Timing of Transfusion, not Hemoglobin Variability, Is Associated with 3-Month Outcomes in Acute Ischemic Stroke

Objectives: This study aimed to investigate whether transfusions and hemoglobin variability affects the outcome of stroke after an acute ischemic stroke (AIS). Methods: We studied consecutive patients with AIS admitted in three tertiary hospitals who received red blood cell (RBC) transfusion (RBCT) during admission. Hemoglobin variability was assessed by minimum, maximum, range, median absolute deviation, and mean absolute change in hemoglobin level. Timing of RBCT was grouped into two categories: admission to 48 h (early) or more than 48 h (late) after hospitalization. Late RBCT was entered into multivariable logistic regression model. Poor outcome at three months was defined as a modified Rankin Scale score ≥3. Results: Of 2698 patients, 132 patients (4.9%) received a median of 400 mL (interquartile range: 400–840 mL) of packed RBCs. One-hundred-and-two patients (77.3%) had poor outcomes. The most common cause of RBCT was gastrointestinal bleeding (27.3%). The type of anemia was not associated with the timing of RBCT. Late RBCT was associated with poor outcome (odd ratio (OR), 3.55; 95% confidence interval (CI), 1.43–8.79; p-value = 0.006) in the univariable model. After adjusting for age, sex, Charlson comorbidity index, and stroke severity, late RBCT was a significant predictor (OR, 3.37; 95% CI, 1.14–9.99; p-value = 0.028) of poor outcome at three months. In the area under the receiver operating characteristics curve comparison, addition of hemoglobin variability indices did not improve the performance of the multivariable logistic model. Conclusion: Late RBCT, rather than hemoglobin variability indices, is a predictor for poor outcome in patients with AIS.

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Elevation of troponin I in acute ischemic stroke

PeerJ ◽

10.7717/peerj.1866 ◽

2016 ◽

Vol 4 ◽

pp. e1866 ◽

Cited By ~ 9

Author(s):

Yu-Chin Su ◽

Kuo-Feng Huang ◽

Fu-Yi Yang ◽

Shinn-Kuang Lin

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Barthel Index ◽

Troponin I ◽

Clinical Deterioration ◽

Stroke Severity ◽

Nihss Score ◽

Poor Outcome

Background. Cardiac morbidities account for 20% of deaths after ischemic stroke and is the second commonest cause of death in acute stroke population. Elevation of cardiac troponin has been regarded as a prognostic biomarker of poor outcome in patients with acute stroke.Methods. This retrospective study enrolled 871 patients with acute ischemic stroke from August 2010 to March 2015. Data included vital signs, laboratory parameters collected in the emergency department, and clinical features during hospitalization. National Institutes of Health Stroke Scale (NIHSS), Barthel index, and modified Rankin Scale (mRS) were used to assess stroke severity and outcome.Results.Elevated troponin I (TnI) > 0.01 µg/L was observed in 146 (16.8%) patients. Comparing to patients with normal TnI, patients with elevated TnI were older (median age 77.6 years vs. 73.8 years), had higher median heart rates (80 bpm vs. 78 bpm), higher median white blood cells (8.40 vs. 7.50 1,000/m3) and creatinine levels (1.40 mg/dL vs. 1.10 mg/dL), lower median hemoglobin (13.0 g/dL vs. 13.7 g/dL) and hematocrit (39% vs. 40%) levels, higher median NIHSS scores on admission (11 vs. 4) and at discharge (8 vs. 3), higher median mRS scores (4 vs3) but lower Barthel index scores (20 vs. 75) at discharge (p< 0.001). Multivariate analysis revealed that age ≥ 76 years (OR 2.25, CI [1.59–3.18]), heart rate ≥ 82 bpm (OR 1.47, CI [1.05–2.05]), evidence of clinical deterioration (OR 9.45, CI [4.27–20.94]), NIHSS score ≥ 12 on admission (OR 19.52, CI [9.59–39.73]), and abnormal TnI (OR 1.98, CI [1.18–3.33]) were associated with poor outcome. Significant factors for in-hospital mortality included male gender (OR 3.69, CI [1.45–9.44]), evidence of clinical deterioration (OR 10.78, CI [4.59–25.33]), NIHSS score ≥ 12 on admission (OR 8.08, CI [3.04–21.48]), and elevated TnI level (OR 5.59, CI [2.36–13.27]).C-statistics revealed that abnormal TnI improved the predictive power of both poor outcome and in-hospital mortality. Addition of TnI > 0.01 ug/L or TnI > 0.1 ug/L to the model-fitting significantly improvedc-statistics for in-hospital mortality from 0.887 to 0.926 (p= 0.019) and 0.927 (p= 0.028), respectively.Discussion.Elevation of TnI during acute stroke is a strong independent predictor for both poor outcome and in-hospital mortality. Careful investigation of possible concomitant cardiac disorders is warranted for patients with abnormal troponin levels.

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Abstract T P307: Similar Rates of Early Cognitive Dysfunction after Intracerebral Hemorrhage and Acute Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.tp307 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

M. Carter Denny ◽

Suhas S Bajgur ◽

Kim Y Vu ◽

Rahul R Karamchandani ◽

Amrou Sarraj ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Ischemic Stroke ◽

Cognitive Dysfunction ◽

Hospital Setting ◽

Stroke Severity ◽

Regression Analyses ◽

Post Stroke ◽

Poor Outcome

Introduction: Post-stroke cognitive dysfunction (CD) affects at least 1/3 of acute ischemic stroke (AIS) patients when assessed at 3 months. Limited data exists on CD in intracerebral hemorrhage (ICH). The role of early, in-hospital cognitive screening using the brief Montreal Cognitive Assessment (mini MoCA) is being investigated at our center. Hypothesis: We assessed the rates of early CD in ICH and AIS and hypothesized that even minor deficits from these disorders causes significant CD. Methods: 1218 consecutive stroke patients admitted from 2/13 to 12/13 were reviewed; 610, 442 with AIS and 168 with ICH, with admission NIHSS and mini MoCAs were included in the final analyses. CD was defined as mini MoCA <9 (max 12). Poor outcome was defined as discharge mRS 4-6. Stroke severity was stratified by NIHSS score of 0-5, 6-10, 11-15, 16-20, 21-42 as in ECASS-I . Chi-squared tests and univariate logistic regression analyses were performed. Results: Baseline characteristics are shown in table 1. AIS and ICH groups were similar with regard to race, gender and stroke severity. ICH patients were younger, had longer stroke service lengths of stay and poorer outcomes than AIS patients (p=0.03, p<0.001, p<0.001). No difference was seen in rates of CD between AIS and ICH patients (60% vs. 57%, p=0.36, OR 1.2 (CI 0.8-1.7)). CD rates ranged from 36% for NIHSS 0-5 to 96% for 21-42 (figure 1). Older patients were twice as likely to have CD (p<0.001, OR 2.2 (CI 1.6 - 3.0)). Patients with CD had five times the odds of having a poor outcome compared to the cognitively intact (p<0.001, OR 5.2 (CI 3.4-7.7)). In univariate logistic regression analyses, age was a significant predictor of CD in AIS, but not in ICH (p= <0.001, p=0.06). Conclusion: Post-stroke CD is common across all severities and occurs at similar rates in AIS and ICH. More than 1/3 of patients with minor deficits (NIHSS 0-5) had CD in the acute hospital setting. Whether early CD is predictive of long term cognitive outcomes deserves further study.

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Association of Iron Deficiency Anemia with Stroke Severity in patients with Acute Ischemic Stroke

10.53350/pjmhs2115113004 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3004-3006

Author(s):

Rabia Rathore ◽

Nasir Farooq Butt ◽

Adil Iqbal ◽

Hina Latif ◽

Mariam Azeem ◽

...

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Descriptive Study ◽

World Health ◽

Deficiency Anemia ◽

P Value ◽

Stroke Severity ◽

Cross Sectional

Aim: To study the relationship of Iron Deficiency anemia (IDA) with severity of acute ischemic stroke. Study Design: A cross-sectional descriptive study. Place & Duration of Study: Department of Medicine, Mayo Hospital, Lahore from March 2020 to February 2021 Methods: A descriptive study of cross-sectional type was done on 200 individuals who had acute ischemic stroke (AIS) and were hospitalized at Mayo Hospital Lahore. Consecutive non-probability convenience sampling method was used to gather the data. Severity of stroke was assessed at the time of admission using the National Institute of Health Stroke Scale, (NIHSS) at the same time blood complete examination along with peripheral blood film was done to diagnose anemia in these patients. Iron studies were done to diagnose iron deficiency anemia (IDA). P-value less than 0.05 was taken as significant. Results: About 200individuals presenting with AIS were enrolled in the research work. Anemia according to World Health Organization was seen in 80(40%) and was not present in 120(60%) patients. Among the subjects who had anemia, 16(20%) had a minor AIS, 23(28.75%) had a moderately severe AIS, and 41(51.25%) reported with a severe AIS, according to NIHSS criteria. A notable relationship was found to exist between anemia and stroke severity, (P-value 0.000). Conclusion: Anemia was a commonly found in individuals with acute stroke due to ischemia and had direct relation with severity of stroke. Keywords: Iron deficiency Anemia, severity, ischemic stroke.

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The distribution indices of erythrocytes: which one for acute ischemic stroke?

Turkish Journal of Biochemistry ◽

10.1515/tjb-2019-0103 ◽

2019 ◽

Vol 45 (1) ◽

pp. 65-75

Author(s):

Nahide Ekici Günay ◽

Nurullah Günay

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Linear Relationship ◽

Survival Rates ◽

Prognostic Significance ◽

Fold Increase ◽

Reference Intervals ◽

Stroke Severity ◽

Severity Scores ◽

Poor Outcomes

Abstract Background The erythrocytes distribution indices are reported from same histogram but they have different reference intervals and calculated by distinct measurements. Objectives To explore whether the RDW-CV and RDW-SD values may predictive and prognostic significance in ischemic stroke patients and to clarify the relation each of these indices with stroke severity and 3-months survival. Materials and methods Cumulative survival rates were calculated with the Kaplan-Meier method, and life curves were compared to RDW-CV, RDW-SD quartiles. The risk factors were described with a multivariable cox proportional hazard model. Results In acute ischemic stroke, RDW-CV was more specific and RDW-SD was more sensitive (92% vs. 80%) (52% vs. 48%). RDW-CV values higher than 14.7% are associated with 11-fold increase in the risk of stroke; and the level of RDW-CV does show a linear relationship with the severity of stroke. However, when we evaluated RDW-SD, higher 43.55 fL RDW-SD values was have 16-fold increase in severity of stroke and have a relatively high linear relationship with stroke severity scores to RDW-CV. Conclusions RDW-CV and RDW-SD levels have different prognostic poor outcomes for interpreting in ischemic stroke events approach and these should be used alone and comparatively with the AIS predictive and prognostic approach.

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Elevated plasma D-dimer level is associated with short-term poor outcome in patients with acute ischemic stroke: a prospective, observational study

10.21203/rs.2.9184/v1 ◽

2019 ◽

Author(s):

Tao Yao ◽

Bo-Lin Tian ◽

Gang Li ◽

QIN CUI ◽

Cui-fang Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Clinical Laboratory ◽

Predictive Marker ◽

Stroke Severity ◽

Elevated Plasma ◽

Short Term ◽

Poor Outcome ◽

D Dimer

Abstract Background Elevated level of D-dimer increases the risk of ischemic stroke, stroke severity and progression of stroke status, but the association between D-dimer and functional outcome is unclear. The aim of this study is to investigate whether Plasma D-dimer level is a determinant of short-term poor functional outcomes in patients with acute ischemic stroke (AIS). Methods This prospective study included 877 patients with AIS provided plasma D-dimer level after stroke onset. Patients were categorized per D-dimer level: Quartile 1(≤0.24 mg /L), Quartile 2 (0.25–0.56 mg /L), Quartile 3 (0.57–1.78 mg /L), and Quartile 4 (>1.78mg /L). Each patient’s medical record was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted. Functional outcome at 90 days was assessed with the modified Rankin Scale (mRS). Results Of 877 patients were included (mean age, 64 years; male, 68.5%), poor outcome was present in 302 (34.4%) patients. After adjustment for potential confounding variables, higher D-dimer level on admission was associated with poor outcome (adjusted odds ratio [aOR] 2.257, 95% CI1.349-3.777 for Q4:Q1; P trend = 0.004). According to receiver operating characteristic (ROC) analysis, the best discriminating factor was a D-dimer level ≥0.315 mg/L for pour outcome [area under the ROC curve (AUC) 0.657; sensitivity 83.8%; specificity 41.4%]. Conclusion Elevated plasma D-dimer level on admission was significantly associated with increased poor outcome after admission for AIS, suggesting the potential role of D-dimer as a predictive marker for short-term poor outcomes in patients with AIS.

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Abstract 3436: Specific NIH Stroke Scale Items Strongly Predict Hospital Arrival Mode, Thrombolysis Administration, and Clinical Outcomes in Acute Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3436 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Bruce Ovbiagele ◽

Rema Raman ◽

Thomas M Hemmen ◽

Brett C Meyer ◽

Dawn M Meyer ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Functional Activity ◽

Stroke Severity ◽

Multivariable Logistic Regression Model ◽

Hospital Arrival ◽

Level Of Consciousness ◽

Race Ethnicity ◽

Abnormal Level

Background: The 11-item National Institutes of Health Stroke Scale (NIHSS) is widely used as an index of stroke severity and prognostication. However, no studies have specifically examined the influence of NIHSS items on care processes and outcomes in Acute Ischemic Stroke (AIS). Furthermore, potential distinctions in neurologic signs of AIS that may contribute to disparities in race-ethnic treatment rates and outcomes have not been evaluated. We assessed the relation of neurological signs on the NIHSS to arrival mode, thrombolysis treatment and clinical outcomes in AIS, and also evaluated the influence of race-ethnicity. Methods: We analyzed the dataset of a hospital network comprising prospectively collected data on AIS patients presenting within 12 hours of ictus between June 2004 and May 2011. Outcomes evaluated were mode of arrival (ambulance vs. other), IV thrombolysis (yes vs. no), discharge destination (home vs. other), unfavorable day-90 functional activity (modified Rankin Scale (mRS) score >1), unfavorable day-90 disability (Barthel Index <95), and day-90 mortality. Outcomes were adjusted for pre-specified covariates in a multivariable logistic regression model. Results: Of 972 AIS patients 462 (48%) were women, 635 (65%) Non-Hispanic White, 162 (17%) White Hispanic, 106 (11%) Black, and 69 (7%) other race/ethnicity. Overall, the presence of extinction/neglect was the strongest predictor of arriving by ambulance (adjusted OR 2.32, 95% CI: 1.53-3.51), and abnormal level of consciousness (LOC) was the strongest predictor of receipt of IV thrombolysis (adjusted OR 2.25, 95% CI: 1.67-3.04), while limb ataxia was the only NIHSS item not significantly associated with either arrival mode or thrombolysis treatment. Presence of gaze preference was the strongest predictor of not going home directly from the hospital (adjusted OR 0.2, 95% CI: 0.14-0.29), unfavorable day-90 functional activity (adjusted OR 0.21, 95% CI: 0.12-0.37) and poor mortality outcome (adjusted OR 5.92, 95% CI: 3.42-10.25), while abnormal LOC was the strongest predictor of unfavorable day-90 disability (adjusted OR 0.27, 95% CI: 0.15-0.47). White Hispanic AIS patients with sensory symptoms were less likely to arrive by ambulance (adjusted OR 0.31, 95%CI: 0.13-0.74) but more likely to go home directly (adjusted OR 2.81, 95% CI: 21.31-6.02), while Black AIS patients with abnormal level of consciousness were more likely to receive IV thrombolysis (adjusted OR 4.69, 1.80-12.26). Conclusions: Specific items on the NIHSS are strongly related to hospital arrival mode, thrombolysis treatment, and clinical outcomes among AIS patients. Some of these associations vary by race and ethnicity. These results could aid prognostication and identify areas in the community, pre-hospital and emergency department phases of stroke care requiring more education, training, or intervention, to boost AIS outcomes.

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Abstract WMP96: The Iscore Predicts Clinical Response To Thrombolysis: Results From VISTA

Stroke ◽

10.1161/str.44.suppl_1.awmp96 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Gustavo Saposnik ◽

S. C Johnston ◽

Matthew Reeves ◽

Philip M Bath ◽

Bruce Ovbiagele ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Response ◽

Clinical Outcomes ◽

Direct Interaction ◽

High Risk Group ◽

P Value ◽

Stroke Severity ◽

Risk Of Death ◽

Secondary Outcomes

Background: The iScore is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. It includes demographics, stroke severity and subtype, comorbidities, pre-stroke status, and glucose on admission. Objective: To determine the ability of the iScore to predict the clinical response after iv thrombolysis (tPA) in the Virtual International Stroke Trials Archive (VISTA). Methods: We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration. We explored the association between the iScore (as continuous and binary [<200 and ≥200] measures) and the outcomes of interest. Outcome Measures: The primary outcome was death or disability at 90 days defined as a modified Rankin scale (mRS) 4-to-6. Secondary outcomes included death at 90 days and favorable outcome (mRS 0-2). Results: Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 712 (10%) had an iScore ≥200. Patients with higher iScore had worse clinical outcomes (p<0.0001 for all outcomes; c-statistics 0.777 for mRS0-6 and 0.748 for death at 90 days). Overall, an iScore ≥200 was associated with nine fold higher risk of death or disability at 90 days (OR 9.41, 95%CI 7.00-12.6). Similar trends were observed for secondary outcomes (Figure). tPA administration in stroke patients with an iScore≥200 was associated with a lower risk of death or disability at 90 days (OR 0.48; 95%CI 0.32-0.72). There was a direct interaction between the iScore and tPA for both death or disability and death alone at 90 days (p-value for the interaction <0.001). Conclusion: The iScore is a useful tool that can be used to estimate clinical outcomes after tPA. Although outcomes were poorer for the high-risk group (iScore≥200), the benefits of tPA in this group were greater than for low-risk patients. Figure

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Abstract 58: The Iscore Predicts Efficacy Of Thrombolytic Therapy For Acute Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a58 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Gustavo Saposnik ◽

Jiming Fang ◽

Moira Kapral ◽

Jack Tu ◽

Muhammad Mamdani ◽

...

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Acute Ischemic Stroke ◽

Clinical Response ◽

Intravenous Thrombolysis ◽

Hemorrhagic Transformation ◽

Neurological Deterioration ◽

Stroke Severity ◽

Risk Of Death ◽

Poor Outcome

Background: The iScore is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. It includes demographics, stroke severity and subtype, vascular risk factors, cancer, renal failure, and pre-admission functional status. Limited information is available to predict the clinical response after intravenous thrombolytic therapy (tPA). Objective: To determine the ability of the iScore to predict the clinical response and risk of hemorrhagic transformation after tPA. Methods: We applied the iScore ( www.sorcan.ca/iscore ) to patients presenting with an acute ischemic stroke at 11 stroke centres in Ontario, Canada, between 2003 and 2008, identified from the Registry of the Canadian Stroke Network (RCSN). We compared outcomes between patients receiving and not receiving tPA adjusting for differences in baseline characteristics through matching by propensity scores. Three groups were defined a priori as per the iScore (low risk 180). Outcome Measures: Poor outcome, the primary outcome measure, was defined as disability at discharge or death at 30 days. Secondary outcomes included disability at discharge, neurological deterioration and intracranial hemorrhage (any type and symptomatic). Results: Among 12,686 patients with an acute ischemic stroke, 1696 (13.4%) received intravenous thrombolysis. Overall, 589 tPA patients were matched with 589 non-tPA patients (low iScore risk), 682 tPA were matched with 682 non-tPA patients (medium iScore risk) and 419 tPA patients were matched with 419 non-tPA patients (high iScore risk). There was good matching in all three groups. Higher iScore was associated with poor functional outcome in both the tPA and non-tPA groups (p<0.001). Among those with low and medium iScore risk, tPA use was associated with lower risk of poor outcome (Low iScore RR 0.74; 95%CI 0.67-0.84; medium iScore RR 0.88; 95%CI 0.84-0.93). There was no difference in clinical outcomes between matched patients receiving and not receiving tPA in the highest iScore group (RR 0.97; 95%CI 0.94-1.01). Similar results were observed for disability at discharge and length of stay. The incident risk of neurological deterioration and hemorrhagic transformation (any or symptomatic) increased with the iScore risk ( Figure ). Conclusion: The iScore appears to predict clinical response and risk of hemorrhagic complications after tPA for an acute ischemic stroke. Patients with high iScores may not benefit from tPA and have higher risk of hemorrhagic transformation, though this finding should be validated independently (underway) before clinical use.

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Frequency of Hypoalbuminemia in Acute Ischemic Stroke patients Based on Stroke Severity

10.53350/pjmhs211561335 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1335-1339

Author(s):

E. U Haq ◽

A. Qayyum ◽

H. A. Qayyum ◽

M. Anam ◽

A. R. Khan ◽

...

Keyword(s):

Ischemic Stroke ◽

Serum Albumin ◽

Acute Ischemic Stroke ◽

Public Health Issue ◽

P Value ◽

Stroke Severity ◽

Stroke Patients ◽

Baseline Serum ◽

Nihss Score ◽

The Mean

Background: Stroke is a serious public health issue and third leading cause of death worldwide. Hypoalbuminemia is commonly found factor in patients of stroke and is also associated with severe disease as well as pro inflammatory patterns of serum protein electrophoresis. Therefore, further research for understanding the role of Hypoalbuminemia in stroke is important to devise strategies for better management of stroke. Aim : To determine the frequency of hypoalbuminemia in acute ischemic stroke patients based on stroke severity. Methods: This descriptive cross- sectional study was conducted in Shifa International hospital stroke unit for 6 months from May 15, 2018 till Nov 15, 2018. Data was collected from 100 patients using purposive sampling. After taking consent from patient or attendant, the demographic data was collected on a structured proforma. Baseline serum albumin and stroke severity using the NIHSS score was also assessed. All data was entered and analysed using SPSS 21. After descriptive analysis, post stratified Chi Square test was applied for gender and age categories. Results: The mean age of patients was 63.60 ± 11.87 years with 57(57%) male and 43(43%) female cases. The mean serum albumin level was 4.03 ± 0.94 with minimum and maximum values as 1.50 and 5.5. Among cases with minor, moderately severe and with severe stroke, 6(37.5%) cases, 18(25.7%) cases and 6(42.9%) cases had Hypoalbuminemia. The frequency of hypoalbuminemia was statistically same with respect to severity of stroke, p-value > 0.05. Conclusion: This study concludes that the frequency of hypoalbuminemia in acute ischemic stroke patients was diagnosed in almost one third cases, however, no statistical association could be found. Hence, screening for hypoalbuminemia should be done for better management of stroke patients. Keywords: Storke, NIHSS score, serum albumin, hypoalbuminemia, mortality

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Effects of Stress Hyperglycemia Ratio on 1-Year Clinical Outcome after Thrombolytic Therapy for Acute Ischemic Stroke

10.21203/rs.3.rs-104474/v1 ◽

2020 ◽

Author(s):

Dehao Yang ◽

Junli Ren ◽

Honghao Huang ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Thrombolytic Therapy ◽

Acute Ischemic Stroke ◽

Glucose Concentration ◽

Fasting Glucose ◽

Glycosylated Hemoglobin ◽

Operating Characteristics ◽

Stress Hyperglycemia ◽

Poor Outcome

Abstract BackgroundStress hyperglycemia manifests as transient hyperglycemia in the context of illness with or without known diabetes, which may cause poor clinical outcome in acute ischemic stroke (AIS) patients. The present study intended to evaluate the association between stress hyperglycemia ratio (SHR) and 1-year clinical outcome after treatment with recombinant tissue plasminogen activator (r-tPA) for AIS patients and compare the predictive effect of fasting glucose concentration, glycosylated hemoglobin (HbA1c) and SHR. MethodsData from 205 AIS patients following thrombolytic therapy with r-tPA in the Third Affiliated Hospital of Wenzhou Medical University from Apr. 2016 to Apr. 2019 were retrospectively reviewed. We grouped AIS patients according to SHR tertiles to contrast the 1-year clinical outcome. Multivariate regression analysis was carried to further analyze the association between SHR and AIS prognosis. Moreover, the receiver operating characteristics (ROC) curve analysis was used for the purpose of comparing the prognostic effects of fasting glucose concentration, HbA1c and SHR on AIS patients. ResultsSHR was an independent predictor for 1-year poor outcome (OR 1.447; 95% CI, 1.124-1.864, p = 0.004) but not the mortality of AIS patients. Restricted cubic spline regression showed a linear relationship between SHR and the odds of poor outcome. Furthermore, SHR is a fair predictor to predict 1-year poor outcome. The cut-off value of SHR levels was 0.79 with 71.0% sensitivity and 72.0 % specificity. ConclusionsThe increased SHR was strongly associated with 1-year poor outcome following thrombolytic therapy with r-tPA. Meanwhile, SHR had higher predictive value for prognosis of AIS patients than fasting glucose concentration and HbA1c. Trial registrationRetrospectively registered

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