scholarly journals Clinical Features and Prognostic Factors of Acute Ischemic Stroke Related to Malignant Gastrointestinal Tumor

2021 ◽  
Vol 12 ◽  
Author(s):  
Yating Liu ◽  
Xin Li ◽  
Feixue Song ◽  
Xin Yan ◽  
Zhijian Han ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Prognostic Factors ◽  
Acute Ischemic Stroke ◽  
Malignant Tumor ◽  
Poor Prognosis ◽  
Good Prognosis ◽  
Imaging Features ◽  
Prognosis Group ◽  
D Dimer

Objectives: To analyze the clinical and imaging features of acute ischemic stroke (AIS) related to gastrointestinal malignant tumor, and to explore the prognostic factors.Methods: Clinical data of consecutive patients with gastrointestinal malignant tumor complicated with AIS admitted to the Department of Neurology and Oncology in Lanzhou University Second Hospital from April 2015 to April 2019 were retrospectively analyzed. Patients were divided into good prognosis (mRS 0–2) and poor prognosis (mRS > 2) based on a 90-day mRS score after discharge. The multivariate logistic regression model was used to analyze the prognostic factors.Results: A total of 68 patients were enrolled with an average age of 61.78 ± 6.65 years, including 49 men (72.06%). There were 18 patients in the good prognosis group and 50 patients in the poor prognosis group. The univariate analysis showed that Hcy, D-dimer, thrombin–antithrombin complex (TAT), and three territory sign in magnetic resonance imaging (MRI) were the risk factors for poor prognosis. Multivariate analysis showed that increased D-dimer (OR 4.497, 95% CI 1.014–19.938) and TAT levels (OR 4.294, 95% CI 1.654–11.149) were independent risk factors for the prognosis in such patients.Conclusion: Image of patients with gastrointestinal malignant tumor-related AIS is characterized by three territory sign (multiple lesions in different vascular supply areas). Increased TAT and D-dimer levels are independent prognostic risk factors. TAT is more sensitive to predict prognosis than D-dimer.

scholarly journals Predictive Value of MPV and Plasma NT-ProBNP Combined with the Simplified Geneva Scale for the Prognosis of Acute Pulmonary Embolism

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jing Wang ◽  
Lu Wang ◽  
Ling Jin ◽  
Xiaolei Rong ◽  
Xueshuang Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Predictive Value ◽  
Poor Prognosis ◽  
Acute Pulmonary Embolism ◽  
Good Prognosis ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
The Poor ◽  
Prognosis Group ◽  
Good Prognosis Group

Objective. To explore the predictive value of mean platelet volume (MPV) and plasma N-terminal probrain natriuretic peptide (NT-ProBNP) combined with a simplified Geneva scale for the prognosis of acute pulmonary embolism (APE). Methods. The clinical data of 68 patients with APE admitted to our hospital from October 2017 to October 2019 were collected. According to the prognosis, the patients were divided into a good prognosis group (n = 45) and a poor prognosis group (n = 23). The clinical data, laboratory clinical indexes, and simplified Geneva scale scores were recorded for the two groups. The risk factors of poor prognosis were analyzed by binary multivariate logistic regression analysis; the predictive ability of each index on the prognosis of patients with APE was analyzed by the ROC curve. Results. The incidences of deep vein thrombosis, diabetes, and hyperlipidemia in the poor prognosis group were higher than those in the good prognosis group ( P < 0.05 ). PLT, platelet distribution width (PDW), MPV, and plasma NT-ProBNP in the poor prognosis group were higher than those in the good prognosis group ( P < 0.05 ). The simplified Geneva scale score of the poor prognosis group was higher than that of the good prognosis group ( P < 0.05 ). PDW, MPV, plasma NT-ProBNP, and simplified Geneva scale were all independent risk factors for the poor prognosis of APE patients ( P < 0.05 ). The AUC of MPV in predicting the prognosis of APE patients was 0.818 (95% CI: 0.712–0.925). When the optimal cutoff value was 0.571, the sensitivity was 77.1%, and the specificity was 80.0%. The AUC of plasma NT-ProBNP in predicting the prognosis of APE patients was 0.762 (95% CI: 0.634–0.891). When the optimal cutoff value was 0.475, the sensitivity was 71.5%, and the specificity was 76.0%. The AUC of the simplified Geneva scale in predicting the prognosis of APE patients was 0.749 (95% CI: 0.618–0.879). When the optimal cutoff value was 0.469, the sensitivity was 82.9%, and the specificity was 64.0%. The AUC of MPV and plasma NT-ProBNP combined with the simplified Geneva scale in predicting the prognosis of APE patients was 0.907 (95% CI: 0.826–0.988). When the optimal cutoff value was 0.726, the sensitivity was 88.6%, and the specificity was 84.0%. Conclusion. MPV, plasma NT-ProBNP, and simplified Geneva scale have a certain predictive value for the prognosis of APE. Compared with a single index, the combination of the three indexes has a significant improvement in predicting the prognosis of APE and has better clinical value.

scholarly journals Impact of Glycosylated Hemoglobin on the Prognosis of Patients with Acute Ischemic Stroke Treated with Arterial Thrombolysis

2020 ◽  
Vol 23 (4) ◽  
pp. E447-E451
Author(s):  
Wentong Ling ◽  
Qiong Chen ◽  
Pu Huang ◽  
Dengke Han ◽  
Wenjun Wu
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hba1c Level ◽  
Poor Prognosis ◽  
Glycosylated Hemoglobin ◽  
Complication Rates ◽  
Nihss Score ◽  
Prognosis Group ◽  
The Impact ◽  
Arterial Thrombolysis

Background: To investigate the impact of glycosylated hemoglobin (HbA1c) on the prognosis of patients with acute ischemic stroke (AIS) treated with intra-arterial thrombolysis (IAT). Methods: The clinical data of 136 patients with AIS treated with IAT at the Zhongshan City People’s Hospital were retrospectively analyzed. The patients were divided into a high HbA1c group (HHbA1c) (≥6.5%) and a normal HbA1c group (NHbA1c) (<6.5%). According to National Institutes of Health Stroke Scale (NIHSS) score after thrombolysis, patients were divided into a good prognosis group (GP) (≥4 or <4 points reduction) and a poor prognosis group (PP) (≤4 or >4 points reduction). Results: There were significant differences in the HbA1c and glucose levels, NIHSS scores at admission and at discharge, complication rates, and mortality rates between groups HHbA1c and NHbA1c (P < .05) and between groups GP and PP (P < .05). The multivariate logistic regression analysis showed that HbA1c level (odds ratio [OR] 0.717; 95% confidence interval [CI] 0.545 to 0.889) and NIHSS score at admission (OR 0.894; 95% CI 0.814 to 0.982) were risk factors for neurological improvement in IAT-treated patients with AIS. Conclusions: HbA1c level is associated with neurological function improvement in IAT-treated patients with AIS and can be used as a serological indicator of poor prognosis.

Development of a prediction model for 1-year poor prognosis in patients with acute ischemic stroke

2019 ◽  
Vol 67 (6) ◽  
pp. 957-963 ◽  
Author(s):  
Xia Ling ◽  
Bo Shen ◽  
Kangzhi Li ◽  
Lihong Si ◽  
Xu Yang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Prediction Model ◽  
Acute Ischemic Stroke ◽  
Poor Prognosis ◽  
Multivariate Logistic Regression ◽  
Lemeshow Test ◽  
Independent Risk Factors ◽  
Auc Value

The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. We identified 196 (25.4%) patients with poor prognosis at 1-year follow-up, and of these 68 (68/196, 34.7%) had died. Multivariate logistic regression and receiver operating characteristic curve analyses showed that age ≥70 years, consciousness (lethargy or coma), history of stroke or transient ischemic attack, cancer, abnormal fasting blood glucose levels ≥7.0 mmol/L, and National Institutes of Health Stroke Scale score were independent risk factors for 1-year poor prognosis in patients with AIS. Scores were assigned for each variable by rounding off β coefficient to the integer score, and a new prediction model with a maximum total score of 9 points was developed. The AUC value of the new prediction model was higher than the THRIVE score (p<0.05). The χ2 value for the Hosmer-Lemeshow test was 7.337 (p>0.05), suggesting that the prediction model had a good fit. The new prediction model can accurately predict 1-year poor prognosis in Chinese patients with AIS.

scholarly journals COMPARISON OF PATIENTS WITH ACUTE ISCHEMIC STROKE WITH AND WITHOUT COVID-19

2021 ◽  
Author(s):  
Dilek YILMAZ OKUYAN ◽  
Meltem KARACAN GÖLEN
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Poor Prognosis ◽  
Degradation Products ◽  
Intubation Rate ◽  
Reactive Protein ◽  
Fibrin Degradation Products ◽  
Laboratory Examinations ◽  
D Dimer

Objectives: Information on the incidence of acute ischemic stroke (AIS), which is an important cause of morbidity and mortality, its association with COVID-19, and its course in infected patients in this pandemic period is limited. In this study, it was aimed to compare the demographic, clinical and stroke characteristics, and the laboratory, prognosis and mortality findings of patients with AIS with and without COVID-19. Methods: This study included 43 patients with a positive nasopharyngeal PCR test who were followed up for AIS, and 70 patients without COVID-19 who were followed up for AIS during the same period. Results: Poor prognosis and mortality were found to be significantly higher in the AIS group with COVID-19 compared with the non-COVID-19 AIS group. In the AIS group with COVID-19, a higher rate of intensive care unit (ICU) need (40% vs. 5%), higher intubation rate (35% vs. 3%) and longer hospital stay (12.9 ± 10.8 vs. 6.6 ± 4.0 days) were observed. In the laboratory examinations, C-reactive protein, ferritin, D-dimer, troponin, and lactate dehydrogenase levels were found to be significantly higher in patients with AIS who were positive for COVID-19. An increase in D-dimer, ferritin and thrombocytopenia were found to be associated with mortality in the COVID-19 positive AIS group. Conclusion: Patients with AIS and COVID-19 had a higher rate of ICU need, higher intubation rate, longer hospital stay, higher mortality, and poorer prognosis than those without COVID-19. High levels of ferritin, D-dimer and fibrin degradation products were associated with a poor prognosis. Keywords: COVID-19, stroke, prognosis, mortality

scholarly journals Comparison of patients with acute ischemic stroke with and without COVID-19

2021 ◽  
Vol 26 (3) ◽  
pp. 449-458
Author(s):  
Dilek Yilmaz Okuyan ◽  
Meltem Karacan Gölen
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Poor Prognosis ◽  
Degradation Products ◽  
Intubation Rate ◽  
Reactive Protein ◽  
Fibrin Degradation Products ◽  
Laboratory Examinations ◽  
D Dimer

Objectives: Information on the incidence of acute ischemic stroke (AIS), which is an important cause of morbidity and mortality, its association with COVID-19, and its course in infected patients in this pandemic period is limited. In this study, it was aimed to compare the demographic, clinical and stroke characteristics, and the laboratory, prognosis and mortality findings of patients with AIS with and without COVID-19. Methods: This study included 43 patients with a positive nasopharyngeal PCR test who were followed up for AIS, and 70 patients without COVID-19 who were followed up for AIS during the same period from the Konya Numune State Hospital, Turkey. Results: Poor prognosis and mortality were found to be significantly higher in the AIS group with COVID-19 compared with the non-COVID-19 AIS group. In the AIS group with COVID-19, a higher rate of intensive care unit (ICU) need (40% vs. 5%), higher intubation rate (35% vs. 3%) and longer hospital stay (12.9 ± 10.8 vs. 6.6 ± 4.0 days) were observed. In the laboratory examinations, C-reactive protein, ferritin, D-dimer, troponin, and lactate dehydrogenase levels were found to be significantly higher in patients with AIS who were positive for COVID-19. An increase in D-dimer, ferritin and thrombocytopenia were found to be associated with mortality in the COVID-19 positive AIS group. Conclusion: Patients with AIS and COVID-19 had a higher rate of ICU need, higher intubation rate, longer hospital stay, higher mortality, and poorer prognosis than those without COVID-19. High levels of ferritin, D-dimer and fibrin degradation products were associated with a poor prognosis.

scholarly journals Therapeutic Effects of Microsurgical Clipping at Different Time Points on Intracranial Aneurysm and Prognostic Factors

2021 ◽  
Author(s):  
Ge Huang ◽  
Yang Sun ◽  
Jinhong Li ◽  
Zhengyuan Xie ◽  
Xiaoguang Tong
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Postoperative Complications ◽  
Poor Prognosis ◽  
Therapeutic Effects ◽  
Time Points ◽  
Microsurgical Clipping ◽  
History Of ◽  
Prognosis Group ◽  
Independent Risk Factors

Abstract Background Microsurgical clipping is effective for treating early rupture hemorrhage in intracranial aneurysm (IA) patients. We aimed to evaluate the therapeutic effects of microsurgical clipping at different time points on IA and to explore prognostic factors. Methods A total of 102 eligible patients were divided into good prognosis group (n = 87) and poor prognosis group (n = 15) according to Glasgow Outcome Scale (GOS) scores at discharge. The effects of microsurgical clipping at different time points (within 24 h, 48 h and 72 h) were compared. The incidence rates of postoperative complications in patients with different Hunt–Hess grades were compared. Prognostic factors were determined by multivariate logistic regression analysis. The nomogram prediction model was established based on independent risk factors and validated. Results The good recovery and success rates of complete aneurysm clipping were significantly higher in patients undergoing surgery within 24 h after rupture. The incidence rate of complications was significantly higher in patients with Hunt–Hess grade IV. Good and poor prognosis groups had significantly different age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and National Institute of Health Stroke Scale (NIHSS) score, as independent risk factors for prognosis. The nomogram model predicted that poor prognosis rate was 14.71%. Conclusion Timing (within 24 h after rupture) microsurgical clipping benefits the prognosis of IA patients. Age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and NIHSS score are independent risk factors for poor prognosis.

Prognosis of men with high-risk prostate cancer stratified by risk factors: A population-based retrospective cohort study

2020 ◽  
Author(s):  
Pan Song ◽  
Qiang Dong
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Poor Prognosis ◽  
Specific Antigen ◽  
Good Prognosis ◽  
High Risk Factors ◽  
Significant Difference ◽  
Prognosis Group ◽  
Good Prognosis Group

Abstract Objective: To evaluate the prognosis of men with high-risk prostate cancers (PCa) stratified by high-risk factors.Methods: Men with localized high-risk PCa were identified from 2004 to 2015. Kaplan–Meier analysis and Cox regressions were adopted to evaluate prostate cancer-specific survival (PCSS). Results: A total of 151,799 patients were included. Seven risk groups were divided including one high-risk factor of T3-4 (A1), prostate-specific antigen (PSA) >20 ng/ml (A2), and Gleason score (GS) 8-10, two high-risk factors of T3-4 PSA>20 ng/ml (B1), T3-4 GS 8-10 (B2), PSA>20 ng/ml GS 8-10 (B3), and three high-risk factors of T3-4 PSA>20 ng/ml and GS 8-10 (C). The PCSS results showed that A1 was the best among all groups. A2, A3 and B1 were similar and were all better than B2. No significant difference existed between B3 and C and these two were the worst in prognosis. The 10-year PCSS rates of A1, A2, A3, B1, B2, B3, and C group were 95.8%, 86.9%, 86.1%, 86.9%, 80.8%, 64.7% and 65.6%, respectively. Three simplified groups were divided including a good prognosis group (A1), an intermediate prognosis group (A2, A3, B1 and B2), and a poor prognosis group (B3 and C). The 10-year PCSS rate of three groups were 95.8% vs 85.1% vs 66.5%. Compared to the good prognosis group, the HR of the intermediate and poor prognosis group were 4.21(3.96~4.48) and 11.36 (10.59~12.19). A nomogram was built based on these factors. The C-index of the nomogram was 0.772, indicating a good accuracy of the model. Conclusions: We regrouped men with high-risk PCa according to their prognosis. PCa with three high-risk factors was not more aggressive than that with two of GS 8-10 and PSA >20 ng/ml.

Abstract TP170: Dihomo-Gamma-Linolenic Acid Decreases Hemorrhagic Complications in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takaya Yasuda ◽  
Munekatsu Ito ◽  
Shinya Hori ◽  
Kazuyuki Mikami ◽  
Toshiaki Bando ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Linolenic Acid ◽  
Good Prognosis ◽  
Controlled Study ◽  
Gamma Linolenic Acid ◽  
Early Improvement ◽  
Hemorrhagic Complications ◽  
Omega 6 ◽  
D Dimer

Introduction: Dihomo-gamma-linolenic acid (DHLA) is an omega-6 essential fatty acid related to thrombotic diseases. There are many reports about the ratio of eicosapentaenoic acid to arachidonic acid which associates with coronary and brain ischemia. But there is no report focusing on DHLA and acute ischemic stroke (AIS). We report a new correlation between DHLA and hemorrhagic complications (HC). Method: We conducted a retrospective single center case-controlled study in Japan. Among all cases of AIS from January 2015 to May 2019, we selected those who had intravenous infusion of tissue plasminogen activator (tpa) with or without endovascular treatment (EVT). Tpa was administered at 0.6mg / kg according to guidelines in Japan. Intracranial hemorrhage confirmed by imaging within 24 hours after tpa was defined as HC. We considered the patient background including lipids and outcomes: mRS0-2 after 90 days, recurrence within 30 days, any complications. We also divided all cases into two groups; the presence (A) or absence (B) of HC, and examined factors that contribute to HC. Lipid fractions (DHLA, AA, EPA, docosahexaenoic acid) were measured before tpa. Result: In the eligible 111 patients, 59 were male, and the median age was 77.4±11.5 years old. There were 30 cases of HC (A); HC within infarction (14), beyond or other than infarction (7), SAH associated with EVT (9), traumatic (0). There were significant differences between two groups: age(median, A:85.0, B:75.0[p<0.001]), Alb(median, A:3.70, B:3.95mg/dL[p=0.0172]), D dimer (median, A:1.95, B:1.10μg/mL[p=0.0254]), DHLA (A:32.0, B:43.5μg/mL[p=0.0295]), eGFR (median A:54.9, B:64.0 [p=0.0129]), and NIHSS (median A:17.5, B:9.0 [p<0.001]). The mRS0-2 after 90 days was 7/30 (23.3%) in A, and 51/81(62.9%) in B [p<0.001].There were no significant differences in clinical type of AIS, lipids other than DHLA, and recurrence of stroke within 30 days. Conclusion: DHLA, age, D dimer, and renal function were significantly associated with HC in resuscitation therapy for AIS. The prognosis was poor in cases of HC. We emphasize DHLA as a new finding. DHLA may be related to vascular vulnerability. There is a possibility that early improvement of DHLA can reduce HC, lead to good prognosis, and decrease the cost.

scholarly journals Serum ICAM-1 as a Predictor of Prognosis in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Lei Wang ◽  
Yan Chen ◽  
Depeng Feng ◽  
Xiaoling Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Poor Prognosis ◽  
Demographic Data ◽  
Characteristic Curve ◽  
Good Prognosis ◽  
The Body ◽  
Intercellular Adhesion Molecule ◽  
Enzyme Linked Immunosorbent Assay ◽  
Intercellular Adhesion Molecule 1

Objective. Inflammation is one of the key mechanisms involved in functional impairment after stroke. Intercellular adhesion molecule-1 (ICAM-1) is an important inflammatory molecule in the body. The purpose of our study was to determine the correlation between ICAM-1 and the prognosis of acute ischemic stroke (AIS). Methods. 286 AIS patients treated at Beijing Tiantan Hospital were continuously included in the study. The demographic data of the patients were collected, and the fasting blood within 24 hours of admission was collected to detect the clinical indicators. The functional prognosis was measured using the modified Rankin Scale (mRS) 3 months after stroke. The poor prognosis is defined as mRS ≥ 3 . The enzyme-linked immunosorbent assay (ELISA) was used to determine the serum ICAM-1 levels. Results. The serum ICAM-1 levels of patients with poor prognosis were significantly higher than that of patients with good prognosis ( 144.2 ± 14.8 vs 117.5 ± 12.1  pg/ml). Receiver operating characteristic curve (ROC) analysis showed that the sensitivity and specificity of serum ICAM-1 for predicting the prognosis of AIS were 74% and 76%, respectively. In logistic regression analysis, the serum ICAM-1 level is still an independent predictor of poor prognosis (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.318-0.839). Conclusions. Higher serum ICAM-1 levels on admission in AIS patients might increase the risk of poor prognosis.

scholarly journals In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Yu ◽  
Xiaolu Liu ◽  
Qiong Yang ◽  
Yu Fu ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Recurrent Events ◽  
Early Stage ◽  
High Rate ◽  
Large Artery ◽  
Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

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