scholarly journals High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody–associated Vasculitis

2018 ◽  
Vol 46 (3) ◽  
pp. 285-293 ◽  
Author(s):  
Amy Kang ◽  
Marilina Antonelou ◽  
Nikki L. Wong ◽  
Anisha Tanna ◽  
Nishkantha Arulkumaran ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Independent Predictor ◽  
Antineutrophil Cytoplasmic Antibody ◽  
First Year ◽  
High Incidence ◽  
All Cause Mortality ◽  
Coronary Events ◽  
The Uk ◽  
Event Rates

Objective.To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV).Methods.This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014.Results.There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1–10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE.Conclusion.Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.

Survival analysis in the incident dialysis patients by different modalities

2021 ◽  
pp. 039139882110416
Author(s):  
Wenlv Lv ◽  
Xiaohong Chen ◽  
Yaqiong Wang ◽  
Jiawei Yu ◽  
Xuesen Cao ◽  
...  
Keyword(s):  
Patient Survival ◽  
Independent Predictor ◽  
Final Analysis ◽  
First Year ◽  
Dialysis Modality ◽  
Dialysis Patients ◽  
All Cause Mortality ◽  
Analysis Survival ◽  
Patient Prognosis

Background: To analysis survival in onset uremic patients who initiating HD or PD dialysis in our dialysis center. Methods: Between Jan. 2015 and June. 2018, patients with onset uremia and initiating planned-start dialysis were retrospectively enrolled in this study and followed up to January, 2019. The relationships between the types of dialysis modality and patient prognosis were assessed. Results: A total of 460 patients were included in the final analysis. Of which, 213 patient (46.30%) undergoing PD and 247 patients (53.70%) undergoing HD with arteriovenous fistula. The average follow-up time was 27.9 months. Eighty-seven (18.91%) patients died during the study period. The all-cause mortality was 127 per 1000 person-year. It was 102 per 1000 person-year in the HD group and 171 per 1000 person-year in the PD group ( p < 0.01). However, dialysis modality was not an independent predictor for survival. During the first year after dialysis initiation, patient survival was comparable between the PD and HD groups (log-rank p = 0.14). As the dialysis age increased over 1 year, HD patients seemed to have a better survival as compared to that of PD patient (log-rank p < 0.05), especially those older than 65 years and without DN. Conclusions: Though dialysis modality was not an independent factor for overall survival, HD therapy seemed to be more suitable for patients without DN.

HbA1c is associated with increased all-cause mortality in the first year after acute ischemic stroke

2014 ◽  
Vol 36 (5) ◽  
pp. 444-452 ◽  
Author(s):  
Shuolin Wu ◽  
Chunxue Wang ◽  
Qian Jia ◽  
Gaifen Liu ◽  
Kolin Hoff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
First Year ◽  
All Cause Mortality

scholarly journals Growth Differentiation Factor-15 is a Biomarker for All-cause Mortality but Less Evident for Cardiovascular Outcomes: A Prospective Study

2020 ◽  
Author(s):  
Xue Bao ◽  
Yan Borné ◽  
BIAO XU ◽  
Marju Orho-Melander ◽  
Jan Nilsson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cardiovascular Mortality ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Competing Risk ◽  
Growth Differentiation Factor 15 ◽  
Markers Of Inflammation ◽  
Differentiation Factor ◽  
All Cause Mortality ◽  
Coronary Events

Abstract Background Previous studies have proposed growth differentiation factor-15 (GDF-15) as a predictor of adverse cardiovascular outcomes and mortality. The present study aimed to determine if such associations remain after accounting for markers of inflammation and cardiac dysfunction as well as death as a competing risk. Methods Plasma GDF-15 levels and cardiovascular risk factors were measured in individuals without cardiovascular diseases (n = 4,518, aged 57.4 ± 5.96 years, 39.2% men), who participated in Malmö Diet and Cancer-Cardiovascular Cohort during 1991–1994 and were followed up for more than 20 years. Incidence of coronary events, ischemic stroke, cardiovascular mortality and all-cause mortality was studied in relation to GDF-15 using Cox proportional hazards regression, with adjustment for potential confounders including high sensitive C-reactive protein (hsCRP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Confounding from death as competing risk was carefully checked using the Fine and Gray subdistribution hazard model. Results During follow-up, 473 coronary events, 366 ischemic stroke, 405 cardiovascular deaths, and 1,445 all-cause deaths occurred. The associations of GDF-15 with coronary events, ischemic stroke, or cardiovascular mortality were attenuated and non-significant after adjusting for NT-proBNP or controlling for death from other causes as a competing risk. All-cause mortality remained significantly related to GDF-15. After multivariate adjustment, the hazard ratio (95% confidence interval) for all-cause mortality was 1.60 (1.34, 1.91), in the top compared with the bottom quartile of GDF-15. Conclusions GDF-15 concentration is a robust biomarker for all-cause mortality but less reliable for coronary event, ischemic stroke or cardiovascular mortality.

ANALYSIS OF THE STRUCTURE AND DYNAMICS OF VERBAL FUNCTIONS FOR THE FIRST YEAR AFTER ISCHEMIC STROKE

2019 ◽  
pp. 19-23
Keyword(s):  
Ischemic Stroke ◽  
Speech Therapy ◽  
Positive Impact ◽  
Speech Disorders ◽  
First Year ◽  
Structure And Dynamics ◽  
Speech Therapist ◽  
Late Recovery ◽  
Verbal Functions ◽  
Stationary Period

The results of psycho-correction speech therapy are analyzed in dynamics in 78 patients with varying severity and various forms of speech disorders in the early and late recovery periods of ischemic stroke. The effectiveness of conducting classes during the stay of patients in a neurological hospital and the positive impact of these exercises in the inpatient period (outpatient classes, classes at home with a speech therapist and trained relatives) are shown. Patients who did not conduct speech recovery classes during the inter-stationary period showed a decrease in speech activity, in some even a negative dynamic.

Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A “Real-world” Study in a Developing Country

2020 ◽  
Vol 17 (4) ◽  
pp. 361-375
Author(s):  
Victor C. Schulz ◽  
Pedro S.C. de Magalhaes ◽  
Camila C. Carneiro ◽  
Julia I.T. da Silva ◽  
Vivian N. Silva ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Real World ◽  
Time Window ◽  
Functional Dependence ◽  
Developed Countries ◽  
First Year ◽  
Middle Income ◽  
Probability Of Survival ◽  
Stroke Center ◽  
Cerebral Reperfusion

Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the “real world” scenario of low and middle-income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil. Methods: Patients from a stroke center of a state-run hospital were included. We compared the survival probability and functional status at 3 and 12 months in patients with severe IS treated or not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined or not with intravenous alteplase (IAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in 2012-2017 did not undergo CRT (NCRT group). Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19% (178/917) in the IVT group and 7% (62/917) in the IAT group. Compared to the NCRT group, IVT patients had a 28% higher (HR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91). For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41; 95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95% CI 0.66-094). These outcomes remained significantly better throughout the first year. Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.

P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bielecka-Dabrowa ◽  
P Gasiorek ◽  
A Sakowicz ◽  
M Banach
Keyword(s):  
Ischemic Stroke ◽  
Independent Predictor ◽  
Reference Group ◽  
Peak Velocity ◽  
Recurrent Stroke ◽  
Mitral Annular Velocity ◽  
Kaplan Meier ◽  
Unfavourable Prognosis ◽  
Undetermined Etiology

Abstract Purpose The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65. Methods Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months. Results At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01). Kaplan-Meier Analysis - survival and AF Conclusions The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF. Acknowledgement/Funding The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz

scholarly journals Extremely High Incidence of Lower Extremity Deep Venous Thrombosis in 48 Patients With Severe COVID-19 in Wuhan

Circulation ◽  
2020 ◽  
Vol 142 (2) ◽  
pp. 181-183 ◽  
Author(s):  
Bin Ren ◽  
Feifei Yan ◽  
Zhouming Deng ◽  
Sheng Zhang ◽  
Lingfei Xiao ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
High Incidence

scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

Advanced cardiometabolic & inflammatory markers for prediction of cardiovascular disease and cancer

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Radenkovic ◽  
S.C Chawla ◽  
G Botta ◽  
A Boli ◽  
M.B Banach ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Score ◽  
Cancer Incidence ◽  
Risk Function ◽  
Patient Characteristics ◽  
Risk Scores ◽  
Uk Biobank ◽  
Training Set ◽  
All Cause Mortality ◽  
The Uk

Abstract   The two leading causes of mortality worldwide are cardiovascular disease (CVD) and cancer. The annual total cost of CVD and cancer is an estimated $844.4 billion in the US and is projected to double by 2030. Thus, there has been an increased shift to preventive medicine to improve health outcomes and development of risk scores, which allow early identification of individuals at risk to target personalised interventions and prevent disease. Our aim was to define a Risk Score R(x) which, given the baseline characteristics of a given individual, outputs the relative risk for composite CVD, cancer incidence and all-cause mortality. A non-linear model was used to calculate risk scores based on the participants of the UK Biobank (= 502548). The model used parameters including patient characteristics (age, sex, ethnicity), baseline conditions, lifestyle factors of diet and physical activity, blood pressure, metabolic markers and advanced lipid variables, including ApoA and ApoB and lipoprotein(a), as input. The risk score was defined by normalising the risk function by a fixed value, the average risk of the training set. To fit the non-linear model &gt;400,000 participants were used as training set and &gt;45,000 participants were used as test set for validation. The exponent of risk function was represented as a multilayer neural network. This allowed capturing interdependent behaviour of covariates, training a single model for all outcomes, and preserving heterogeneity of the groups, which is in contrast to CoxPH models which are traditionally used in risk scores and require homogeneous groups. The model was trained over 60 epochs and predictive performance was determined by the C-index with standard errors and confidence intervals estimated with bootstrap sampling. By inputing the variables described, one can obtain personalised hazard ratios for 3 major outcomes of CVD, cancer and all-cause mortality. Therefore, an individual with a risk Score of e.g. 1.5, at any time he/she has 50% more chances than average of experiencing the corresponding event. The proposed model showed the following discrimination, for risk of CVD (C-index = 0.8006), cancer incidence (C-index = 0.6907), and all-cause mortality (C-index = 0.7770) on the validation set. The CVD model is particularly strong (C-index &gt;0.8) and is an improvement on a previous CVD risk prediction model also based on classical risk factors with total cholesterol and HDL-c on the UK Biobank data (C-index = 0.7444) published last year (Welsh et al. 2019). Unlike classically-used CoxPH models, our model considers correlation of variables as shown by the table of the values of correlation in Figure 1. This is an accurate model that is based on the most comprehensive set of patient characteristics and biomarkers, allowing clinicians to identify multiple targets for improvement and practice active preventive cardiology in the era of precision medicine. Figure 1. Correlation of variables in the R(x) Funding Acknowledgement Type of funding source: None

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