scholarly journals Prediction of unfavorable outcome in ischemic stroke patients with chronic kidney disease

2021 ◽  
pp. 53-59
Author(s):  
A. Antonenko ◽  
K. Antonenko ◽  
L. Vakulenko ◽  
Z. Dubovenko
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Prognostic Factors ◽  
Kidney Disease ◽  
Functional Outcomes ◽  
Unfavorable Outcome ◽  
Stroke Outcome ◽  
Basic Characteristics

Patients with chronic kidney disease (CKD) have significantly poorer functional outcomes and greater mortality after suffering a stroke. The present study aimed to identify the prognostic factors of an unfavorable outcome of the ischemic stroke in patients with CKD. Methods and subjects. The current study was designed retrospectively and performed with data of patients who were hospitalized due to ischemic stroke to the neurological department. A complex clinical and neuroimaging investigation was carried out in 65 patients (30 men and 35 women) aged 53 to 81 years (mean age – (67.7 ± 5.9) years) with acute stroke and CKD. Patients underwent all the necessary ancillary investigations according to guidelines. According to the clinical outcome on the 21-st day by the modified Rankin scale (mRS) all patients were divided into two groups: 1-st –favorable stroke outcome (mRS=0-3) – 34 (52.3%), 2-nd – unfavorable stroke outcome – (mRS=4-6) – 31 (47.7%). Results. During comparing the basic characteristics of both groups, it was revealed that patients with unfavorable functional outcomes were almost twice as likely to have diabetes mellitus (51.6% vs. 26.5%, p<0.037) and atrial fibrillation (41.9% vs. 17.6%, p<0.032). In age-and sex-adjusted multifactor logistic regression it was found that ischemic stroke unfavorable outcome is associated with diabetes mellitus (OR – 2.5, CI: 1.6-8.3; p=0.014), atrial fibrillation – 2.7, CI: 0.7-9.6; p=0.043), dialysis therapy (OR – 3.4, CI: 2.3-8.1; p=0.007), GFR <42 ml/min/1.73 m2 (OR – 2.7, CI: 2.1-7.8; p=0.003). Conclusions. Determining prognostic factors of unfavorable course of the ischemic stroke in patients with CKD allows to optimize the management of such patients in the acute period of ischemic stroke and improve the prognosis.

scholarly journals FAKTOR-FAKTOR RISIKO STROKE PADA PENYAKIT GINJAL KRONIK STADIUM V YANG MENJALANI HEMODIALISIS

2018 ◽  
Vol 35 (2) ◽  
Author(s):  
Susanti Dwi Ariani ◽  
Dodik Tugasworo ◽  
Maria Imakulata Widiastuti Samekto
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Case Group ◽  
Chi Square ◽  
Stroke Incidence ◽  
Incidence And Mortality

RISK FACTORS OF STROKE IN STAGE V CHRONIC KIDNEY DISEASE WHO UNDERWENT HEMODIALYSISABSTRACTIntroduction: Chronic kidney disease (CKD) and end-stage renal disease are associated with a significantly in- creased risk of stroke. Incidence and mortality of stroke in CKD patients is higher rather than among the general popula- tion. Stroke in hemodialysis patients is also associated with high mortality.Aims: To analyze risk factors that have a relationship with the occurrence of stroke in patients with stage V CKD who underwent hemodialysis in Dr. Kariadi Hospital, Semarang.Method: A case control with retrospective cohort study of patients diagnosed with stage V CKD undergoing hemo- dialysis in Dr. Kariadi Hospital, Semarang, from March 2016 to August 2017. Subject was divided into case group, who experienced stroke, and control group, who did not experience stroke. Bivariate analysis was performed with Chi-square test, multivariate analysis with logistic regression test and rasio Odds.Results: There were 140 subjects with stage V CKD, 70 subjects in each groups. In case group, 85.7% experienced ischemic stroke while the rest hemorrhagic stroke. The duration of hemodialysis was related to the incidence of stroke. In multivariate analysis, patients with diabetes mellitus were more likely to have a stroke by 0.14 times compared to patients who did not have diabetes mellitus, and patients who underwent hemodialysis >12 months, were more likely to have a stroke 4.05 times greater than patients who underwent hemodialysis <12 months.Discussion: There is a relationship between diabetes mellitus and duration of hemodialysis with the occurrence of ischemic stroke, in stage V CKD patients who underwent hemodialysis.Keywords: Chronic kidney disease, hemodialysis, strokeABSTRAKPendahuluan: Penyakit ginjal kronik (PGK) dan penyakit ginjal stadium akhir terkait dengan peningkatan risiko yang signifikan dari stroke. Insiden dan mortalitas stroke pada pasien PGK lebih tinggi dibandingkan populasi umum. Stroke pada pasien dialisis juga dihubungkan dengan mortalitas yang tinggi.Tujuan: Untuk menganalisis faktor-faktor risiko yang memengaruhi terjadinya stroke pada pasien dengan PGK stadium V yang menjalani hemodialisis (HD) di RSUP Dr. Kariadi, Semarang.Metode: Penelitian kasus kontrol dengan pendekatan kohort retrospektif terhadap pasien penyakit ginjal kronik stadium V yang menjalani HD di RSUP Dr. Kariadi, Semarang dari bulan Maret 2016 hingga Agustus 2017. Subjek dibagi ke dalam kelompok kasus, yaitu yang mengalami stroke dan kelompok kontrol yang tidak mengalami stroke. Dilakukan analisis bivariat dengan uji Chi-square dan analisis multivariat dengan uji regresi logistik serta rasio Odds.Hasil: Didapatkan 140 subjek dengan PGK stadium V yang masing-masing kelompok terdiri dari 70 orang. Pada kelompok kasus, sebanyak 85,7% adalah stroke iskemik dan sisanya stroke hemoragik. Lama HD berhubungan dengan kejadian stroke. Pada uji multivariat, subjek yang menderita diabetes melitus (DM) berisiko mengalami stroke sebesar 0,14 kali dibandingkan yang tidak DM dan subjek yang menjalani HD >12 bulan berisiko mengalami stroke 4,05 kali lebih besar dibandingkan yang menjalani HD <12 bulan.Diskusi: Terdapat pengaruh faktor risiko DM dan lama hemodialisis terhadap kejadian stroke iskemik pada pasien PGK stadium V yang menjalani HD.Kata kunci: Hemodialisis, penyakit ginjal kronik, stroke

scholarly journals High blood pressure in acute ischemic stroke and clinical outcome

2009 ◽  
Vol 1 (1) ◽  
pp. 1 ◽  
Author(s):  
Yasuhiro Manabe ◽  
Syoichiro Kono ◽  
Tomotaka Tanaka ◽  
Hisashi Narai ◽  
Nobuhiko Omori
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
High Blood Pressure ◽  
Pressure Measurements ◽  
Pressure Group ◽  
History Of

This study aimed to evaluate the prognostic value of acute phase blood pressure in patients with acute ischemic stroke by determining whether or not it contributes to clinical outcome. We studied 515 consecutive patients admitted within the first 48 hours after the onset of ischemic strokes, employing systolic and diastolic blood pressure measurements recorded within 36 hours after admission. High blood pressure was defined when the mean of at least 2 blood pressure measurements was ≥200 mmHg systolic and/or ≥110 mmHg diastolic at 6 to 24 hours after admission or ≥180 mmHg systolic and/or ≥105 mmHg diastolic at 24 to 36 hours after admission. The high blood pressure group was found to include 16% of the patients. Age, sex, diabetes mellitus, hypercholesterolemia, atrial fibrillation, ischemic heart disease, stroke history, carotid artery stenosis, leukoaraiosis, NIH Stroke Scale (NIHSS) on admission and mortality were not significantly correlated with either the high blood pressure or non-high blood pressure group. High blood pressure on admission was significantly associated with a past history of hypertension, kidney disease, the modified Rankin Scale (mRS) on discharge and the length of stay. On logistic regression analysis, with no previous history of hypertension, diabetes mellitus, atrial fibrillation, and kidney disease were independent risk factors associated with the presence of high blood pressure [odds ratio (OR), 1.85 (95% confidence interval (CI): 1.06-3.22), 1.89 (95% CI: 1.11-3.22), and 3.31 (95% CI: 1.36-8.04), respectively]. Multi-organ injury may be presented in acute stroke patients with high blood pressure. Patients with high blood pressure had a poor functional outcome after acute ischemic stroke.

scholarly journals Features of comorbid pathology spectrum and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease

2021 ◽  
Vol 23 (2) ◽  
pp. 214-219
Author(s):  
O. V. Riabokon ◽  
V. V. Cherkaskyi ◽  
T. Ye. Onishchenkо ◽  
Yu. Yu. Riabokon
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Age Structure ◽  
Statistical Data ◽  
Severe Disease ◽  
Persistent Atrial Fibrillation ◽  
Comorbid Conditions ◽  
Postinfarction Cardiosclerosis

The aim was to analyze spectrum of comorbid pathology and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease. Materials and methods. The study included 85 oxygen-dependent patients with severe COVID-19. The patients were divided into groups: I – 70 patients with recovery; II – 15 patients in whom the disease was fatal. Statistical data processing was performed in the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Among the patients with fatal outcomes of the disease, elderly and senile were dominated – 93.3 % (14 of 15) versus 67.1 % (47 of 70) among patients who recovered (P < 0.05). Analysis of comorbid pathology structure in oxygen-dependent patients with severe COVID-19 showed that patients who died more often had hypertension (93.3 % vs. 30.0 %, P < 0.001), postinfarction cardiosclerosis (26.7 % vs. 2.9 %, P < 0.001), rhythm disturbance as persistent atrial fibrillation (20.0 % vs. 1.4 %, P < 0.01) as compared to those who survived. The patients of group II were more commonly diagnosed with chronic kidney disease (20.0 % vs. 4.3 %, P < 0.05) as the comorbid pathology. The presence of ischemic stroke in COVID-19 infection influenced the disease outcome (20.0 % vs. 4.3 %, P < 0.05). Fatal outcomes in the patients with COVID-19 were associated with a combination of 3 or more comorbid conditions in 46.7 % versus 17.4 % among oxygen-dependent survivors with severe disease (P < 0.01). Conclusions. Elderly and senile oxygen-dependent patients are more likely to die from severe COVID-19 (P < 0.05). Comorbid hypertension, postinfarction cardiosclerosis, arrhythmia in the form of persistent atrial fibrillation, chronic kidney disease and ischemic stroke or the combination of 3 or more comorbid conditions listed are more common among patients with COVID-19 who died (P < 0.05) as compared to survivors.

scholarly journals Predicting atrial fibrillation after acute abdominal surgery

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C V Madsen ◽  
B Leerhoey ◽  
L Joergensen ◽  
C S Meyhoff ◽  
A Sajadieh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
At Risk ◽  
Kidney Disease ◽  
Abdominal Surgery ◽  
Prediction Model ◽  
Vital Signs ◽  
Patients At Risk

Abstract Introduction Post-operative atrial fibrillation (POAF) is currently considered a phenomenon rather than a definite diagnosis. Nevertheless, POAF is associated with an increased rate of complications, including stroke and mortality. The incidence of POAF in acute abdominal surgery has not been reported and prediction of patients at risk has not previously been attempted. Purpose We aim to report the incidence of POAF after acute abdominal surgery and provide a POAF prediction model based on pre-surgery risk-factors. Methods Designed as a prospective, single-centre, cohort study of unselected adult patients referred for acute, general, abdominal surgery. Consecutive patients (&gt;16 years) were included during a three month period. No exclusion criteria were applied. Follow-up was based on chart reviews, including medical history, vital signs, blood samples and electrocardiograms. Chart reviews were performed prior to surgery, at discharge, and three months after surgery. Atrial fibrillation was diagnosed either by specialists in Cardiology or Anaesthesiology on ECG or cardiac rhythm monitoring (≥30 seconds duration). Multiple logistic regression with backward stepwise selection was used for model development. Receiver operating characteristic curves (ROC) including area under the curve (AUC) was produced. The study was approved by the Regional Ethics committee (H-19033464) and comply with the principles of the Declaration of Helsinki of the World Medical Association. Results In total, 466 patients were included. Mean (±SD) age was 51.2 (20.5), 194 (41.6%) were female, and cardiovascular comorbidity was present in ≈10% of patients. Overall incidence of POAF was 5.8% (27/466) and no cases were observed in patients &lt;60 years. Incidence was 15.7% (27/172) for patients ≥60 years. Prolonged hospitalization and death were observed in 40.7% of patients with POAF vs 8.4% patients without POAF (p&lt;0.001). Significant age-adjusted risk-factors were previous atrial fibrillation odds ratio (OR) 6.84 [2.73; 17.18] (p&lt;0.001), known diabetes mellitus OR 3.49 [1.40; 8.69] (p=0.007), and chronic kidney disease OR 3.03 [1.20; 7.65] (p=0.019). A prediction model, based on age, previous atrial fibrillation, diabetes mellitus and chronic kidney disease was produced (Figure 1), and ROC analysis displayed AUC 88.26% (Figure 2). Conclusions A simple risk-stratification model as the one provided, can aid clinicians in identifying those patients at risk of developing POAF in relation to acute abdominal surgery. This is important, as patients developing POAF are more likely to experience complications, such as prolonged hospitalization and death. Closer monitoring of heart rhythm and vital signs should be considered in at-risk patients older than 60 years. Model validation is warranted. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals New Possibilities in Quantitative Assessment of Albuminuria in Patients with Atrial Fibrillation and Chronic Kidney Disease

2021 ◽  
Vol 17 (3) ◽  
pp. 423-428
Author(s):  
A. A. Sokolova ◽  
A. I. Skripka ◽  
I. I. Ivanov ◽  
V. V. Kogay ◽  
A. I. Listratov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Clinical Trials ◽  
Small Sample Size ◽  
Small Sample ◽  
Median Score ◽  
Ckd Progression ◽  
Patients With Diabetes

Aim. To evaluate the relationship between albumin to creatinine ratio (ACR) in a single and 24-hours urine spots and chronic kidney disease (CKD) progression pace in patients with atrial fibrillation, CKD and diabetes mellitus.Material and methods. 60 patients with atrial fibrillation (AF) and CKD were enrolled, study duration was 15 months. The patients were divided into two groups depending on the presence of DM. Total number of ACR tests was 170, dynamics of CKD progression was estimated with CKD-EPI formula for first visit and 15th month’s follow-up.Results. The median score of CHA2DS2VASс scale was 4 [3;5]. The risk of hemorrhagic complications in both groups was low (median score 1 [1;1]. There is a strong statistically significant correlation between ACR in a single and 24-hours urine spots (p<0.001). No significant changes in kidney function within 15 months were found (GFR 53 [46;59] ml/min/1.73 m2 vs 50.5 [45.63] ml/min/1.73 m2 for patients with diabetes mellitus [DM] [p=0.94] and GFR 52.5 [46.58] ml/min/1.73 m2 vs 50 [44.58] ml/min/1.73 m2 for patients without DM [p=0.711]). When comparing the renal function of patients with and without DM after 15 months statistically significant differences were also not found (p = 0.510).Conclusion. In respect that assessment of single sample ACR is much more practical and reliable, this method might replace traditional 24-hours urine assessment in future. However, due to the small sample size and the presence of wide discrepancies in individual cases, which can be associated with preanalytical errors in urine collection, large randomized clinical trials are needed to confirm the obtained data.

scholarly journals The association of anticoagulation, ischemic stroke, and hemorrhage in elderly adults with chronic kidney disease and atrial fibrillation

2017 ◽  
Vol 91 (4) ◽  
pp. 928-936 ◽  
Author(s):  
Vaibhav Keskar ◽  
Eric McArthur ◽  
Ron Wald ◽  
Ziv Harel ◽  
Deborah Zimmerman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Elderly Adults

Serum Anti-AP3D1 Antibodies Are Broad-Spectrum Biomarkers for Atherosclerosis, Acute Ischemic Stroke, Cardiovascular Disease, Diabetes Mellitus, Chronic Kidney Disease, and Digestive Organ Cancer

2020 ◽  
Author(s):  
Shu-Yang Li ◽  
Yoichi Yoshida ◽  
Eiichi Kobayashi ◽  
Masaaki Kubota ◽  
Tomoo Matsutani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Broad Spectrum ◽  
Serum Antibody ◽  
Digestive Organ ◽  
Antibody Levels

Abstract Background: Atherosclerosis has been considered as the main cause of morbidity, mortality, premature incapacity, and disability worldwide. For early and sensitive diagnosis, development of novel biomarkers is expected and of significant practical importance.Methods: The first screening for antigen markers was conducted using the serological identification of antigens by recombinant cDNA expression cloning (SEREX). Serum antibody levels were examined using the amplified luminescent proximity homogeneous assay-linked immunosorbent assay (AlphaLISA) using a recombinant protein as an antigen.Results: SEREX screening has identified adaptor-related protein complex 3 subunit delta 1 (AP3D1) as an antigen recognized by serum IgG antibodies of patients with atherosclerosis. As per the results of AlphaLISA, it was determined that the serum antibody levels against AP3D1 were higher in patients with acute ischemic stroke (AIS), transient ischemic attack (TIA), diabetes mellitus (DM), cardiovascular disease (CVD), chronic kidney disease (CKD), esophageal squamous cell carcinoma (ESCC), and colorectal carcinoma than those in the healthy donors. The area under the curve values of DM, nephrosclerosis type of CKD, and ESCC calculated using receiver operating characteristic curve analysis were noted to be higher than that of other diseases. Correlation analysis showed that the anti-AP3D1 antibody levels were highly associated with maximum intima-media thickness, which indicates that this marker reflected the development of atherosclerosis. The Japan Public Health Center-based Prospective Study results have verified that the serum antibody levels against AP3D1 showed significantly higher odds ratios with the risk of AIS for persons with the third quartiles and the highest quartiles versus the lowest quartile, indicating that this antibody marker is deemed useful as risk factors for AIS.Conclusions: Serum anti-AP3D1 antibodies, which are broad-spectrum biomarkers of atherosclerotic diseases and digestive organ cancers, could be useful in predicting the onset of AIS.

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