scholarly journals Elevation of troponin I in acute ischemic stroke

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1866 ◽  
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.

scholarly journals Advanced Age and Higher National Institutes of Health Stroke Scale Score as Predictors of Poor Outcome in Ischemic Stroke Patients Treated with Alteplase: A Study from a Tertiary Care Centre in Rural North-west India

2017 ◽  
Vol 08 (02) ◽  
pp. 236-240 ◽  
Author(s):  
Amit Bhardwaj ◽  
Girish Sharma ◽  
Sunil Kumar Raina ◽  
Ashish Sharma ◽  
Monica Angra
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Tertiary Care ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Nihss Score ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor

ABSTRACT Introduction: Thrombolytic therapy in acute ischemic stroke has been approved for treatment of acute stroke for past two decades. However, identification of predictors of poor outcome after the intravenous (IV) alteplase therapy in acute stroke patients is a matter of research. The present study was conducted with the aim of identifying poor prognostic factors in patients of acute ischemic stroke patients. Methods: The data of 31 acute stroke patients treated with alteplase were gathered to identify the factors that were independent predictors of the poor outcome. Outcome was dichotomized using modified Rankin scale (mRS) score and National Institutes of Health Stroke Scale (NIHSS) score at 3 months after treatment into good outcome mRS - 0–2 and poor outcome mRS - 3–6. Predictors of poor outcome were analyzed. Results: Good outcome (mRS – score 0–2) was seen in 15 (48.4%) patients with median age of (60) and poor outcome (mRS – score 3–6) was seen in 16 (51.6%) patients median age of 75 years, which was statistically significant with the P = 0.002. The presence of risk factors such as hypertension, diabetes, dyslipidemia, smoking, alcohol intake, history of stroke, coronary artery disease, and rheumatic heart disease among the two groups did not seem influence outcome. The severity of stroke as assessed by NIHSS score at the time of presentation was significantly higher among the patients with poor outcome, with P = 0.01. Conclusion: Advance age and higher NIHSS score at the time of onset of stroke and are the independent predictors of the poor outcome after thrombolysis with IV alteplase treatment in acute ischemic stroke patients.

scholarly journals A study on elevation of troponin I in ischemic stroke as an independent prognostic marker of outcomes

2020 ◽  
Vol 17 (2) ◽  
pp. 26-34
Author(s):  
Pradeep Thapa ◽  
Jagdish Prasad Agrawal ◽  
Rajani Baniya
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Troponin I ◽  
Multiple Logistic Regression Analysis ◽  
Stroke Severity ◽  
Elevated Troponin ◽  
Stroke Patients ◽  
Nihss Score ◽  
Laboratory Parameters ◽  
Poor Outcomes

Background: Stroke is the second leading cause of death worldwide, comprising approximately 10% of all deaths. A substantial number of stroke patients have elevated cardiac troponin levels and are associated with poorer prognosis. Methods: This was a prospective observational study conducted for 1 year at Tribhuvan University Teaching Hospital, in which 101 acute ischemic stroke patients were enrolled. Data included vital signs, laboratory parameters, and clinical features evaluated at the time of admission. The National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) were used to assess stroke severity and outcomes. Results: Elevated troponin I (> 0.034 ng/mL) was observed in eight (7.9%) patients. Compared to patients with normal troponin I, patients with elevated troponin I were older(mean age 61vs 59.68 years), had higher blood glucose( 10.6 vs. 7.04 mmol/L), higher median white blood cells( 9.3 vs. 8.9 1,000/m3) and creatinine levels(119.5 μmol/L vs. 95.9 μmol/L), higher mean NIHSS scores on admission(16 vs. 8.6), and discharge(14.5 vs. 6.8), higher median mRS scores( 4.13 vs. 1.8) at discharge(p<0.001). Poor outcomes were observed in 34(33.66%) patients of 101 patients and death occurred in five (4.9%) patients. Patients with abnormal troponin I had poorer outcomes than normal troponin I level patients (p=<0.001) and significantly higher deaths (p=0.006). Univariate analysis of continuous variables revealed that patients with poor outcomes compared to good outcomes had higher troponin levels (0.029 vs. 0.013 ng/mL, p=0.001), creatinine levels (113.5 vs. 89.8μmol/L, p=0.007), NIHSS score on admission (13.4 vs. 5.10, p<0.001),discharge (12.4 vs. 5.1, p<0.001), and higher mRS scores at discharge (3.71 vs. 1.16, p<0.001).Multiple logistic regression analysis revealed that NIHSS score on admission>13(OR 15.902; 95%CI[3.65-69.28],p=<0.001) and abnormal troponin I level, troponin I>0.029 ng/mL (odds ratio[OR]:28.451; 95% CI[2.785-290.6],p=0.005) were significant predictors of poor outcomes. Significant predictor of in hospital mortality only included troponin I level >0.04 ng/mL (0R 0.071; 95% CI [0.005-1.037], P=0.05). Conclusion: Troponin I provide better information than age and other laboratory parameters in the prediction of outcomes of stroke. Elevation of troponin I during acute stroke is a strong predictor of both poor outcomes and in-hospital mortality.  

Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Amy K Starosciak ◽  
Italo Linfante ◽  
Gail Walker ◽  
Osama O Zaidat ◽  
Alicia C Castonguay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Power ◽  
Rescue Therapy ◽  
Univariate Analysis ◽  
Stroke Patients ◽  
Good Outcome ◽  
Poor Outcome

Background: Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. Methods: The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power. Results: Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80). Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.

Abstract P75: Cerebrovascular Events and Outcomes in Hospitalized Patients With Covid-19: The Society of Vascular and Interventional Neurology Multinational Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
James E Siegler ◽  
Pere Portela ◽  
Juan F Arenillas ◽  
Alba Chavarria-Miranda ◽  
Ana Guillen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Significant Risk ◽  
Stroke Severity ◽  
Cerebrovascular Event ◽  
Cerebrovascular Events ◽  
Observational Cohort

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in 4 countries (2/1/2020 - 06/16/2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) of whom were female and 96/172 (55.8%) were between the ages 60-79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130 - 280/100,000) and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p<0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p<0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p=0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98 p=0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19 associated cerebrovascular complications, therefore aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

Abstract MP29: Effects of System-Level Factors on Race/Ethnic Differences in In-Hospital Mortality After Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Abdullah Ibish ◽  
Philip Sun ◽  
Daniela Markovic ◽  
Roland Faigle ◽  
Rebecca F Gottesman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Black Women ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Cause Of Death ◽  
Primary Diagnosis ◽  
System Level ◽  
Stroke Severity ◽  
Race Ethnicity ◽  
Minority Men

Introduction: Stroke mortality has declined, with differential changes by race; stroke is now the 5 th leading cause of death overall, but 2 nd leading cause of death in blacks. Little is known about recent race/ethnic trends in in-hospital mortality after acute ischemic stroke (AIS) and whether system-level factors contribute to possible differences. Methods: Using the National Inpatient Sample, adults (>18 yrs) with a primary diagnosis of AIS from 2006 to 2017 (n=763,808) were identified. We assessed in-hospital mortality by race/ethnicity (white, black, Hispanic, Asian/Pacific Islander [API], other), sex, and age. Hospitals were categorized by proportion of minority patients served: <25% minority (white hospitals); 25-50% (mixed hospitals), and >50% (minority hospitals). Using survey adjusted logistic regression, the association between race/ethnicity and odds of mortality was assessed, adjusting for key sociodemographic, clinical, and hospital characteristics (e.g. age, comorbidities, stroke severity, DNR status, and palliative care). Results: Overall, mortality decreased from 5.0% in 2006 to 2.9% in 2017, p<0.001. Comparing 2006-2011 to 2012-2017, there was a 66% reduction in mortality after adjustment for covariates, most prominent in whites (68%) and smallest in blacks (58%). Compared to whites, blacks and Hispanics had lower adjusted odds of mortality (AOR 0.82, 95% CI 0.78-0.86 and AOR 0.92, CI 0.86-0.98), primarily driven by those >65 yrs (age x ethnicity interaction p = 0.003). Compared to white men, black, Hispanic, and API men and black women had lower odds of mortality. Adjusted mortality was lower in minorities vs. whites and most pronounced in white hospitals (white: AOR 0.78, 0.73-0.85; mixed: 0.85, 0.80-0.91; minority: 0.89, 0.82-0.95; interaction effect: p=0.018). These differences were present for both minority men and women in white and mixed hospitals, but not women in minority hospitals. Discussion: AIS mortality decreased dramatically in recent years. Overall, black and Hispanic AIS patients have lower mortality than whites, a difference that is most striking in white hospitals. Further study is needed to understand these differences and to what extent biological, sociocultural, and system-level factors play a role.

scholarly journals Dynamic functional connectivity analysis reveals transiently increased segregation in patients with severe stroke

2020 ◽  
Author(s):  
Anna K. Bonkhoff ◽  
Markus D. Schirmer ◽  
Martin Bretzner ◽  
Mark Etherton ◽  
Kathleen Donahue ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Network Connectivity ◽  
Functional Network ◽  
Angular Gyrus ◽  
Stroke Severity ◽  
Functional Network Connectivity ◽  
Dynamic Connectivity ◽  
Dynamic Functional Network Connectivity

AbstractBackground and PurposeTo explore the whole-brain dynamic functional network connectivity patterns in acute ischemic stroke (AIS) patients and their relation to stroke severity in the short and long term.MethodsWe investigated large-scale dynamic functional network connectivity of 41 AIS patients two to five days after symptom onset. Re-occurring dynamic connectivity configurations were obtained using a sliding window approach and k-means clustering. We evaluated differences in dynamic patterns between three NIHSS-stroke severity defined groups (mildly, moderately, and severely affected patients). Furthermore, we established correlation analyses between dynamic connectivity estimates and AIS severity as well as neurological recovery within the first 90 days after stroke (DNIHSS). Finally, we built Bayesian hierarchical models to predict acute ischemic stroke severity and examine the inter-relation of dynamic connectivity and clinical measures, with an emphasis on white matter hyperintensity lesion load.ResultsWe identified three distinct dynamic connectivity configurations in the early post-acute stroke phase. More severely affected patients (NIHSS 10–21) spent significantly more time in a highly segregated dynamic connectivity configuration that was characterized by particularly strong connectivity (three-level ANOVA: p<0.05, post hoc t-tests: p<0.05, FDR-corrected for multiple comparisons). Recovery, as indexed by the realized change of the NIHSS over time, was significantly linked to the acute dynamic connectivity between bilateral intraparietal lobule and left angular gyrus (Pearson’s r = –0.68, p<0.05, FDR-corrected). Increasing dwell times, particularly those in a very segregated connectivity configuration, predicted higher acute stroke severity in our Bayesian modelling framework.ConclusionsOur findings demonstrate transiently increased segregation between multiple functional domains in case of severe AIS. Dynamic connectivity involving default mode network components significantly correlated with recovery in the first three months post-stroke.

scholarly journals The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Mona Laible ◽  
Ekkehart Jenetzky ◽  
Markus Alfred Möhlenbruch ◽  
Martin Bendszus ◽  
Peter Arthur Ringleb ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Kidney Injury ◽  
Stroke Severity ◽  
Post Contrast ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
The Impact

Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT.Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or &gt;25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models.Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p &lt; 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p &lt; 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p &lt; 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001).Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.

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

Stroke ◽  
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.

Elevated total homocysteine predicts in-hospital pneumonia and poor functional outcomes in acute ischemic stroke

2020 ◽  
Author(s):  
Shoujiang You ◽  
Lixuan Wang ◽  
Huaping Du ◽  
Danni Zheng ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Fold Increase ◽  
Short Term ◽  
Thcy Level ◽  
Poor Outcome ◽  
Total Homocysteine ◽  
The Impact

Abstract Background The impact of elevated total homocysteine (tHcy) on functional outcomes and pneumonia after acute ischemic stroke (AIS) is still not well understood. We investigated the association between tHcy levels upon hospital admission and in-hospital short-term outcomes in AIS patients. Methods A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into 4 groups according to their level of admission tHcy: Q1 (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. Results During hospitalization, 332 patients (15.9%) had pneumonia, 57 patients (2.7%) died from all causes and 784 (37.6%) patients experienced poor outcome at discharge. The risk of in-hospital pneumonia was significantly higher in patients with highest tHcy level (Q4) compared to those with lowest (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P -trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality(adjusted OR 3.35; 95% CI, 1.11–10.13; P -trend =0.015) and poor outcome upon discharge(adjusted OR 1.50; 95% CI, 1.06–2.12; P -trend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. Subgroup analyses further confirmed a significant association between higher tHcy levels and a high risk of short-term outcomes. Conclusions Having a high admission tHcy level was independently associated with in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge in AIS patients. Moreover, the association between higher tHcy and poor functional outcome was not modified by pneumonia.

scholarly journals Evaluating the Role of Oxidative Stress in Acute Ischemic Stroke

2020 ◽  
Vol 11 (01) ◽  
pp. 156-159
Author(s):  
Bindu Menon ◽  
Krishnan Ramalingam ◽  
Rajeev Kumar
Keyword(s):  
Oxidative Stress ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Lipid Membranes ◽  
Demographic Data ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Antioxidant Power

Abstract Background The role of oxidative stress in neuronal injury due to ischemic stroke has been an interesting topic in stroke research. Malondialdehyde (MDA) has emerged as a sensitive oxidative stress biomarker owing to its ability to react with the lipid membranes. Total antioxidant power (TAP) is another biomarker to estimate the total oxidative stress in stroke patients. We aimed to determine the oxidative stress in acute stroke patients by measuring MDA and TAP. Materials and Methods MDA and TAP were determined in 100 patients with ischemic stroke and compared with that in 100 age- and sex-matched healthy adults. Demographic data, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), and disability measured by the Barthel index (BI) were recorded. The association of MDA and TAP with other variables was analyzed by paired t-test. Results Of the whole sample, 74% represented males. The mean NIHSS score was 13.11 and BI was 38.87. MDA was significantly higher in stroke patients (7.11 ± 1.67) than in controls (1.64 ± 0.82; p = 0.00). TAP was significantly lower in stroke patients (5.72 ± 1.41) than in controls (8.53 ± 2.4; p = 0.00). The lipid profile and blood sugar levels were also significantly higher in stroke patients. There was no association of MDA and TAP with other variables. Conclusion We found that oxidative stress was associated with acute ischemic stroke. However, we could not establish an association between oxidative stress and the severity of acute stroke.

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