evaluate the safety of ticagrelor in patients with moderate to severe ischemic stroke. Methods: This was a retrospective cohort study of adults discharged on ticagrelor after presenting with acute ischemic stroke and NIHSS > 5 from January 2016 to December 2019 at a large, urban, academic comprehensive stroke center. Patients were excluded if they underwent carotid or intracranial angioplasty and/or stenting, or carotid endarterectomy during admission. Baseline clinical characteristics, imaging, and outcomes were reviewed. Data was organized into continuous and categorical variables. Results: Sixty-one patients met inclusion and exclusion criteria. Median age was 61 (IQR, 52-68) years; 33 (54%) were men, and 33 (54%) were African American. Median NIHSS was 11 (IQR, 8-15). Fourteen (23%) patients received IV Alteplase and 35 (57%) patients underwent mechanical thrombectomy. Five (8%) patients received both IV Alteplase and mechanical thrombectomy. Median ticagrelor start date was hospital day 1 (IQR, 0-3). Large artery atherosclerosis was presumed etiology in 53 (87%) patients. No patients experienced neurologic worsening, recurrent stroke, sICH, or major bleeding during inpatient stay. Sixty (98%) patients were on aspirin and ticagrelor at discharge. Follow-up information was available for 53 (87%) patients for a median duration of 3 (IQR, 2-6) months. Following discharge, 3 (5%) patients experienced recurrent ischemic stroke despite being compliant. One (2%) patient experienced major bleeding—gastrointestinal hemorrhage requiring transfusion—two months after hospital discharge. Conclusions: This study highlights the potential expanding role for ticagrelor in secondary stroke prevention in patients with moderate to severe stroke. Early ticagrelor use did not result in sICH during inpatient stay—and only 1 major bleeding event on follow-up—in our cohort. While further research in this area is needed, these findings present an exciting opportunity for future prospective studies.

scholarly journals Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

2017 ◽  
Vol 176 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Olaf M Dekkers ◽  
Erzsébet Horváth-Puhó ◽  
Suzanne C Cannegieter ◽  
Jan P Vandenbroucke ◽  
Henrik Toft Sørensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Arterial Embolism ◽  
Registration System ◽  
Increased Risk ◽  
All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke

Neurology ◽  
2019 ◽  
Vol 93 (18) ◽  
pp. e1675-e1685 ◽  
Author(s):  
Chongke Zhong ◽  
Guangli Wang ◽  
Tan Xu ◽  
Zhengbao Zhu ◽  
Daoxia Guo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Scale Score ◽  
Primary Outcome ◽  
Tissue Inhibitor ◽  
Vascular Events ◽  
Baseline Serum ◽  
Hazard Ratios ◽  
Increased Risk

ObjectiveTo prospectively investigate the relationships between serum tissue inhibitor metalloproteinase-1 (TIMP-1) and clinical outcomes in patients with acute ischemic stroke.MethodsWe derived data from the China Antihypertensive Trial in Acute Ischemic Stroke. Baseline serum TIMP-1 concentrations were measured in 3,342 participants. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.ResultsA total of 843 participants (25.2%) experienced major disability or died within 3 months. After adjustment for age, sex, admission NIH Stroke Scale score, and other important covariates, odds ratios or hazard ratios (95% confidence intervals) of 1-SD (0.17 ng/mL) higher log-TIMP-1 were 1.17 (1.06–1.29) for the primary outcome, 1.13 (1.02–1.25) for major disability, 1.49 (1.19–1.87) for death, and 1.34 (1.11–1.62) for the composite outcome of death and vascular events. The addition of serum TIMP-1 to conventional risk factors model significantly improved risk prediction of the primary outcome (net reclassification index 9.0%, p = 0.02; integrated discrimination improvement 0.2%, p = 0.03). Participants with both higher TIMP-1 and matrix metalloproteinase-9 levels simultaneously had the highest risk of all study outcomes.ConclusionsHigher TIMP-1 levels were associated with increased risk of mortality and major disability after acute ischemic stroke. Our findings provided evidence supporting the important prognostic role of extracellular matrix biomarkers after acute ischemic stroke.

STUDY ON PROGNOSIS OF SERUM ACID URIC IN ACUTE ISCHEMIC STROKE

2017 ◽  
pp. 119-123
Author(s):  
Dinh Toan Nguyen ◽  
Viet Hoan Tong
Keyword(s):  
Uric Acid ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Dependence ◽  
Prognostic Significance ◽  
Current Evidence ◽  
Control Group ◽  
Hospital Arrival ◽  
The Relationship

Background: Current evidence shows that uric acid is a potent antioxidant whose serum concentration increases rapidly after acute ischemic stroke (AIS). Nevertheless, the relationship between serum uric acid (SUA) levels and AIS outcome remains debatable. We aimed to describe the prognostic significance of SUA in AIS. Methods: We studied 84 patients with AIS admitted to the cardiology, Hue Central Hospital from May, 2015 to October 2016. Acid uric concentration was measured at hospital arrival, day 3 and day 7. Correlated equation was constructed to analyze the association of SUA with functional outcome as assessed by the modified Rankin scale (mRS) at 30-day follow-up. Results: Mean SUA concentration at hospital arrival was (344.86±64.84 μmol/l), day 2 (323.76±57.47 μmol/l), day 3 (308.57±42.50 μmol/l) and higher than those of control group significantly (304.93±38.29 μmol/l). SUA was correlated positively with severity assessed by NIHSS and the functional dependence (mRS >2) at 30 days. Conclusions: Our findings support the hypothesis that SUA is more a marker of the magnitude of the cerebral infarction than an independent predictor of stroke outcome. Key words: acute ischemic stroke (AIS), uric acid, prognosis

scholarly journals Association between Iron Status and Incident Type 2 Diabetes: A Population-Based Cohort Study

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3249
Author(s):  
Andrés Díaz-López ◽  
Lucía Iglesias-Vázquez ◽  
Meritxell Pallejà-Millán ◽  
Cristina Rey Reñones ◽  
Gemma Flores Mateo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Primary Healthcare ◽  
Iron Status ◽  
Baseline Serum ◽  
Incident Type ◽  
Increased Risk ◽  
Incident Type 2 Diabetes

Type 2 diabetes poses a major public health challenge. Here, we conducted a cohort study with a large sample size to determine the association of baseline serum ferritin (SF), a marker of iron status, with incident type 2 diabetes in primary healthcare patients in Catalonia, a western Mediterranean region. A total of 206,115 patients aged 35–75 years without diabetes and with available baseline SF measurements were eligible. The variables analyzed included sociodemographic characteristics, anthropometry, lifestyle, morbidity and iron status (SF, serum iron and hemoglobin). Incident type 2 diabetes during follow-up (2006–2016) was ascertained using the International Classification of Diseases, 10th edition. Cox proportional-hazards models adjusted for multiple baseline confounders/mediators were used to estimate hazard ratios (HRs). Over a median follow-up of 8.4 years, 12,371 new cases of type 2 diabetes were diagnosed, representing an incidence rate of 7.5 cases/1000 persons/year. Since at baseline, the median SF concentration was higher in subjects who developed type 2 diabetes (107.0 µg/L vs. 60.3 µg/L; p < 0.001), SF was considered an independent risk predictor for type 2 diabetes; the multivariable-adjusted HRs for incident type 2 diabetes across SF quartiles 1–4 were 1.00 (reference), 0.95 (95% CI = 0.85–1.06), 1.18 (95% CI = 1.65–1.31) and 1.51 (95% CI = 1.36–1.65), respectively. Our study suggested that higher baseline SF was significantly associated with an increased risk of new-onset type 2 diabetes in Catalan primary healthcare users, supporting the relevance of monitoring iron stores in order to improve the diagnosis and management of diabetes in clinical practice.

Impact of old and very old age on outcomes in patients with acute ischemic stroke undergoing endovascular therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Proietti ◽  
A.P Mascolo ◽  
F Maramma ◽  
D Morosetti ◽  
V Da Ros ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Age Groups ◽  
Sensitivity Analyses ◽  
Composite Outcome ◽  
Very Elderly ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background and purpose Only a restricted number of elderly patients has been included in the majority of recent endovascular stroke trials. We provided an analysis about differences in outcomes after mechanical thrombectomy (MT) according to age. Methods A retrospective analysis of an observational registry of patients with anterior large vessel acute ischemic stroke was performed. Main analysis was performed comparing patients &lt;80 vs. ≥80 years old. A sensitivity analysis was performed comparing 3 age groups: i) &lt;80 years; ii) 80–84 years; iii) ≥85 years. Outcomes were: i) any hemorrhagic infarction; ii) alive with disability; iii) death; iv) a composite outcome of alive with disability/death. Results 615 patients were identified. 227 (36.9%) patients were ≥80 years old, with 115 (18.5%) ≥85 years old. Elderly (≥80 years) patients showed a higher modified Rankin Scale (mRS) at discharge and 3-months follow-up (F=9.819, p=0.001) [Figure 1]. Comparing the three groups (&lt;80 years, 80–84 years, ≥85 years) a progressively higher mRS was found at discharge and 3 months follow-up (F=4.899, p=0.008). A progressively higher rate of death and composite outcome between the age groups was found, both in the main and sensitivity analyses. In the logistic regression analysis age ≥80 years was found associated with an increased risk of death (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.27–4.00) and showed a trend in higher risk for composite outcome (OR: 1.61, 95% CI: 0.92–2.281). No difference was found between 80–84 years and &lt;80 years patients, while very elderly (≥85 years) had an increased risk of death (OR: 2.85, 95% CI: 1.60–5.10) and composite outcome (OR: 2.37, 95% CI: 1.30–4.33). Conclusions In our analysis elderly patients have an increased risk of death and composite outcome of disability and death. In particular, this risk appears to be significantly higher in very elderly patients (≥85 years old). Figure 1. mRS according to main analysis Funding Acknowledgement Type of funding source: None

scholarly journals Lowered cognitive function and the risk of the first events of cardiovascular diseases: findings from a cohort study in Lithuania

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dalia Luksiene ◽  
Laura Sapranaviciute-Zabazlajeva ◽  
Abdonas Tamosiunas ◽  
Ricardas Radisauskas ◽  
Martin Bobak
Keyword(s):  
Cohort Study ◽  
Cognitive Function ◽  
Cognitive Functions ◽  
Recall Score ◽  
Composite Score ◽  
Baseline Survey ◽  
Men And Women ◽  
Verbal Recall ◽  
Increased Risk

Abstract Background The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains predict the risk of first cardiovascular disease (CVD) events in middle-aged and older populations. Methods Seven thousand eighty-seven participants, men and women aged 45–72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008 in the city of Kaunas, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at the baseline survey) was evaluated. Cox proportional hazards regression models were applied to examine how cognitive function predicts the first events of CVD. Results During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased the risk of a first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score – by 17% in men and 24% in women; and a composite score of cognitive function – by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of a first cardiovascular event according to the categories of a composite score of cognitive function, revealed that a lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p < 0.05). Conclusions The findings of this follow-up study suggest that men and women with lower cognitive functions have an increased risk for a first event of CVD compared to participants with a higher level of cognitive functions.

Abstract WP371: Role of Troponin as a Biomarker for Predicting Outcome After Ischemic Stroke: A Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adel A Alhazzani ◽  
Amit Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Biomarker ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Elevated Serum ◽  
Cochrane Central Register ◽  
Central Register ◽  
Predicting Outcome

Background: After acute ischemic stroke, a higher level of troponin has been considered as an important biomarker for predicting mortality. The aim of the study was to quantitatively assess the prognostic significance of the effect of baseline troponin levels on mortality in patients with acute ischemic stroke using a meta-analysis approach. Design: The following electronic databases, PubMed, EMBASE, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials , TRIP Database, ClinicalTrials.govwas used for getting the relevant article from literuare. Data were extracted in standardized data collection by two independent investigators. Any disagreements were resolved by consensus. All the statistical analyses were performed in STATA software. Results: 18 studies were included in the present meta-analysis involving a total of 8723 patients. The pooled results suggested that the elevated serum troponin level was associated with in -hospital mortality (RR 2.39, 95% CI 1.37 to 3.41), at the end of last follow up mortality (RR 1.75; 95% CI 1.38 to 2.11) and for overall mortality (RR 1.82; 95% CI 1.47 to 2.17). Sensitivity analysis by removing a single study by turns indicated that there was no obvious impact of any individual study on the pooled risk estimate. No significant publication bias was observed. Conclusion: Our findings indicate that a higher level of troponinmight be an important prognostic biomarker for in hospital and follow up mortality in patients with acute ischemic stroke. The study might have clinical implications by using troponin as a prognostic biomarker for patient stratification and early intervention.

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