Prognostic Impact of the Metabolic Syndrome and Its Components in Acute Type A Aortic Dissection After Surgery: A 3-Year Follow-Up

Background The aim of this study is to explore whether or to what extent the metabolic syndrome (METs) and its components was associated with poor outcome in acute type A aortic dissection patients (ATAAD) after surgery. Methods This study involved 353 ATAAD patients undergo surgery. Data on demographic and clinical characteristics were collected. Subgroup analysis, mixed models regression analysis, score systems and receiver-operating characteristic curves (ROC) analysis were done. Results Overall, 353 inpatients were assigned to the poor outcome group (n = 69) and control group (n = 284) with or without METs. Compared to control group, the incidence of METs was higher in poor outcome group. Poor outcome were present in 0%, 4.4%, 12.3%, 47.6%, 71.4% and 100% of the six groups, who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times. For multivariable logistic regression, quartiles of BMI remained the risk factors of poor outcome after adjustment other risk factors. After adjustment for potential confounding factors, METs was an independent risk factors in several models. Assigning a score of one for each components, the AUC were 0.877 (95%CI: 0.823-0.923) in all patients, 0.864 (95%CI: 0.7945-0.935) in METs and 0.700 (95%CI: 0.567-0.833) in non-METs by Receiver-operating characteristic. Conclusions METs, especially for BMI, confers greater risk for poor outcome in ATAAD after surgery during 3-year follow up.

Intracranial Pressure Patterns and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Survivors after Targeted Temperature Management: A Retrospective Observational Study

We aimed to investigate intracranial pressure (ICP) changes over time and the neurologic prognosis for out-of-hospital cardiac arrest (OHCA) survivors who received targeted temperature management (TTM). ICP was measured immediately after return of spontaneous circulation (ROSC) (day 1), then at 24 h (day 2), 48 h (day 3), and 72 h (day 4), through connecting a lumbar drain catheter to a manometer or a LiquoGuard machine. Neurological outcomes were determined at 3 months after ROSC, and a poor neurological outcome was defined as Cerebral Performance Category 3–5. Of the 91 patients in this study (males, n = 67, 74%), 51 (56%) had poor neurological outcomes. ICP was significantly higher in the poor outcome group at each time point except day 4. ICP elevation was highest between days 2 and 3 in the good outcome group, and between days 1 and 2 in the poor outcome group. However, there was no difference in total ICP elevation between the poor and good outcome groups (3.0 vs. 3.1; p = 0.476). All OHCA survivors who had received TTM had elevated ICP, regardless of neurologic prognosis. However, the changing pattern of ICP levels differed depending on the neurological outcome.

Monocyte/High-Density Lipoprotein Ratio Predicts the Prognosis of Large Artery Atherosclerosis Ischemic Stroke

Objective: Monocyte to high-density lipoprotein ratio is considered as a new inflammatory marker and has been used to predict the severity of coronary heart disease and the incidence of adverse cardiovascular events (ACEs). However, there is a lack of data relative to large artery atherosclerosis (LAA) ischemic stroke. We investigated whether the monocyte to high-density lipoprotein (HDL) ratio (MHR) is related to the 3-month functional prognosis of LAA ischemic stroke.Materials and Methods: A retrospective analysis was conducted on 316 LAA ischemic stroke patients. The 3-month functional outcome was divided into good and poor according to the modified Rankin Scale (mRS) score. Multivariate logistic regression analysis was performed to evaluate the correlation between MHR and prognosis of ischemic stroke.Results: The MHR level of poor functional outcome group was higher than that of the good functional outcome group [0.44 (0.3, 0.55) vs. 0.38 (0.27, 0.5), P = 0.025]. Logistic stepwise multiple regression revealed that MHR [odds ratio (OR) 9.464, 95%CI 2.257–39.678, P = 0.002] was an independent risk factor for the 3-month poor outcome of LAA ischemic stroke. Compared to the lower MHR tertile, the upper MHR tertile had a 3.03-fold increase (95% CI 1.475–6.225, P = 0.003) in the odds of poor functional outcome after adjustment for potential confounders. Moreover, a multivariable-adjusted restricted cubic spline (RCS) showed a positive close to a linear pattern of this association.Conclusion: Elevated MHR was independently associated with an increased risk of poor 3-month functional outcome of patients with LAA ischemic stroke.

Alpha-power in Electroencephalography as Good Outcome Predictor for Out-of-Hospital Cardiac Arrest Survivors

Background This study aimed to identify the quantitative EEG biomarkers for predicting good neurologic outcomes in OHCA survivors treated with targeted temperature management (TTM) using power spectral density (PSD), event-related spectral perturbation (ERSP), and spectral entropy (SE). Methods This observational registry-based study was conducted at a tertiary care hospital in Korea using data of adult nontraumatic comatose OHCA survivors who underwent standard EEG and treated with TTM between 2010 and 2018. Good neurological outcome at 1 month (Cerebral Performance Category scores 1 and 2) was the primary outcome. The linear mixed model analysis was performed for PSD, ESRP, and SE values of all and each frequency band. Results Thirteen of the 54 comatose OHCA survivors with TTM and EEG, 13 were excluded due to poor EEG quality or periodic/rhythmic pattern, leaving 41 patients for analysis. The median time to EEG was 21 h, and the rate of the good neurologic outcome at 1 month was 52.5%. The good neurologic outcome group was significantly younger and showed higher PSD and ERSP and lower SE features for each frequency than the poor outcome group. After age adjustment, only the alpha-PSD was significantly higher in the good neurologic outcome group (1.13 ± 1.11 vs. 0.09 ± 0.09, p = 0.031) and had best performance with 0.903 of the area under the curve for predicting good neurologic outcome. Conclusions Alpha-PSD best predicts good neurologic outcome in OHCA survivors and is an early biomarker for prognostication. Larger studies are needed to conclusively confirm these findings.

Abstract 9724: Variance of the Intracranial Pressure Over Time and Relationship With Neurologic Prognosis in Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

Introduction: Increased intracranial pressure (ICP) is one of the most serious post-cardiac arrest (CA) complications, and is associated with poor outcomes. However, only a few studies have described the changes in ICP over time according to neurologic outcomes during targeted temperature management (TTM) after CA. We aimed to investigate the changes in the ICP over time and neurologic prognosis in out-of-hospital cardiac arrest (OHCA) survivors who received TTM. Methods: This retrospective single-center study included OHCA survivors who underwent TTM between May 2018 and December 2020. ICP was measured immediately after the return of spontaneous circulation (ROSC) (Day 1), and after 24 h (Day 2), 48 h (Day 3), and 72 h (Day 4) by connecting a lumbar drain. The neurologic outcome was determined 3 months after the ROSC, and the Cerebral Performance Category (CPC) was dichotomized into good (CPC 1-2) and poor (CPC 3-5) outcomes. Results: We included 91 patients (males, 67; 74%); of whom 51 (56%) had a poor outcome. The ICP was significantly higher in the poor outcome group at each time point, except for Day 4. Moreover, the peak ICP levels were also higher in the poor outcome group (17.0 vs. 14.8; P = 0.002). The change in ICP levels was highest between Day 2 and Day 3 in the good outcome group, but between Day 1 and Day 2 in the poor outcome group. However, there was no difference in the total ICP change between the poor and good outcome groups (3.00 vs 3.09; P = 0.52). Using receiver operating characteristic analyses, the optimal cutoff values of the ICP levels for the prediction of poor outcomes were determined as: day 1, > 11.8; day 2, > 14.0; day 3, > 15.0; and day 4, > 14.8. Conclusions: All OHCA survivors who received TTM had an elevated ICP, regardless of the neurologic prognosis. However, peak ICP levels and the change in the ICP level on the first day after the ROSC was significantly higher in the poor outcome group. A prospective, multi-center study is required to confirm these results.

Abstract 9720: A New Window on a Cerebral Penumbra at Risk for a Secondary Ischemic Brain Injury in Post-Cardiac Arrest Patients

Aim: This study aimed to investigate new target having potential neuroprotective effect against a secondary ischemic brain injury in post out-of-hospital cardiac arrest (OHCA) patients. Methods: This study analyzed physiological variables among OHCA patients with good or poor neurological outcomes despite having normal diffusion-weighted image findings before targeted temperature management (TTM). The factors affecting cerebral perfusion after OHCA, such as the time-weighted average (TWA) of arterial carbon dioxide (PaCO 2 ), oxygen (PaO 2 ), and mean arterial pressure (MAP); and the intracranial pressure (ICP) and quotient albumin ratio (Qalb), measured at 0 and 24 h from the return of spontaneous circulation (ROSC), were analyzed retrospectively using prospectively collected data. The primary outcome was the association between the factors and poor neurological outcome. Results: Fifty-one patients were included in this study. Among them, 11 had poor neurological outcomes. The pre-hospital factors such as anoxic time, initial rhythm; and TWA of physiological factors (PaCO 2 , PaO 2 , and MAP), were not significantly different between groups (p > 0.05). The inter-group comparisons of Qalb at 0 and 24 h were not significant (p > 0.05), whereas Qalb (median [interquartile range]) significantly increased from 0 to 24 h in the poor outcome group (0.007 [0.003 - 0.011] to 0.013 [0.005 - 0.029]; p = 0.04). Simultaneously, the ICP of the poor outcome group significantly increased over time (12.0 mmHg [8.1 - 13.0] to 16.0 mmHg [9.3 - 22.4]; p = 0.03), and higher than those of good outcome group at 24 h (11.0 mmHg [6.5 - 16.0] vs. 16.0 [9.3 - 22.4]; p < 0.01). Conclusion: Blood-brain barrier disruption and increasing ICP were apparent in OHCA patients who progressed into poor outcome despite no significant difference of brain injury before TTM compared with those of good outcome. These factors may be the key window on strategy to prevent the secondary ischemic brain injury after OHCA.

Multimodal CT Imaging Characteristics in Predicting Prognosis of Wake-Up Stroke

Background: Multimodal CT imaging can evaluate cerebral hemodynamics and stroke etiology, playing an important role in predicting prognosis. This study aimed to summarize the comprehensive image characteristics of wake-up stroke (WUS), and to explore its value in prognostication.Methods: WUS patients with anterior circulation large vessel occlusion were recruited into this prospective study. According to the 90-day modified Rankin Scale (mRS), all patients were divided into good outcome (mRS 0–2) or bad (mRS 3–6). Baseline clinical information, multimodal CT imaging characteristics including NECT ASPECTS, clot burden score (CBS), collateral score, volume of penumbra and ischemic core on perfusion were compared. Multivariate logistic regression analysis was further used to analyze predictive factors for good prognosis. Area under curve (AUC) was calculated from the receiver operating characteristic (ROC) curve to assess prognostic value.Results: Forty WUS were analyzed in this study, with 20 (50%) achieving good outcome. Upon univariable analysis, the good outcome group demonstrated higher ASPECTS, higher CBS, higher rate of good collateral filling and lower penumbra volume when compared with the poor outcome group. Upon logistic regression analysis, poor outcome significantly correlated with penumbra volume (OR: 1.023, 95% CI = 1.003–1.043) and collateral score (OR: 0.140, 95% CI = 0.030–0.664). AUC was 0.715 for penumbra volume (95% CI, 0.550–0.846) and 0.825 for good collaterals (95% CI, 0.672–0.927) in predicting outcome.Conclusions:Penumbra volume and collateral score are the most relevant baseline imaging characters in predicting outcome of WUS patients. These imaging characteristics might be instructive to treatment selection. As the small sample size of current study, further studies with larger sample size are needed to confirm these observations.

Clinical factors associated with unfavorable outcomes in HIV-positive tuberculosis patients

The objective: to identify clinical factors with the highest sensitivity and specificity associated with an unfavorable outcome in the patient with tuberculosis and HIV infection.Subjects. 363 patients with TB/HIV co-infection. Group 1 – 59 (16.3%) patients with the unfavorable outcome, Group 2 – 304 (83.7%) patients with a favorable outcome.Methods: analysis of paired contingency tables by Pearson criterion, quantitative signs by Mann – Whitney test, simple and multiple logistic regression.Results. The following factors promoting unfavorable outcomes in the patient with TB/HIV co-infection with the highest sensitivity and specificity were identified: hemoglobin level (sensitivity – 78.0%; specificity – 73.7%), gastrointestinal candidiasis (72.9% and 84.5%), loose stool (40.7% and 97.4%), no lymphadenopathy (89.8% and 57.2%), and headache (49.2% and 88.5%). The combination of these clinical manifestations provides sensitivity of 78.0% and specificity of 94.4%.A formula is proposed for calculating the probability of an unfavorable outcome in the patient TB/HIV co-infection.

Level of IL-6 in cerebrospinal fluid is a preoperative predictor of short - term outcome in acquired hydrocephalus

Background: Acquired hydrocephalus (AH) is a common complication in patients with severe brain injury. Brain tissue injury has been proposed to induce a neuroinflammatory reaction reflected by cytokines release, particularly interleukin-6 (IL-6), which associates with early brain damage. The present study measured IL-6 in the cerebrospinal fluid (CSF) of AH patients and determined its relationship to functional outcome following shunt operation.Methods: The study included a total of 32 patients with a shunt operation due to hydrocephalus. CSF samples from 26 AH subjects and 6 iNPH patients were collected via lumbar puncture before surgery. IL-6 level was measured using the micro ELISA immunoassay method. AH subjects were dichotomized into good versus poor outcomes based on modified Rankin Scale (mRS) at 3 months after shunting.Results: CSF analysis demonstrated that IL-6 was significantly elevated in the CSF of the AH group compared to controls (p = 0.023). Within the AH group, eighteen (69.2%) had a good outcome while eight (30.8%) patients had a poor outcome. Mean IL-6 level in the good outcome group was approximately four-times higher than the poor outcome group (p = 0.004). Glasgow Coma Scale (GCS) on admission was significantly different between the two groups (p = 0.014). IL-6 level and admission GCS were significantly correlated with improvement of mRS score (r = 0.473, p = 0.015 and r = 0.691, p＜0.0001, respectively). Receiver operating characteristic curve analysis showed that both factors can accurately differentiate between patients with good versus poor functional outcome (AUC = 0.861, p = 0.0039 and AUC = 0.823, p = 0.0098, respectively). Conclusions: The CSF level of IL-6 is elevated in AH patients and higher levels correlate with improvement of post-shunt functional outcome. Therefore, IL-6 CSF level might serve as a complementary surrogate parameter for operative indication. A possible IL-6 threshold in clinical routine might be a 6.98-pg/ml cutoff value to rule out unresponsive and poor outcome AH patients that are under the 6.98-pg/ml threshold.

Relationship of Alberta Stroke Program Early CT Score (ASPECTS) with the outcome of ischemic stroke and the neurocognitive stroke biomarkers

Background Reliable and acceptable biomarkers are needed to anticipate the outcome and cognitive impairment following ischemic stroke. The goal of this research is to examine the association of ASPECTS with cognitive decline, biomarkers of stroke, and acute ischemic stroke outcomes. This study included 120 patients with ischemic stroke in the middle cerebral artery region. The initial NIHSS, non-contrast CT brain assessed by ASPECTS, and the biomarkers of cognitive decline such as ESR, CRP, S100B, MMP9, and glutamate were investigated. The Montreal Cognitive Assessment and modified Rankin scale (mRS) were evaluated after 3 months. Correlations between ASPECTS, MoCA, biomarkers of cognitive impairment, and mRS were done by Spearman correlation. Results The incidence of cognitive impairment in our patients was 25.8%. Stroke biomarkers (ESR, CRP, S100B, MMP9, and glutamate) were significantly increased in cognitively disabled individuals with significantly lower mean MoCA scores than in cognitively intact patients. There was a strong direct correlation linking the initial ASPECTS and total MoCA test score after 3 months follow-up. Cases with unfavorable outcomes were older, more incidence of hypertension, and had higher average initial NIHSS (P < 0.05). While the average ASPECTS scores for the favorable outcome group of patients were significantly higher and there was a significant negative correlation between the initial ASPECTS and modified Rankin Scale score. Conclusions ASPECTS is a reliable scale to identify the extent of acute ischemic injury and could participate in assessing the outcome. ASPECTS and particular neurocognitive stroke biomarkers will enable the early detection of post-stroke cognitive impairment. Trial registration Registration of Clinical Trial Research: ClinicalTrials.gov ID: NCT04235920