scholarly journals Evaluation of serum retinol-binding protein-4 levels as a biomarker of poor short-term prognosis in ischemic stroke

2018 ◽  
Vol 38 (5) ◽  
Author(s):  
Yan-yan Zhu ◽  
Jian-long Zhang ◽  
Li Liu ◽  
Yingbo Han ◽  
Xiaomin Ge ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Serum Levels ◽  
Retinol Binding Protein ◽  
Short Term ◽  
Poor Functional Outcome ◽  
Nihss Score ◽  
Retinol Binding Protein 4 ◽  
The Poor ◽  
Poor Outcomes

The aim was to investigate the relationship between retinol-binding protein 4 (RBP4) levels and short-term functional outcome, and to determine its possible role in acute ischemic stroke (AIS). In a prospective observational study, 299 first-ever AIS who were admitted to our hospital were included. Serum levels of RBP4 were assayed and severity of stroke was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score on admission. The prognostic value of RBP4 to predict the poor outcome within 3 months was compared with the NIHSS and with other known outcome predictors. The median age of the included patients was 66 (interquartile range (IQR): 55–77) years and 155 (51.8%) were women. A poor functional outcome was found in 88 patients (29.4%), and significantly higher RBP4 values were found in poor outcomes rather than good outcomes patients (P<0.001). The poor outcomes distribution across the RBP4 quartiles ranged between 9.3% (first quartile) and 60.8% (fourth quartile). In multivariate models comparing the second(Q2), third, and fourth quartiles against the first quartile of the RBP4, RBP4 in Q3 and Q4 were associated with poor functional outcome, and increased risk of poor functional outcome by 144% (OR: 2.44; 95% confidence interval (CI): 1.22–5.03) and 602% (7.02; 3.11–12.24), respectively. Interestingly, RBP4 improved the NIHSS score (area under the curve (AUC) of the combined model, 0.79; 95% CI: 0.74–0.85; P<0.001). The data showed that elevated serum levels of RBP4 at admission were associated with severity and prognosis of AIS, suggesting that vitamin A metabolism or impaired insulin signaling could be involved.

Abstract W P160: Elevated Lipoprotein A Levels Predict Worse Short-term Outcomes in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Alyana A Samai ◽  
Dominique J Monlezun ◽  
Amir Shaban ◽  
Alexander George ◽  
Janelle Cyprich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Serum Levels ◽  
Stroke Severity ◽  
Short Term ◽  
Poor Functional Outcome ◽  
Lipoprotein A ◽  
Stroke Registry ◽  
History Of

Background: Lipoprotein A (Lp(a)) is a risk factor for vascular disease; however, few studies have examined the relationship between serum levels of Lp(a) and patient outcomes in acute ischemic stroke (AIS). In this study, we sought to assess whether AIS patients with elevated Lp(a) levels exhibit characteristic differences in stroke severity, in-hospital complications, and short-term outcomes as compared to patients with normal Lp(a) levels. Methods: From our prospective stroke registry, patients consecutively admitted and diagnosed with AIS 07/2008-10/2013 were included if Lp(a) levels were measured during admission. Regressions, adjusting for key covariates, analyzed outcomes in patients with elevated (+) and severely elevated (++) Lp(a) with respect to normal (-) Lp(a). The primary outcome was poor functional outcome (modified Rankin Scale > 2) on discharge. Results: Among the 1,453 patients in our stroke registry, 159 patients met our inclusion criteria; 24 patients (15.1%) were in the +Lp(a) group and 37 patients (23.3%) in the ++Lp(a) group. After adjustment for total cholesterol, LDL, HDL, and triglycerides, patients with ++Lp(a) were more than twice as likely to experience poor functional outcome (OR=2.48, 95% CI 1.0781-5.7231, p=0.033) as those with -Lp(a). Adjusting for age, NIHSS baseline, history of diabetes, admission glucose level, and tPA administration, patients with ++Lp(a) were more than 2.5 times more likely to experience poor functional outcome (OR=2.59, 95% CI 1.0129-6.6282, p=0.047) as compared to those with -Lp(a). Conclusions: Lp(a) elevation predicts higher odds of poor functional outcomes for patients with AIS compared to patients with normal levels. Our findings support the utility of Lp(a) level as a clinically useful biomarker in the development of patient risk profiles.

Abstract TP204: Neutrophil-to-lymphocyte Ratio Predicts Short-term Functional Outcome in Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Meyung Kug Kim ◽  
Yoon Suk Ha ◽  
Bong Goo Yoo
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Nihss Score ◽  
Poor Outcome ◽  
The Poor

Introduction: As indicators of the systemic inflammatory response, the neutrophil-to-lymphocyte ratio (NLR) have been proposed to predict the clinical outcome in cardiovascular disease, diabetes, and various malignancies. We assessed the significance of NLR as a predictor of the outcome in patients with acute ischemic stroke. Methods: We retrospectively analyzed the clinical characteristics, laboratory parameters, and NLR in 356 consecutive patients (62.2% men, mean age 65.8±13.0 years) within 3 days after the onset of acute ischemic stroke between July 2012 and March 2015. The NLR was calculated from the differential counts by dividing the neutrophil number by the lymphocyte number at the time of admission. All subjects were divided into four groups according to quartiles of the NLR. Outcomes were measured as 3-month modified Rankin scale (mRS) score. A good functional outcome was defined as a mRS of 0-2 points, whereas a poor outcome was defined as a mRS of >2 points. Multivariate logistic regression analysis was used to assess association among the clinical, inflammatory and serological parameters including NLR and mRS scores. Results: The frequency of atrial fibrillation, heart failure, hypertension, and diabetes, the NIHSS score at admission, and the level of hs-CRP, D-dimer and the NLR were each significantly higher in the poor outcome group (p < 0.05). The cut-off values of NLR and NIHSS score at admission for prediction of the poor outcome were 2.135 (sensitivity 0.864 and specificity 0.533) and 3.5 (sensitivity 0.862 and specificity 0.787), respectively. In age-adjusted analysis, the NLR were significantly correlated with 3-month mRS score (partial r = 0.329, p < 0.001) and NIHSS score at discharge (partial r = 0.301, p < 0.001). Multivariate logistic regression analysis demonstrated that age of ≥65 (OR, 10.2; 95% CI, 3.31-31.21, p < 0.001), presence of diabetes mellitus (OR, 3.3; 95% CI, 1.36-8.12, p = 0.008), NIHSS score of ≥4 (OR, 26.4 95% CI, 9.81-71.15, p < 0.001), NLR of ≥2.135 (OR, 9.2; 95% CI, 3.18-26.4, p < 0.001) were independently associated with poor functional outcome. Conclusion: The NLR is a useful marker for short-term functional outcome in acute ischemic stroke. The NLR may have a role in risk stratification for predicting poor outcome.

scholarly journals Association of Level and Increase in D‐Dimer With All‐Cause Death and Poor Functional Outcome After Ischemic Stroke or Transient Ischemic Attack

2021 ◽  
Author(s):  
Huiqing Hou ◽  
Xianglong Xiang ◽  
Yuesong Pan ◽  
Hao Li ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Transient Ischemic Attack ◽  
Cox Regression ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Poor Outcomes ◽  
Ischemic Attack ◽  
High Level ◽  
D Dimer

Background D‐dimer is involved in poor outcomes of stroke as a coagulation biomarker. We aimed to investigate the associations of the level and increase in D‐dimer between baseline and 90 days with all‐cause death or poor functional outcome in patients after ischemic stroke or transient ischemic attack. Methods and Results We collected data from the CNSRIII (Third China National Stroke Registry) study. The present substudy included 10 518 patients within 7 days (baseline) of ischemic stroke or transient ischemic attack and 6268 patients at 90 days. Poor functional outcome at 1 year was assessed on the basis of the modified Rankin Scale (≥3). Multivariable Cox regression or logistic regression was used to assess the association of D‐dimer levels with all‐cause death or poor functional outcome. D‐dimer levels at 90 days were lower than those at baseline (1.4 µg/mL versus 1.7 µg/mL; P <0.001). Higher baseline D‐dimer level was associated with all‐cause death (adjusted hazard ratio [HR], 1.77; 95% CI, 1.25–2.52; P =0.001) and poor functional outcome (adjusted odds ratio [OR], 1.49; 95% CI, 1.23–1.80; P <0.001) during 1‐year follow‐up. Higher D‐dimer level at 90 days was also associated with poor outcomes independently. Furthermore, an increase in D‐dimer levels between baseline and 90 days was associated with all‐cause death (since 90 days to 1 year after index event) (adjusted HR, 1.99; 95% CI, 1.12–3.53; P =0.019) but not with poor functional outcome (adjusted OR, 1.08; 95% CI, 0.82–1.41). Conclusions Our study shows that high level and an increase in D‐dimer between baseline and 90 days are associated with poor outcomes in patients after ischemic stroke or transient ischemic attack.

scholarly journals Assessment of leptomeningeal collateral status using single-phase computed tomography angiography and its clinical value

2021 ◽  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Single Phase ◽  
Reperfusion Therapy ◽  
Modified Rankin Scale ◽  
Short Term ◽  
Clinical Value ◽  
Nihss Score ◽  
The Poor ◽  
Maximal Intensity Projection

At present, there is a lack of consensus regarding the high-cost performance method for evaluating the leptomeningeal collateral (LMC) status, and there are only few reports on the relationship between the LMC status and short-term neurological improvements in patients with acute middle cerebral artery (MCA) stroke. To evaluate the LMC status using single-phase computed tomography angiography (CTA) and assess the effect of the LMC status on short-term outcomes in patients with acute MCA regional ischemic stroke without reperfusion therapy. Thirty patients with acute MCA regional ischemic stroke without reperfusion therapy were sampled prospectively. Then, 256-layer single-phase CTA (using enhanced computed tomography, maximal intensity projection technology and multi-plane volume reconstruction) was used to measure each patient’s LMC status using the MCA regional collateral score. The correlation between the LMC status and changes in the National Institutes of Health Stroke Scale (NIHSS) score was assessed. Differences in the modified Rankin scale score at 3 months after discharge between patients with a good (MCA territory collateral score ≥2) and those with a poor (MCA territory collateral score 0–1) LMC status were assessed. The NIHSS score change between admission and discharge correlated with the LMC status at admission (r = 0.88, p = 0.03). Three months after discharge, the mean modified Rankin scale scores in the poor and good LMC status groups were 1.91 ± 1.65 and 1.03 ± 1.36, respectively (p = 0.0394). The NIHSS scores at 3 months after discharge in the poor and good LMC status groups were 4.31 ± 4.29 and 2.16 ± 2.06, respectively (p = 0.0489). Our findings can further reinforce the understanding of the appropriate assessment of LMCs and its clinical value. A 256-slice single-phase CTA-maximal intensity projection can provide good assessment of the LMC status. In patients with MCA regional acute ischemic stroke, the LMC status may predict the short-term prognosis. Further research is needed to confirm these findings.

scholarly journals Neutrophil Lymphocyte Ratio as a Prognostic Marker in Acute Ischemic Stroke: a Systematic Review and Meta-analysis

2021 ◽  
Vol 18 (4) ◽  
pp. 573-579
Author(s):  
Subodh Sharma Paudel ◽  
Bikram Thapa ◽  
Ritesh Luitel
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Prognostic Marker ◽  
Meta Analysis ◽  
Forest Plot ◽  
Poor Functional Outcome ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
The Poor

Background: Acute ischemic stroke leads to an inflammatory response and the neutrophil-to-lymphocyte ratio is an inflammatory indicator for determining prognosis in acute ischemic stroke. This meta-analysis aims to show evidence that neutrophil-to-lymphocyte can act as an independent and early prognostic marker in cases of acute ischemic stroke. Methods: Databases of PubMed, and Embase were searched for literature. Relevant data were extracted by SSP and BT from eligible literature. Odds ratios with 95% confidence intervals were pooled and a Forest plot was used to evaluate the prognostic value of neutrophil-to-lymphocyte in acute ischemic stroke. Modified Rankin Scale ? 3 was defined as a poor functional outcome. A funnel plot is used to show the symmetric distribution and no publication bias. Results: According to Joanna Briggs Institute assessment for analytical observational studies, the studies included are of fair to good quality. Eight relevant studies with 3011 patients were included, one with no data on OR. The pooled OR of 6 studies with the poor functional outcome at 3 months was 1.47(P<0.02 95%CI: 1.40-2.31) while one study with the poor functional outcome at discharge was OR=2.49. Conclusions: In patients with acute ischemic stroke, elevated neutrophil-to-lymphocyte correlates with poorer functional outcome and increased chances of developing symptomatic Intracranial Hemorrhage. Baseline neutrophil-to-lymphocyte can be an inexpensive and easily available biomarker, especially in resource-poor settings, for predicting clinical outcomes in patients with ischemic stroke. Keywords: Ischemic stroke; lymphocyte; neutrophil; prognosis.

Abstract WP22: A Scoring System Based on Age and DWI Volume Predicts Poor Functional Outcome Following Endovascular Treatment for Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
John Liggins ◽  
Nishant K Mishra ◽  
Hayley M Wheeler ◽  
Matus Straka ◽  
Stephanie Kemp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scoring System ◽  
Poor Functional Outcome ◽  
Nihss Score ◽  
Clinical Variables ◽  
Poor Outcome ◽  
New Scoring

Background: The Houston IAT (HIAT) score predicts poor outcome following endovascular stroke therapy based on clinical variables (age, serum glucose, and NIHSS score). We aimed to validate the HIAT score in an independent cohort of patients treated with endovascular therapy (DEFUSE 2) and determine if prediction of poor outcome could be improved by including neuroimaging variables in the prediction score. Methods: Patients enrolled in the DEFUSE 2 study had a clinical diagnosis of acute ischemic stroke and underwent MRI prior to endovascular treatment. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6 at day 90. The relationship between baseline clinical and neuroimaging variables and poor functional outcome was assessed using univariate and multivariate logistic regression. Statistically significant variables in the multivariate model were used to create a new scoring system. We evaluated the new scoring system and the HIAT score using ROC analysis. Results: One hundred and ten patients were included in the analysis; forty-two patients had a poor functional outcome. Validation of the HIAT score demonstrated similar ROC properties in the DEFUSE 2 cohort (AUC=0.69) compared to the Houston derivation cohort (AUC=0.73). In DEFUSE 2, age (p=0.001), baseline DWI volume (p=0.09), baseline NIHSS score (p=0.03) and hypertension (p=0.003) were associated with poor functional outcome in univariate analysis. In multivariate analysis, age (p<0.001) and baseline DWI volume (p=0.03) were independent predictors of poor functional outcome. Based on this we developed a new scoring system with a maximum of 3 points awarded for age (0 points, < 55; 1 point, 56-69; 2 points, 70-79; 3 points, ≥ 80) and a maximum of 1 point awarded for baseline DWI volume (0 points, volume ≤ 15 cc; 1 point, volume >15 cc). The percentage of patients with poor functional outcomes increased with the number of points awarded (0% poor outcomes in patients with 0 points, 25% with 1 point, 30% with 2 points, 75% with 3 points, and 89% with 4 points). The AUC for the new scoring system was 0.82. Conclusion: The new scoring system that incorporates baseline DWI volume and age predicts poor outcome more accurately than a scoring system based on clinical variables alone.

scholarly journals Outcome predictors of intravenous thrombolytic therapy in acute ischemic stroke patients: an Egyptian center experiences

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Mohamed A. Tork ◽  
Hany M. Aref ◽  
Hala M. El-Khawas ◽  
Mohamed F. Khalil ◽  
Ahmed ElSadek
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cerebral Vessels ◽  
Outcome Predictors ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Nihss Score ◽  
Stroke Lesion

Abstract Background Intravenous thrombolytic therapy remains the guideline-recommended treatment to improve outcomes after acute ischemic stroke. However, the functional outcome among patients with acute ischemic stroke after receiving intravenous thrombolytic therapy is influenced by huge variety of factors, and this was the aim of our study to evaluate the outcome predictors of intravenous thrombolytic therapy in a sample of Egyptian patients with acute ischemic stroke. Methods We enrolled 183 acute ischemic stroke patients who were treated with intravenous recombinant tissue plasminogen activator (IV rtPA) according to the last updated guidelines of American Heart Association and American Stroke Association (AHA/ASA) from February 2018 to February 2020; however, only 150 patients of them completed our study plan till the end. Data of study variables were collected, analyzed statistically and correlated with the functional outcome 3 months after receiving IV rtPA using the modified Rankin Scale (mRS). Results Good functional outcome was seen in 98 (65.3%) patients and poor functional outcome was seen in 52 (34.7%) patients. Multivariate analysis of the study variables was done to detect the significant independent predictors of the functional outcome. Atrial fibrillation (AF) (P value < 0.001*OR 6.28* (95% C.I)), hypertension (P value 0.001*OR 3.65*(95% C.I)), diabetes mellitus (DM) (P value 0.009*OR 2.805*(95% C.I)), increased National Institute of Health Stroke Scale (NIHSS) score 24 h after receiving IV rtPA (P value 0.003* OR 8.039* (95% C.I)), increased pulsatility index (PI) value in cerebral vessels at the same side of stroke lesion (P value 0.038* OR 42.48*(95% C.I)) were the significant independent predictors of poor functional outcome. On the other hand decreased NIHSS score 24 h after receiving IV rtPA (P value 0.003* OR 0.124*(95% C.I)), Normal value of PI in cerebral vessels at the same side of stroke lesion (P value 0.038* OR 42.48*(95% C.I)) were the significant independent predictors of good functional outcome. Conclusion Intravenous thrombolytic therapy improves the functional outcome of acute ischemic stroke patients. Also, AF, hypertension, DM, NIHSS 24 h after receiving IV rtPA and PI could be used as independent predictors of the functional outcome.

Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry

2021 ◽  
pp. 1-7
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Kuniyuki Nakamura ◽  
Tetsuro Ago ◽  
Masahiro Kamouchi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Neurological Deterioration ◽  
Stroke Outcome ◽  
Matched Cohort ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Chei Treatment

Introduction: Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia. Methods: We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3–6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study. Results: Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46–0.99]) and neurological deterioration (0.52 [0.31–0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40–0.92]) and between the treatment and neurological deterioration (0.47 [0.25–0.86]). Conclusions: Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.

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