scholarly journals Predictive Relevance of Baseline Lactate and Glucose Levels in Patients with Spontaneous Deep-Seated Intracerebral Hemorrhage

2021 ◽  
Vol 11 (5) ◽  
pp. 633
Author(s):  
Felix Lehmann ◽  
Lorena M. Schenk ◽  
Matthias Schneider ◽  
Joshua D. Bernstock ◽  
Christian Bode ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Outcome Prediction ◽  
Multivariate Logistic Regression Analysis ◽  
Serum Levels ◽  
Prognostic Models ◽  
Multivariate Logistic Regression ◽  
Glucose Levels ◽  
Ich Score ◽  
Time Of Admission ◽  
Elevated Lactate

(1) Background: As elements of the standard admission blood panel, lactate and glucose represent potential biomarkers for outcome prediction. In patients with intracranial hemorrhage (ICH), data on the predictive value of these blood values is exceedingly sparse. (2) Methods: Between 2014 and August 2020, all patients with deep-seated ICH referred to the neurovascular center at the authors’ institution were included in the subsequent study. Serum levels of lactate and glucose at the time of admission were compared with mortality at 90 days. In addition, a multivariate analysis was performed in order to identify independent admission predictors for 90-day mortality. (3) Results: Among the 102 patients with deep-seated ICH, elevated lactate and glucose levels on admission were significantly associated with increased mortality at 90 days. Multivariate logistic regression analysis identified “ICH score ≥ 3” (p = 0.004) along with “admission hyperlactatemia” (p = 0.025) and “admission hyperglycemia” (p = 0.029) as independent and significant predictors of 90-day mortality in patients with deep-seated ICH. (4) Conclusions: Initially elevated lactate and glucose levels after spontaneous intracerebral hemorrhage are associated with poor outcome, suggesting a potential application for future prognostic models when considered in conjunction with other parameters.

scholarly journals Increased Serum Levels of Asymmetric Dimethylarginine and Symmetric Dimethylarginine and Decreased Levels of Arginine in Sudanese Patients with Essential Hypertension

2020 ◽  
Vol 45 (5) ◽  
pp. 727-736
Author(s):  
Sahar Gamil ◽  
Jeanette Erdmann ◽  
Edzard Schwedhelm ◽  
Khalid Hussein Bakheit ◽  
Ihab B.B. Abdalrahman ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Essential Hypertension ◽  
Amino Acid ◽  
Asymmetric Dimethylarginine ◽  
Multivariate Logistic Regression Analysis ◽  
Serum Levels ◽  
Control Group ◽  
Multivariate Logistic Regression ◽  
Symmetric Dimethylarginine

Introduction: Essential hypertension (EH) is a disease caused by various environmental and genetic factors. Nitric oxide (NO) is important for the functional integrity of the endothelium. It is produced in endothelial cells by endothelial NO synthase (eNOS) that mediates the conversion of the amino acid arginine into NO and citrulline. Asymmetric dimethylarginine (ADMA) acts as an inhibitor of eNOS. In contrast, symmetric dimethylarginine (SDMA) has no direct effect on eNOS but plays an important role competing with arginine for transport across the amino acid transporter. ADMA and SDMA have been found to play a central role in the development of cardiovascular diseases. Serum ADMA levels may serve as a future diagnostic marker and a target of therapy in hypertensive patients in the Sudanese population. This study aimed to investigate the relation between serum arginine, ADMA, and SDMA levels with EH in the Sudanese population. Methods: Patients (n = 260) with established hypertension and controls (n = 144) with normal blood pressure were included in this case-control study. Serum blood samples were analyzed for arginine, ADMA, and SDMA, using high-performance liquid chromatography-tandem mass spectrometry. Other laboratory data were measured using routine methods. Mann-Whitney’s U test and χ2 tests were used for continuous and categorical data, respectively. A multivariate logistic regression analysis was conducted to investigate the independent effect of multiple variables on the development of hypertension. Results: Serum arginine levels were significantly lower in the patient group than in the control group (p < 0.001). ADMA and SDMA levels were significantly higher in the patient group than the control group (p < 0.001, p = 0.001, respectively). Multivariate logistic regression analysis showed that only older age, being a male, and arginine levels are independent factors controlling the development of hypertension (p < 0.001, p < 0.001, and p = 0.046, respectively). ADMA and SDMA levels were not independent factors for the development of hypertension. Conclusions: This study demonstrated increased serum levels of ADMA and SDMA and decreased arginine levels in Sudanese patients with EH. Lowering serum ADMA levels or increasing the arginine levels might be a novel therapeutic target in these individuals.

scholarly journals Prognostic value of early glycosylated hemoglobin and blood glucose levels in patients with basal ganglia cerebral hemorrhage

2019 ◽  
pp. 030006051987203
Author(s):  
Wentao Sun ◽  
Qunliang Hu ◽  
Juan Wang ◽  
Ning Zheng ◽  
Kai Chen ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Basal Ganglia ◽  
Cerebral Hemorrhage ◽  
Glycosylated Hemoglobin ◽  
Multivariate Logistic Regression Analysis ◽  
Neurological Impairment ◽  
Glucose Levels ◽  
Bleeding Volume ◽  
Consciousness Disorder ◽  
Ich Score

Objective This study was performed to analyze the relationships of the early glycosylated hemoglobin (GHb) level and blood glucose level (BGL) with prognosis in patients with basal ganglia cerebral hemorrhage (BGCH). Methods In total, 186 patients with BGCH were included in this prospective study. The GHb level, fasting BGL, bleeding volume, degree of consciousness disorder, intracerebral hemorrhage (ICH) score, functional outcome in patients with primary ICH (FUNC) score, ICH grading scale (ICH-GS) score, and neurological impairment were recorded during a 30-day observation period. Results The mean BGCH volume was 58.42 mL. The 30-day mortality rate was 22.32%. The ICH-GS score [odds ratio (OR) = 0.815, 95% confidence interval (95% CI) = 0.504–0.688, R = 0.624] and bleeding volume (OR = 0.882, 95% CI = 0.785–0.918, R = 0.784) were significant predictors of 30-day mortality. The GHb level (OR = 6.138, R = 0.705) and BGL (OR = 1.055, R = 0.418) were independent predictors of 30-day mortality according to the multivariate logistic regression analysis. Conclusion The GHb level and BGL are strong predictors of 30-day mortality in patients with BGCH and accurately predict the prognosis in these patients.

scholarly journals Usefulness of Anticoagulant Therapy in the Prevention of Embolic Complications in Patients with Acute Infective Endocarditis

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Seung-Jae Lee ◽  
Sam-Sae Oh ◽  
Dal-Soo Lim ◽  
Suk-Keun Hong ◽  
Rak-Kyeong Choi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Anticoagulant Therapy ◽  
Multivariate Logistic Regression Analysis ◽  
Hospital Death ◽  
Multivariate Logistic Regression ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Time Of Admission ◽  
The Impact

Background. The use of anticoagulant therapy (ACT) in patients with acute infective endocarditis (IE) remains a controversial issue. Our study attempts to estimate the impact of ACT on the occurrence of embolic complications and the usefulness of ACT in the prevention of embolism in IE patients.Methods. The present authors analyzed 150 patients with left-sided IE. Embolisms including cerebrovascular events (CVE) and the use of ACT were checked at the time of admission and during hospitalization.Results. 57 patients (38.0%) experienced an embolic event. There was no significant difference in the incidence of CVE and in-hospital mortality between patients with and without warfarin use at admission, although warfarin-naïve patients were significantly more likely to have large (>1 cm) and mobile vegetation. In addition, there was no significant difference in the incidence of postadmission embolism and in-hospital death between patients with and without in-hospital ACT. On multivariate logistic regression analysis, ACT at admission was not significantly associated with a lower risk of embolism in patients with IE.Conclusions. The role of ACT in the prevention of embolism was limited in IE patients undergoing antibiotic therapy, although it seems to reduce the embolic potential of septic vegetation before treatment.

Incidence of Steroid-induced Diabetes in COVID-19 patients

2021 ◽  
Vol 15 (10) ◽  
pp. 2595-2596
Author(s):  
M. Asim Rana ◽  
Mujtaba H. Siddiqui ◽  
Sitara Raza ◽  
Kinza Tehreem ◽  
M. F.Ullah Mahmood ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glucose Level ◽  
Fasting Blood Glucose ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Keywords Hyperglycaemia ◽  
Associated Risk Factors

Background: Since the COVID-19 pandemic has started, glucocorticoids have been proved to be one of the most effective lifesaving treatments for respiratory complications associated with SARS CoV-2. Aim: To review the incidence of steroid induced diabetes and the associated risk factors in COVID-19 patients. Study Design: Retrospective cohort study Place and duration of the study: Bahria International Hospital Lahore from 15th April 2020 to 31st December 2020 Methodology: Two hundred and thirty patients of COVID-19 cases treated with glucocorticoids (Dexamethasone 4mg BID) were enrolled. All known cases of pre-existing diabetes mellitus and with initial (admission) random blood glucose levels of more than 200 mg/dl were excluded. Patients labelled as glucocorticoid induced diabetes mellitus (GI-DM)met the following criteria, fasting blood glucose level of more than 126 mg/dl or a random glucose level of more than200 mg/dlon two occasions after starting these patients on steroids. Results: The glucocorticoid induced diabetes mellitus was 36 (15.65%). Multivariate logistic regression analysis revealed that older age (odds ratio 1.19, 95% confidence interval (1.02-1.36) was found to be the most profound risk factor for GI-DM. Conclusion: Glucocorticoid induced diabetes mellitus found to be associated with glucocorticoid used among COVID-19 patients especially in older ages. So, it is recommended that the treating physicians should consider this side effect of steroids especially when dealing with geriatric cases. Keywords: Hyperglycaemia, COVID-19, Steroids, SARS-CoV-2, Diabetes mellitus, Steroids induced diabetes, Glucocorticoids

scholarly journals Prognostication after intracerebral hemorrhage: a review

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Jens Witsch ◽  
Bob Siegerink ◽  
Christian H. Nolte ◽  
Maximilian Sprügel ◽  
Thorsten Steiner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Intracerebral Hemorrhage ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Prognostic Scores ◽  
Predictor Variables ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Net Benefit ◽  
Patient Reported ◽  
Ich Score

Abstract Background Approximately half of patients with spontaneous intracerebral hemorrhage (ICH) die within 1 year. Prognostication in this context is of great importance, to guide goals of care discussions, clinical decision-making, and risk stratification. However, available prognostic scores are hardly used in clinical practice. The purpose of this review article is to identify existing outcome prediction scores for spontaneous intracerebral hemorrhage (ICH) discuss their shortcomings, and to suggest how to create and validate more useful scores. Main text Through a literature review this article identifies existing ICH outcome prediction models. Using the Essen-ICH-score as an example, we demonstrate a complete score validation including discrimination, calibration and net benefit calculations. Score performance is illustrated in the Erlangen UKER-ICH-cohort (NCT03183167). We identified 19 prediction scores, half of which used mortality as endpoint, the remainder used disability, typically the dichotomized modified Rankin score assessed at variable time points after the index ICH. Complete score validation by our criteria was only available for the max-ICH score. Our validation of the Essen-ICH-score regarding prediction of unfavorable outcome showed good discrimination (area under the curve 0.87), fair calibration (calibration intercept 1.0, slope 0.84), and an overall net benefit of using the score as a decision tool. We discuss methodological pitfalls of prediction scores, e.g. the withdrawal of care (WOC) bias, physiological predictor variables that are often neglected by authors of clinical scores, and incomplete score validation. Future scores need to integrate new predictor variables, patient-reported outcome measures, and reduce the WOC bias. Validation needs to be standardized and thorough. Lastly, we discuss the integration of current ICH scoring systems in clinical practice with the awareness of their shortcomings. Conclusion Presently available prognostic scores for ICH do not fulfill essential quality standards. Novel prognostic scores need to be developed to inform the design of research studies and improve clinical care in patients with ICH.

scholarly journals Can brain natriuretic peptide, S100b, and interleukin-6 prognosticate the neurological consequences in Egyptian patients presented with supratentorial intracerebral hemorrhage?

2020 ◽  
Vol 11 ◽  
pp. 460
Author(s):  
Hany A. Fikry Eldawoody ◽  
Mohammed Abdel Bari Mattar ◽  
Abeer Mesbah ◽  
Ashraf Zaher ◽  
Mohammed Elsherif
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Interleukin 6 ◽  
Calcium Binding ◽  
Length Of Hospital Stay ◽  
Serum Levels ◽  
Severity Scores ◽  
Egyptian Patients ◽  
Ich Score

Background: Biomarkers in supratentorial intracerebral hemorrhage (SICH) enhance the prognosis of the disease. This study aimed to assess the prognosticative grade of S100 calcium-binding protein B (S100B), interleukin-6 (IL-6), and the pro-brain natriuretic peptide (pro-BNP) in SICH outcome prediction. Methods: Blood samples of 50 SICH patients were analyzed for the biomarkers. The patients were classified into two groups with and without intraventricular hemorrhage (IVH). The following scales including Glasgow Coma Score (GCS), the Barthel index (BI), intracerebral hemorrhage (ICH) score, ICH volume, National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Score (mRS), and length of stay were used to evaluate the severity. Results: The severity scores (NIHSS, GCS, BI, mRI) were significantly higher in SICH patients with IVH versus SICH patients without IVH (P = 0.002, 0.008, 0.001, and 0.03, respectively). Serum levels for a pro-BNP and S100b are significantly higher in SICH patients with IVH versus SICH patients without IVH (P = 0.02 and 0.027, respectively). Multivariate correlations between demographic (age), biomarkers panel (IL-6, S100b, and proBNP), and clinical and severity scores (ICH score, ICH volume, length of hospital stay [LOS], BI, mRS, GCS, and NIHSSS) in all studied patients showed a highly significant correlation between ICH score and pro-BNP (P = 0.04). There was a highly significant correlation between LOS and IL-6 (P = 0.003). Conclusion: Pro-BNP, IL-6, and S100b are greatly associated with the presence of IVH that, in turn, correlated well with poor clinical outcome measures.

scholarly journals 30-days’ outcome of haemorrhagic stroke: correlation between intracerebral hemorrhage score and modified Rankin score

Mediscope ◽  
2018 ◽  
Vol 5 (1) ◽  
pp. 10-14
Author(s):  
AH Sarder ◽  
BK Das ◽  
KJ Mondal ◽  
MA Kabir ◽  
B Basu ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Haemorrhagic Stroke ◽  
Tertiary Hospital ◽  
Modified Rankin Scale ◽  
Grading Scale ◽  
Ich Score ◽  
Clinical Grading

Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes. Within 30 days reported mortality is 35-52% and only 20% is functionally independent in 6 months. Despite several existing outcome prediction models for ICH, modified Rankin scale is found to be best predictor of outcome in early and long term period. To find out 30-day mortality in ICH and predict outcome based on modified Rankin score. In this study, 48 patients presenting with acute ICH presenting to a tertiary hospital in Khulna were enrolled. The 30-day mortality and disability were recorded, and ICH score along with modified Rankin score at presentation were calculated. In this study, the 30-day mortality rate was 27.1%; regression analysis showed the correlation between the scores (as measured by modified Rankin scale) for patient disability, intraventricular hemorrhage, the Glasgow Coma score, and volume of hematoma (>30 ml vs <30 ml) were significantly correlated with corresponding ICH scores. The ICH scale is a simple clinical grading scale which can predict mortality as well as disability in haemorrhagic stroke within 30 days that can be helpful to physicians in prioritization of their patient management and forecasting about prognosis.Mediscope Vol. 5, No. 1: Jan 2018, Page 10-14

scholarly journals The Diagnostic Value of β-Human Chorionic Gonadotropin, Progesterone, and Ischemia-Modified Albumin and Their Combined Use in the Prediction of First Trimester Abortions

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Mehmet A. Osmanağaoğlu ◽  
S. Caner Karahan ◽  
Turhan Aran ◽  
Süleyman Güven ◽  
Elif Turgut ◽  
...  
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Serum Levels ◽  
First Trimester ◽  
Diagnostic Value ◽  
Multivariate Logistic Regression ◽  
Missed Abortion ◽  
Ischemia Modified Albumin ◽  
Group I ◽  
Combined Use ◽  
Group Ii

Objective. To investigate serum levels of free β-HCG, progesterone, and ischemia-modified albumin (IMA) and their combined use in the prediction of first trimester abortions. Methods. A total of 156 pregnant women between 5 and 13 weeks of gestational age were included in this study. At admission, serum levels of free β-HCG, progesterone, and IMA were noted and all cases were divided into two groups; Group I (n=77) resulted in abortion including missed abortion, incomplete/complete abortion, and inevitable abortion whereas Group II (n=79) included normal pregnancies. Results. Compared to Group II, the significantly decreased value of free β-HCG progesterone and significantly increased value of IMA were found in Group I (P<0.01, P<0.01, P<0.01, resp.). When combining all three parameters, sensitivity 75%, specificity 99%, PPV 98%, and NPV 76% were obtained. The multivariate logistic regression analysis revealed the free β-HCG, progesterone, and IMA independent factors in the prediction of abortions. Conclusions. The combined use of free β-HCG, progesterone, and IMA levels can be useful in the prediction of first trimester spontaneous abortions.

Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage

2017 ◽  
Vol 44 (3-4) ◽  
pp. 105-112 ◽  
Author(s):  
Yoshiteru Shimoda ◽  
Satoru Ohtomo ◽  
Hiroaki Arai ◽  
Ken Okada ◽  
Teiji Tominaga
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Multivariate Logistic Regression Analysis ◽  
High Density ◽  
Multivariate Logistic Regression ◽  
Poor Functional Outcome ◽  
Poor Outcome ◽  
Intraventricular Bleeding

Background: The presence of high-density starry dots around the intracerebral hemorrhage (ICH), which we termed as a satellite sign, is occasionally observed in CT. The relationship between ICH with a satellite sign and its functional outcome has not been identified. This study aimed to determine whether the presence of a satellite sign could be an independent prognostic factor for patients with ICH. Methods: Patients with acute spontaneous ICH were retrospectively identified and their initial CT scans were reviewed. A satellite sign was defined as scattered high-density lesions completely separate from the main hemorrhage in at least the single axial slice. Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Poor functional outcome was defined as mRS scores of 3-6. Univariate and multivariate logistic regression analyses were applied to assess the presence of a satellite sign and its association with poor functional outcome. Results: A total of 241 patients with ICH were enrolled in the study. Of these, 98 (40.7%) had a satellite sign. Patients with a satellite sign had a significantly higher rate of poor functional outcome (95.9%) than those without a satellite sign (55.9%, p < 0.0001). Multivariate logistic regression analysis revealed that higher age (OR 1.06; 95% CI 1.03-1.10; p = 0.00016), large hemorrhage size (OR 1.06; 95% CI 1.03-1.11; p = 0.00015), and ICH with a satellite sign (OR 13.5; 95% CI 4.42-53.4; p < 0.0001) were significantly related to poor outcome. A satellite sign was significantly related with higher systolic blood pressure (p = 0.0014), higher diastolic blood pressure (p = 0.0117), shorter activated partial thromboplastin time (p = 0.0427), higher rate of intraventricular bleeding (p < 0.0001), and larger main hemorrhage (p < 0.0001). Conclusions: The presence of a satellite sign in the initial CT scan is associated with a significantly worse functional outcome in ICH patients.

scholarly journals Serum Biomarkers of Inflammation and Turnover of Joint Cartilage Can Help Differentiate Psoriatic Arthritis (PsA) Patients from Osteoarthritis (OA) Patients

Diagnostics ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 52
Author(s):  
Michał Waszczykowski ◽  
Anna Fabiś-Strobin ◽  
Igor Bednarski ◽  
Aleksandra Lesiak ◽  
Joanna Narbutt ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Odds Ratio ◽  
Multivariate Logistic Regression Analysis ◽  
Serum Levels ◽  
Serum Biomarkers ◽  
Control Group ◽  
Healthy Individuals ◽  
Joint Cartilage ◽  
Multivariate Logistic Regression ◽  
Knee Oa

The aim of this study was to find characteristic biomarkers in the serum of patients with osteoarthritis (OA) and psoriatic arthritis (PsA) responsible for inflammation and destruction of joint cartilage, which could differentiate these two diseases. The study included 67 people: 22 patients with knee OA, 22 patients with PsA, and 23 individuals who were the control group of healthy individuals (HC). The concentration of IL-18, IL-20, IL-6, MMP-1, MMP-3, COMP, PG-AG, and YKL-40 in serum were determined. Among the OA and PsA patients group, the radiological assessment and clinical assessment were also performed. The concentration of 7 out of 8 of examined biomarkers (except MMP-1) was statistically significantly higher in the serum of patients with OA and PsA than in the control group. Compering OA and PsA groups only, the serum PG-AG level in OA patients was statistically significantly higher than in PsA patients (p < 0.001). The results of univariate and multivariate logistic regression analysis comparing OA and PsA biomarker serum levels identified PG-AG and COMP as markers that are significantly different between patients with OA and PsA (odds ratio 0.995 and 1.003, respectively). The ROC curve constructed using the model with age showed PG-AG and COMP had an AUC of 0.907. The results of this study show that COMP and PG-AG may be sensitive markers differentiating patients with osteoarthiritis from psoriatic arthritis.

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