scholarly journals Impact of Nutritional Assessment on Long-Term Outcomes in Patients with Carotid Artery Stenting

2021 ◽  
Author(s):  
Muhammed Demir ◽  
Mehmet Ozbek
Keyword(s):  
Carotid Artery ◽  
Nutritional Status ◽  
Carotid Artery Stenting ◽  
Nutritional Assessment ◽  
Survival Rates ◽  
Multivariate Logistic Regression Analysis ◽  
Adverse Outcomes ◽  
Cardiac Events ◽  
Prognostic Information ◽  
Conut Score

Objective: Malnutrition is associated with poor clinical outcomes in many diseases. The Controlling Nutritional Status (CONUT) is an objective index used for evaluating nutritional status of hospitalized patients. The aim of this study was to investigate the relationship between malnutrition assessed by CONUT score and the prognosis in patients undergoing carotid artery stenting (CAS). Methods: The study included 170 patients who underwent CAS due to symptomatic or asymptomatic severe carotid artery stenosis. Median follow-up period was 50 (interquartile range [IQR], 41-60) months. Patients were divided into two groups according to the CONUT score: (i) normal nutrition (<2) and (ii) malnutrition (≥2). Primary endpoint was accepted as MACE (major adverse cardiac events) including all-cause death and ischemic stroke. Results:The prevalence of MACE was significantly higher in the malnutrition group (p=0.001). Kaplan Meier analysis showed lower survival rates in the malnutrition group (log rank = 9.36, p=0.002; Figure 4). In multivariate logistic regression analysis, age and CONUT score were independent predictors of all-cause death and stroke after adjustment for confounding factors, respectively, (OR: 1.058, 95% CI: 1.013-1.105, p=0.011, OR: 1.318, 95% CI: 1.017-1.881, p=0.039). Conclusion: Higher CONUT scores were associated with adverse outcomes in patients with CAS. Malnutrition assessed by the CONUT score may provide valuable prognostic information in patients with CAS.

scholarly journals Nutritional Status in Childhood Cancer Survivors with Solid Tumors: A Longitudinal Study

2021 ◽  
Author(s):  
Nancy Sacks ◽  
Wendy Hobbie ◽  
Laura Byham-Gray ◽  
Robert Denmark ◽  
Yuane Jia ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Nutritional Status ◽  
Solid Tumors ◽  
Weight Status ◽  
Nutritional Assessment ◽  
Childhood Cancer Survivors ◽  
Growth Patterns ◽  
Adverse Outcomes ◽  
Z Score ◽  
Large Tumor

Background: Malnutrition (under and overnutrition) occurs in children with solid tumors and has been linked with adverse outcomes during and after treatment. Assessment of nutritional status (NS) can be challenging due to large tumor burdens, atypical growth patterns and different methods for assessing NS. Methods: Retrospective longitudinal study of children with solid tumors (n=61). Anthropometric data assessed [(diagnosis, after diagnosis (1.5, 3, 6 and 12 months, 5 years), end of treatment (EOT), initial cancer survivorship program (CSP) visit]. Registered dietitian nutritionist nutritional assessment (NA) during treatment and Intensity of Treatment Rating (ITR) documented. Results: At diagnosis, prevalence of undernutrition [(Z-score -1.0 to -2.99)] and overnutrition (Z-score ≥ +2.0) were 13.8% and 8.6%, respectively; weight status categories, 8.6%, 6.9%/13.8% were underweight, overweight/obese, respectively. Weight loss and decreased weight-for-age Z-score (WAZ) occurred in 31.9% and 74.5% patients, respectively, at 1.5 months. At EOT, compared to diagnosis, WAZ and height-for-age Z-score (HAZ) decreased and BMIZ increased. From EOT to CSP visit, overweight/obesity doubled, 7.7%/5.8% and 15.2/11.9%, respectively. Thirty-one percent of patients received a NA, occurring at lowest WAZ. Over 50% had ITR of level 3 or 4 and 88.9% had NA in level 4. Conclusions: Suboptimal NS continues at diagnosis, during treatment and survivorship. Normalized measures, accounting for expected growth, should be used instead of raw numbers. More than one nutrition indicator will identify atypical growth patterns and a proactive approach would help prevent malnutrition. Evidence based research is essential and collaboration necessary to meet the needs of this population.

scholarly journals Association of postoperative glycemic control with outcomes after carotid procedures

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 16-24
Author(s):  
Jonathan Bath ◽  
Robin L Kruse ◽  
Jamie B Smith ◽  
Naveen Balasundaram ◽  
Todd R Vogel
Keyword(s):  
Renal Failure ◽  
Carotid Artery ◽  
Length Of Stay ◽  
Carotid Endarterectomy ◽  
Glucose Control ◽  
Carotid Artery Stenting ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Cardiac Complications ◽  
The Relationship

Objective There are limited data evaluating the impact of postoperative hyperglycemia in patients undergoing vascular procedures. This study evaluated the relationship between suboptimal glucose control and adverse outcomes after carotid artery stenting and carotid endarterectomy. Methods Patients admitted for elective carotid procedures were selected from the Cerner Health Facts® (2008–2015) database using ICD-9-CM diagnosis and procedure codes. We examined the relationship between patient characteristics, postoperative hyperglycemia (any value > 180 mg/dL), and complications with chi-square analysis. A multivariable model examined the association between patient characteristics, procedure type, and glucose control with infection, renal failure, stroke, respiratory and cardiac complications, and length of stay over 10 days. Results Of the 4287 patients admitted for an asymptomatic carotid procedure, 788 (18%) underwent carotid artery stenting and 3499 (82%) underwent carotid endarterectomy. Most patients (87%) had optimal postoperative glucose control (80–180 mg/dL); 13% had suboptimal glucose control. On average, patients with suboptimal glucose control experienced: higher stroke rates (6.2% vs. 2.7%; p <  0.001); more cardiac complications (5.1% vs. 2.0%; p <  0.001); longer hospital stays (3.1 vs. 1.8 days; p < .001); higher rates of post-procedure infection (4.0% vs. 1.8%; p = .001); and more complications than patients with optimal glucose control. Multivariable logistic regression demonstrated that patients with suboptimal glucose control had higher odds of having an infectious (pneumonia, cellulitis, surgical site, etc.) complication (OR 1.91, 95% CI 1.10–3.34), renal failure (OR 3.36, 95% CI 1.95–5.78), respiratory complications (OR 1.81, 95% CI 1.21–2.71), stroke (OR 1.82, 95% CI 1.15–2.88), or length of stay > 10 days (OR 4.07, 95% CI 2.02–8.20). Conclusions Suboptimal glucose control was associated with adverse events after carotid artery stenting and carotid endarterectomy, independent of a diabetes diagnosis. Several adverse outcomes were associated with hyperglycemia, including stroke. Given the singular role of carotid procedures in preventing stroke, we suggest that incorporating rigorous post-operative glucose control into best medical treatment of carotid disease should be considered as a standard practice.

Prognostic Value of 3 Nutritional Screening Tools to Predict 30-Day Outcome in Patients Undergoing Carotid Artery Stenting

Angiology ◽  
2021 ◽  
pp. 000331972110403
Author(s):  
Ender Ö Çakmak ◽  
Lütfi Öcal ◽  
Emrah Erdoğan ◽  
Sinan Cerşit ◽  
Süleyman Çağan Efe ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Risk Index ◽  
Predictive Ability ◽  
Prognostic Nutritional Index ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Post Procedure ◽  
Nutritional Risk Index ◽  
Conut Score

The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability.

scholarly journals Angiographic lesion characteristics can predict adverse outcomes after carotid artery stenting

2008 ◽  
Vol 47 (1) ◽  
pp. 81-87 ◽  
Author(s):  
Shariq Sayeed ◽  
Stephen F. Stanziale ◽  
Mark H. Wholey ◽  
Michel S. Makaroun
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Adverse Outcomes

Predictors of Carotid Artery Stenting-Induced Hemodynamic Instability

2021 ◽  
pp. 153857442110056
Author(s):  
Mahmoud Saleh ◽  
Haitham Ali ◽  
Khaled Atalla ◽  
Mohammed Shahat ◽  
Enrico Cieri
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Binary Logistic Regression ◽  
Neurological Status ◽  
Hemodynamic Instability ◽  
Adverse Outcomes ◽  
Binary Logistic Regression Model ◽  
Stent Deployment ◽  
Symptomatic Carotid ◽  
Independent Risk Factors

Background: To address the predictors of hemodynamic instability (HI) related to carotid artery stenting (CAS) and evaluate the association between HI and periprocedural adverse outcomes. Methods: This study comprised all consecutive patients who underwent CAS for atherosclerotic carotid artery stenosis from March 2014 to May 2018. A standardized dose of atropine (0.4 mg) was given prior to stent deployment. Changes in heart rate, blood pressure, and neurological status were monitored and recorded. Potential predictors of HI were tested in multivariate analysis using binary logistic regression model. Results: A total of 728 patients were enrolled. Two hundred twenty seven patients (31.2%) developed periprocedural HI. The presence of hypertension (OR, 2.037; 95% CI, 1.292-3.211; P = 0.0022), symptomatic carotid lesions (OR, 1.704; 95% CI, 1.057-2.747; P = 0.0287), right sided lesions (OR, 3.090; 95% CI, 1.934-4.935; P ≤ 0.0001), hyperechoic/calcified plaques (OR, 2.195; 95% CI, 1.458-3.304; p P = 0.0002), and longer lesions (OR, 1.043; 95% CI, 1.012-1.076; P = 0.0072) were significant predictable factors for the occurrence of HI. On the other hand, smoking was significantly associated with a 48.1% decrease in risk of development of HI (OR, 0.519; 95% CI, 0.358-0.754; P = 0.0006). There were no statistically significant differences in periprocedural morbidity or mortality between patients with and without HI. Conclusion: HI occurs in a considerable percentage of patients undergoing CAS. Hypertension, right sided, symptomatic carotid lesions, calcified plaques, and longer lesions were shown to be independent risk factors for the development of periprocedural HI. Conversely, smoking demonstrated a protective effect. HI did not appear to predispose to periprocedural adverse events.

Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during carotid artery stenting

2014 ◽  
Vol 8 (6) ◽  
pp. 576-580 ◽  
Author(s):  
Masaomi Koyanagi ◽  
Kazumichi Yoshida ◽  
Yoshitaka Kurosaki ◽  
Nobutake Sadamasa ◽  
Osamu Narumi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Single Photon ◽  
Photon Emission ◽  
Multivariate Logistic Regression Analysis ◽  
Black Blood ◽  
Plaque Imaging ◽  
Cerebrovascular Reserve ◽  
Increased Risk ◽  
Significant Difference

BackgroundReduced cerebrovascular reserve (CVR) is associated with increased risk of ischemic events in carotid steno-occlusive diseases.ObjectiveTo determine whether pretreatment CVR can predict postoperative ischemic lesions after carotid artery stenting (CAS) by retrospective analysis.MethodsWe retrospectively reviewed the medical records of 46 patients (42 men; mean age 74.2±8.3 years) who underwent CAS and preprocedural cerebral blood flow measurement by quantitative single-photon emission CT. Ischemic lesions were evaluated by diffusion-weighted image (DWI) within 72 h after the intervention. We also evaluated plaque characteristics using black-blood MR plaque imaging.ResultsNew ipsilateral DWI-positive lesions were found in 11 cases (23.9%). Patients were classified into two groups based on the presence or absence of new DWI-positive lesions, and no significant differences in characteristics were found between the DWI-positive and DWI-negative groups, except for age and CVR of the ipsilateral middle cerebral artery (MCA) territory. The DWI-positive group was significantly older than the DWI-negative group (79.7±4.1 vs 72.5±8.6 years; p=0.0085) and had lower average regional CVR (1.4±18.2% vs 22.4±25.8%; p=0.016). MR plaque imaging showed no significant difference in relative overall plaque MR signal intensity between the two groups (1.53±0.37 vs 1.34±0.26; p=0.113). In multivariate logistic regression analysis, lower CVR of the ipsilateral MCA territory (<11%) was the only independent risk factor for new ischemic lesions following CAS (OR=6.99; 95% CI 1.17 to 41.80; p=0.033).ConclusionsImpaired pretreatment CVR was associated with increased incidence of new infarction after CAS.

scholarly journals Preoperative Controlling Nutritional Status (CONUT) Score Predicts Short-term Surgical Outcomes in Patients with Gastric Cancer After Laparoscopy-assisted Radical Gastrectomy

2020 ◽  
Author(s):  
Yun Qian ◽  
Huaying Liu ◽  
Junhai Pan ◽  
Weihua Yu ◽  
Jiemin Lv ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Nutritional Status ◽  
Assessment Tool ◽  
Nutritional Assessment ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Youden Index ◽  
Short Term ◽  
Conut Score

Abstract Background: The Controlling Nutritional Status (CONUT) score is an emerging nutrition assessment tool that is useful in gastric cancer (GC) patients. The aim of our study was to assess the predictive ability of the preoperative CONUT score for short-term outcomes in GC patients undergoing laparoscopy-assisted gastrectomy.Methods: We retrospectively reviewed the medical records of 309 patients who underwent curative laparoscopy-assisted gastrectomy. The patients were divided into two groups according to the optimal cut-off value of the CONUT score. The clinical characteristics and postoperative complications were evaluated and analysed in the low- and high-score groups. The risk factors for complications were identified by univariate and multivariate analysis.Results: The preoperative CONUT score showed a good predictive ability for postoperative complications (area under the curve (AUC)=0.718, Youden index=0.343) compared with other indexes, with an optimal cut-off value of 2.5. Patients with high CONUT scores had a higher incidence of overall complications (P<0.001) and mild complications (P<0.001). Univariate and multivariate analyses revealed that the CONUT score was independently associated with postoperative complications (P=0.012; odds ratio (OR)=2.433; 95% confidence interval (CI): 1.218-4.862).Conclusions: The preoperative CONUT score is a reliable and useful nutritional assessment tool for predicting short-term outcomes in GC patients after laparoscopy-assisted gastrectomy.

Carotid artery stenting versus endarterectomy in relation to perioperative myocardial ischemia, troponin T release and major cardiac events

2007 ◽  
Vol 18 (6) ◽  
pp. 483-487 ◽  
Author(s):  
Harm H.H. Feringa ◽  
Johanna M. Hendriks ◽  
Stefanos Karagiannis ◽  
Olaf Schouten ◽  
Radosav Vidakovic ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Myocardial Ischemia ◽  
Carotid Artery Stenting ◽  
Troponin T ◽  
Cardiac Events
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