scholarly journals Predicting ambulatory recovery in acute ischemic stroke patients with thrombolytic therapy

2020 ◽  
Vol 15 (2) ◽  
pp. FNL45
Author(s):  
Matthew Scalise ◽  
Leanne Brechtel ◽  
Zachary Conn ◽  
Benjamin Bailes ◽  
Jordan Gainey ◽  
...  

Aim: The aim of this study was to determine the predictive value of clinical presentations on functional ambulation following thrombolytic therapy. Materials & methods: Logistic regression analysis was used to determine associations between functional ambulation and thrombolytic therapy. Results & conclusion: In the results, Hispanic ethnicity (odds ratio (OR): 2.808; p = 0.034; 95% CI: 1.08–7.30), high National Institute of Health Stroke Scale (NIHSS) (OR: 1.112; p ≤ 0.001; 95% CI: 1.06–1.17), weakness/paresis (OR: 1.796; p = 0.005; 95% CI: 1.19–2.71), Broca’s aphasia (OR: 1.571; p = 0.003; 95% CI = 1.16–2.12) and antihypertensive medication (OR: 1.530; p = 0.034; 95% CI: 1.03–2.26) were associated with an improved ambulation in patients without thrombolytic therapy. In thrombolytic treated patients, Broca’s aphasia was associated with improved functional outcome.

2020 ◽  
Vol 25 (45) ◽  
pp. 4827-4834 ◽  
Author(s):  
Limin Zhang ◽  
Xingang Li ◽  
Dongzhi Wang ◽  
Hong Lv ◽  
Xuezhong Si ◽  
...  

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.


2018 ◽  
Author(s):  
Matthew Scalise ◽  
Jordan Gainey ◽  
Benjamin Bailes ◽  
Leanne Brecthtel ◽  
Zachary Conn ◽  
...  

Abstract Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = <0.001, CI =0.92-0.96), patients with congestive heart failure (OR = 0.496, P = 0.040, CI = 0.25-0.97), higher NIHSS (OR=0.876, P = 0.001, CI = 0.80-0.95), taking antihypertensive medication (OR = 0.436, P = 0.023, CI = 0.21-0.89) were not associated with improved ambulatory functional outcome with thrombolysis. The discriminating ability for the model was 74.2% for the total population, 71.7% for the rtPA group, and 72.2% for the no-rtPA group indicating strong performance. Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.


2020 ◽  
Vol 33 (6) ◽  
pp. 534-542
Author(s):  
Chami Im ◽  
Tak Kyu Oh ◽  
In-Ae Song

Abstract Background This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective noncardiac surgery. Methods In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent noncardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis. Results Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41–0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41–0.72; P &lt; 0.001). Conclusions This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent noncardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takashi Shimoyama ◽  
Sibaji Gaj ◽  
Kunio Nakamura ◽  
Shivakrishna Kovi ◽  
Ken Uchino

Background and Purpose: Intracranial arterial calcification is a marker of atherosclerosis burden in the general population. The aim of the study is to investigate risk factor profiles of vascular calcification in ischemic stroke patients. Methods: We identified ischemic stroke patients who underwent complete CTA from a prospective single-hospital stroke registry in 2018. Automatic artery and calcification segmentation method measured calcification volumes in the intracranial, extracranial, and aortic arteries using deep-learning U-net model and region-grow algorithms. Severe vascular calcification was defined as patients in the upper quartile calcification volume. The prevalence of severe vascular calcification and mean calcification volume were investigated by age category (<60 years, 60-70 years, 70-80 years, 80 years ≥). The relation between each potential risk factors and severe vascular calcification was assessed using the multivariate logistic regression analysis adjusted for age, sex, NIHSS score, and TOAST stroke subtypes. Results: Of the 558 consecutive acute ischemic stroke patients, 388 patients (212 males; mean age 66.6±14.2 years) met inclusion and with quantitative CTA calcification. The prevalence of severe vascular calcification (CTA calcification volume> 812 mm 3 ) increased with increasing age category (<60 years: 6.8% (7/103), 60-70 years: 15.7% (18/115), 70-80 years: 39.6% (38/105), 80 years ≥: 45.9% (34/74), P<0.001 for χ 2 test). Over age 80 years subsets had significantly higher mean calcification volume with 1213 mm 3 than other age category (<60 years: 225 mm 3 , P<0.001; 60-70 years: 462 mm 3 , P<0.001; 70-79 years: 817 mm 3 , P=0.020 for t-test). In the multivariate logistic regression analysis, age (OR 1.096, 95% CI 1.066-1.128, P<0.001), smoking (OR 3.430, 95% CI 1.833-6.419, P<0.001), and large artery atherosclerosis (LAA) (OR 4.260, 95% CI 1.963-9.247, P<0.001) were independently associated with severe vascular calcification. Conclusion: In the quantitative CTA analysis of calcification volume, older age and smoking were high risk for severe atherosclerotic calcium burden in ischemic stroke patients. Moreover, severe vascular calcification may differentiate LAA from other stroke etiology.


2016 ◽  
Vol 74 (12) ◽  
pp. 986-989 ◽  
Author(s):  
Daniel Amitrano ◽  
Ivan Rocha Ferreira da Silva ◽  
Bernardo B. Liberato ◽  
Valéria Batistella ◽  
Janaina Oliveira ◽  
...  

ABSTRACT Objective We aimed to develop a model to predict unfavorable outcome in patients with acute ischemic stroke treated with intravenous thrombolytic therapy (IVT), based on simple variables present on admission. Methods Retrospective analysis of acute ischemic stroke patients treated with IVT in a hospital in Rio de Janeiro. Clinical and radiographic variables were selected for analysis. Multivariate logistic regression was used to develop a predictive model. Results We analyzed a total of 82 patients. Median National Institutes of Health Stroke Scale (NIHSS) on admission was 9 (3–22), 40.2% presented with a hyperdense artery sign (HAS), 62% had identifiable early parenchymal changes and 61.6% experienced a favorable outcome. An NIHSS score of > 12 on arrival, age > 70 and the presence of HAS were associated with the outcome, even after correction in a logistic regression model. Conclusion An NIHSS > 12 on arrival, presence of HAS and age > 70 years were predictors of unfavorable outcome at three months in patients with acute ischemic stroke treated with IVT.


2021 ◽  
Vol 12 ◽  
Author(s):  
Chong-xi Xu ◽  
Hui Xu ◽  
Tong Yi ◽  
Xing-yang Yi ◽  
Jun-peng Ma

Objective: This investigation aimed at studying the prevalence of cerebral microbleeds (CMBs), including risk factors and the correlation of CMBs to ischemic stroke (IS) patient end results.Methods: Four hundred and fifty-nine acute IS cases were recruited between April 2014 and December 2016. Cerebral microbleeds were analyzed using susceptibility-weighted imaging (SWI) brain MRI scan. The enrolled patients with acute IS were followed up for 12–24 months, with a median follow-up time of 19 months. The follow-up endpoint events including recurrent ischemic stroke (RIS), intracranial hemorrhage (ICH), transient ischemic attack (TIA), mortality, and cardiovascular events. The associations between vascular risk factors and CMBs in IS patients were analyzed using univariate and multivariate logistic regression analysis. Cox regression model was employed for evaluating CMB impact on clinical outcome.Results: Among 459 enrolled patients, 187 (40.7%) had CMBs and 272 (59.2%) had no CMB. In comparison with patients with no CMBs, age was higher and hypertension was more frequent in patients with CMBs. Multivariate logistic regression analyses revealed age and hypertension were independently associated with the presence of CMBs. Among the patient cohort, 450 cases completed the follow-up. During the follow-up period, 22 (4.9%) of patients developed ICH, 12 (2.7%) developed TIA, 68 (15.1%) developed RIS, cardiovascular events occurred in 20 (4.44%), and 13 (2.89%) cases were mortalities. Compared with patients without CMBs, IS patients with CMBs have an increased prevalence of ICH (p &lt; 0.05). However, no statistically valid variations regarding other outcome incidences between both groups was identified (p &gt; 0.05). The incidence of ICH was elevated in tandem with elevations in number of CMBs. Following adjusting for age, multivariate Cox proportional-hazards regression analysis revealed that CMBs ≥10 were independent predictors of ICH in acute IS patients.Conclusion: Age and hypertension are independently associated with the presence of CMBs. Intracranial hemorrhage incidence rate was increased with the number of CMBs, and the number of CMBs ≥10 were independent predictors of ICH in acute stroke patients.


2020 ◽  
Vol 13 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Noel van Horn ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
Rosalie McDonough ◽  
Milani Deb-Chatterji ◽  
...  

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Satoshi Suda ◽  
Takashi Shimoyama ◽  
Yohei Takayama ◽  
Takahiro Ouchi ◽  
Masafumi Arakawa ◽  
...  

Background and purpose: Post-stroke infection (PSI) is a common and it is associated with a severe prognosis. Recent studies have shown that thyroid hormones play critical roles in the immune system regulation. However, association between PSI and thyroid hormone have not been fully elucidated. We therefore investigated the impact of thyroid hormone on PSI in acute stroke patients. Methods: We retrospectively enrolled 520 consecutive patients with acute ischemic stroke (326 male, 71.9 ± 13.2 years) admitted to our department between September 2014 and June 2016. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were evaluated upon admission. PSI was defined as infection occurring during hospitalization. The impact of the thyroid hormone on PSI was evaluated using multiple logistic regression analysis. Separate analyses were conducted according to PSI and quartile serum FT3 concentration. Results: PSI was diagnosed in 107 patients (20.6 %). The most common infection was pneumonia with the prevalence of 65 patients (60.7 %), followed by urinary tract infection recorded in 19 patients (17.8 %). Age ( P < 0.001), body mass index ( P = 0.0044), pre-admission mRS ( P = 0.002), NIHSS score on admission ( P < 0.001), admission FT3 (2.63 ± 0.49 pg/mL vs. 2.24 ± 0.66 pg/mL, P < 0.001), and cardio-embolic stroke ( P < 0.001) were significantly associated with PSI, but no relationship between TSH (2.84 ± 8.12 mIU/L vs. 2.20 ± 1.45 mIU/L, P = 0.4610), FT4 (1.22 ± 0.21 ng/dL vs. 1.21 ± 0.28 ng/dL, P = 0.1478), and PSI were found. On multivariable logistic regression analysis, low FT3 (< 2.29 pg/mL; odds ratio [OR], 2.96; 95% confidence interval [CI], 1.61- 5.45; P = 0.0005) and high admission NIHSS score (≥ 9 points, OR, 7.65; 95% CI, 4.10-14.73; P <0.0001) were independently associated with PSI. In comparisons between PSI and FT3 quartiles (Q1 [≤ 2.25 pg/mL], Q2 [2.26-2.55 pg/mL], Q3 [2.56-2.89 pg/mL], Q4 [≥ 2.90 pg/mL]), patients with PSI were significantly more frequent in Q1 than in Q2, Q3, and Q4 after multivariate adjustment. Conclusions: Our results showed that a low FT3 at admission should be associated with PSI in acute ischemic stroke patients.


Author(s):  
Rizaldy Taslim Pinzon ◽  
Fransiska Theresia Meivy Babang ◽  
Esdras Ardi Pramudita

<p>Background <br />The mortality rate after ischemic stoke is influenced by various factors. Prognosis after ischemic stroke can be predicted using a scoring system to help the doctor to evaluate patient’s condition, neurologic deficits, and possible prognosis as well as make appropriate management decisions. The objective of this study was to identify the factors which determine mortality rates in patients after ischemic stroke and to determine the prognosis of ischemic stroke patients using the predictive mortality score.</p><p>Methods<br />This was a nested case control study using data from the stroke registry and medical records of patients at the Neurology Clinic of Bethesda Hospital Yogyakarta between 2011-2015. Data was analysed using simple and multiple logistic regression analysis. The scoring was analyzed using receiver-operating characteristic (ROC) curve and the cut-off point using area under the curve (AUC).</p><p>Results<br />Multiple logistic regression analysis showed a significant association between mortality of ischemic stroke patients and age (OR: 4.539, 95% CI: 1.974-10.439, p&lt;0.001), random blood glucose (OR: 2.692, 95% CI: 1.580-4.588, p&lt;0.001), non-dyslipidemia (OR: 2.313, 95% CI: 1.395-3.833, p=0.001), complications (OR: 1.609, 95% CI: 1.019-2.540, p=0.041), risk of metabolic encephalopathy (OR: 2.499, 95% CI: 1.244-5.021, p=0.010) and use of ventilators (OR: 17.278, 95% CI: 2.015-148.195, p=0.009).</p><p>Conclusions<br />Age, high random blood glucose level, complications, metabolic encephalopathy risk and the use of ventilators are associated with mortality after ischemic stroke. The predictive mortality score can be used to assess the prognosis of patients with ischemic stroke.</p>


2016 ◽  
Vol 24 (1) ◽  
pp. 45-54
Author(s):  
Felicia Maria Petrişor ◽  
Andreea Cătană ◽  
Dragoş Horea Mărginean ◽  
Adrian Pavel Trifa ◽  
Radu Anghel Popp ◽  
...  

Abstract Introduction: Being a multifactorial disease, stroke is one of a major causes of death and disability worldwide. Several genetic polymorphisms have been associated with stroke etiophatology and FGB −455 G>A and GP IIIa PIA1/A2 are among them. In the present study, we investigated the association between FGB −455 G>A and GP IIIa PIA1A2 polymorphisms and the risk of ischemic stroke in a group of Romanian stroke patients. Subjects and methods: This case-control study included 148 patients with ischemic stroke and 150 healthy age, sex and ethnically matched unrelated controls. FGB −455G>A and GP IIIa PIA1A2 genotyping was carried out using PCR-RFLP. The association of FGB −455G>A and GP IIIa PIA1A2 polymorphisms and cardiovascular risk factors with ischemic stroke was tested using logistic regression analysis. Results: Molecular analysis did not reveal an increased frequency of the FGB -455 G>A variant allele and GP IIIa PIA1/A2 variant allele in the study group compared to the control group (p = 0.140, OR = 0.750, 95% CI = 0.522 - 1.077; p = 0.823, OR = 0.944, 95% CI = 0.558 - 1.599 respectively). Furthermore, after performing logistic regression analysis adjusted for the known risk factors, a positive association with stroke was found in smokers (p = 0.026, OR = 1.800, 95% CI = 1.071 - 3.024) Conclusions: No association was found between FGB −455 G>A and GP IIIa PIA1/A2 polymorphisms and ischemic stroke in the studied population.


Sign in / Sign up

Export Citation Format

Share Document