Population-Based Validation of the iScore for Predicting Mortality and Early Functional Outcome in Ischemic Stroke Patients

2013 ◽  
Vol 41 (3-4) ◽  
pp. 169-173 ◽  
Author(s):  
Yannick Béjot ◽  
Agnès Jacquin ◽  
Benoit Daubail ◽  
Jérôme Durier ◽  
Maurice Giroud
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Population Based ◽  
Stroke Patients ◽  
Early Functional Outcome

Abstract 3263: Cystatin C is Associated with Early Functional Outcome in Acute Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Mi-Young Oh ◽  
Seung-Hoon Lee ◽  
Chi Kyung Kim ◽  
Sang-Bae Ko ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Cystatin C ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Kidney Dysfunction ◽  
Nihss Score ◽  
Hb A1c ◽  
Early Functional Outcome

Background: Cystatin C, a competitive inhibitor of lysosomal cysteine protease, is regarded as a sensitive marker of kidney dysfunction. Lower estimated glomerular filtration rate (eGFR) was associated with poor prognosis and all cause of mortality in stroke patients. Cystatin C was a more sensitive and accurate marker to detect subclinical kidney dysfunction, compared to creatinine, or creatinine based eGFR. We evaluated whether Cystatin C would predict functional outcome, independent of eGFR level in ischemic stroke. Methods: We evaluate consecutive patients with acute stroke who were admitted to Seoul National University Hospital between January 2008 and May 2011. We defined the unfavorable outcome group as containing each patient with a discharge mRS score of 1 with admission NIHSS score of 0 to 7, a discharge mRS score of 2 with admission NIHSS score 8 to 14, or a discharge mRS score of ≥3 with admission NIHSS score 15. Results: Among the total patients, 544(76.2%) patients had unfavorable outcome at discharge. Participants with unfavorable outcome tended to be female, older and to have higher Cystatin C, CRP, fibrinogen and Hb A1c concentrations. The proportion of patient with unfavorable outcome was gradually increased according to the cystatin C quartile. Compared to the lowest quartile of Cystatin C (47.2<nmol/L), higher quartiles (47.2 -54.7, 54.7-65.7, 65.7≥nmol/L) were likely to have a higher chance of unfavorable outcome [adjusted OR (95%CI), 1.55(0.73-3.31), 2.66 (1.21-5.87) and 2.84(1.15-7.09)] after adjusting for age, diabetes, Hb A1c, fibrinogen, CRP, NIHSS scale on admission, hemorrhagic transformation, IV thrombolytic treatment. In contrast, eGFR did not show any significant association with unfavorable outcome. Compared to the lowest category of eGFR (≥60 ml/min/1.73m2), higher categories (45.0- 60.0, 15.0-45.0, ≤15.0 ml/min/1.73m2) did not show significant association with unfavorable outcome. Conclusions: An increased level of Cystatin C was associated with functional outcome in stroke patients. Cystatin C may be a potent predictor to predictor of functional outcome after ischemic stroke.

Abstract TP169: Neuroprotective Effect of Pre-stroke Statin Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Maria C Zurrú ◽  
Claudia Alonzo ◽  
Laura Brescacín ◽  
Geraldina Linares ◽  
Natalia Balian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Statin Therapy ◽  
Functional Outcome ◽  
Neuroprotective Effect ◽  
Vascular Diseases ◽  
Vascular Risk Factor ◽  
Statin Treatment ◽  
Stroke Patients ◽  
Glucose Levels ◽  
Early Functional Outcome

Background and purpose: In observational studies, patients under statin therapy at the time of stroke onset have lower likelihoods of mortality and poor functional outcome. This neuroprotective effect could be related to anti-inflammatory and antiplatelet actions of statins. Our objective was to evaluate early functional outcome in a cohort of ischemic stroke patients. Design and Method: stroke patients were included in PROTEGE-ACV, a multidisciplinary secondary prevention program aimed to improve adherence to clinical practice guidelines. Vascular risk factor (VRF) profile and control, and statin treatment in the year before stroke were collected, and functionality one-month after discharge was evaluated using modified Rankin scale. Results: 1981 ischemic stroke patients (20% TIA) were included between December 2006 and December 2015; mean age was 76±11 years with 57% females. Patients receiving statins (n 713, 38%) had a significant higher prevalence of hypertension, diabetes, dislipidemia, obesity, metabolic syndrome, coronary heart disease, peripheral artery disease, chronic renal failure and previous stroke. Both groups had similar blood pressure, and patients under statins had lower total cholesterol (182±42 vs 200±40 mg/dL, p 0.00001), LDL-c (106±36 vs 128±47, p 0.00001) with similar levels of HDL-c and triglycerides; these patients also had lower GFR (62±23 vs 67±31 mL/min, 0.0003) and higher fasting glucose levels (103±26 vs 99±21 mg/mL; p 0.0003). Predictors of bad outcome in the multivariate analysis adjusted by age and VRF are shown in the table. Conclusion: Even though patients under statin treatment before stroke had higher prevalence of vascular diseases, they have better functional outcomes one-month after the event. In our cohort, previous statin use seems to have neuroprotective effect, which could be related to modulation of inflammatory response, platelet aggregation, fibrinolysis and nitric oxide production.

Abstract 3305: Intensive Lipid-lowering and Early Functional Outcome in Acute Ischemic Stroke: Propensity Score Matching Analysis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Woo-Keun Seo ◽  
Mi-Yeon Eun ◽  
Ji Hyun Kim ◽  
Kyungmi Oh ◽  
Seong-Beom Koh
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Propensity Score Matching ◽  
Favorable Outcome ◽  
Lipid Lowering ◽  
Stroke Patients ◽  
Early Functional Outcome ◽  
Significant Difference

Background This retrospective case-control study was designed to compare the effect of early high-dose atorvastatin treatment on early functional outcome in acute ischemic stroke patients using propensity score matching (PSM). Study design and population Acute ischemic stroke patients were selected from prospectively collected hospital-based stroke registry. Because the purpose of this study was comparing two treatment strategies for statin treatment, patients with cardioembolic stroke subtype or other-etiology were excluded. Patients were allocated into two groups: Intensive treatment group (atorvastatin 80mg; IT) and conventional treatment group (atorvastatin 10-40mg or other lipid-lowering agent; CT). All the patients were prescribed for aspirin 300mg at admission except for the patients who were considered for thrombolysis. After admission, the patients were prescribed for antithrombotics according to the clinical decision of the attending physician. All other practice guidelines except management of dyslipidemia were followed for previously published guidelines for management of stroke patients. Detailed demographic factors, vascular risk factors, laboratory parameters and vascular imaging were recorded. The end points were composed of two parameters. First, early neurological deterioration (END) defined as 4 points or more deterioration of National Institute of Health Stroke Score (NIHSS) from admission to the seventh hospital day. In case of discharge before the seventh hospital day, NIHSS at discharge was substituted for that of the seventh hospital day. Second, favorable outcome was defined as 0-2 of modified Rankin Score (mRS) measured at 3 months from the onset of stroke. Because baseline characteristics between the groups was supposed to be different, propensity score matching was performed to adjust for potential selection biases and confounding. A logistic regression model was fitted relating treatment strategies (IT and CT) to pretreatment patient characteristics. For the comparison between IT and CT in terms of END and favorable outcome, McNemar test were performed. Results: Among the study population, data of 178 patients for IT and 218 patients for CT were collected. Between the groups, history of previous stroke, TOAST classification, and previous medication of clopidogrel showed significant difference. There was no significant difference of 90-day favorable outcome and END. After PSM, 116 patients for each group were selected. There was no significant difference of baseline characteristics between the groups after PSM. There was no significant difference between IT and CT in terms of 90-day favorable outcome (75.3% in IT and 78.4% in CT, p = 0.457) and END (IT 72.3%, CT 78.6%, p = 0.097). Conclusion In this study, effect of intensive lipid-lowering treatment in acute stroke patients was negligible in terms of early functional outcome.

scholarly journals Disparities in the Use of Intravenous t-PA among Ischemic Stroke Patients: Population-based Recent Temporal Trends

2019 ◽  
Vol 28 (5) ◽  
pp. 1243-1251 ◽  
Author(s):  
Mohammad A. Faysel ◽  
Jonathan Singer ◽  
Caroline Cummings ◽  
Dimitre G. Stefanov ◽  
Steven R. Levine
Keyword(s):  
Ischemic Stroke ◽  
Temporal Trends ◽  
Population Based ◽  
Stroke Patients

Abstract 3313: Outcomes of “Drip-and-Ship” Paradigm Among Patients with Acute Ischemic Stroke. Results of a State Wide Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Gustavo J Rodriguez ◽  
M. Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Population Based ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Stroke Patients ◽  
Frequency Distributions ◽  
Number Of Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: “Drip-and-ship” denotes patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 hours to a comprehensive stroke center. Although drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population based level. Methods: State-wide estimates of thrombolysis, associated in-hospital outcomes and mortality were obtained from 2008-2009 Minnesota Hospital Association (MHA) data. Patient numbers and frequency distributions were calculated for state-wide sample of patients hospitalized with a primary diagnosis of ischemic stroke. Patients outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. Results: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n=473) or drip-and-ship paradigm (n=129). The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with drip-and-ship paradigm (8.5% versus 3.1, p=0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or drip-and-ship paradigm (5.9% versus 7.0%). The mean hospital charges were $65,669 for primary ED arrival and $47,850 for drip-and-ship treated patients (p<0.001). Conclusions: The results of drip-and-ship paradigm compare favorably with IV rt-PA treatment through primary ED arrival in this state-wide study.

scholarly journals Brain-derived neurotrophic factor in peripheral blood mononuclear cells and stroke outcome

2018 ◽  
Vol 243 (15-16) ◽  
pp. 1207-1211 ◽  
Author(s):  
Martin Pedard ◽  
Céline Brenière ◽  
Nicolas Pernet ◽  
Catherine Vergely ◽  
Yannick Béjot ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Peripheral Blood Mononuclear Cells ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Stroke Outcome ◽  
Stroke Patients ◽  
Peripheral Blood Mononuclear ◽  
Ischemic Brain ◽  
Blood Mononuclear Cells

Stroke outcome is dependent on brain-derived neurotrophic factor (BDNF)-dependent neuroplasticity. As peripheral blood mononuclear cells (PBMC) contain BDNF, diapedesis of these cells might be followed by BDNF delivery to the ischemic brain. To test this hypothesis, we investigated the association between BDNF levels in PBMC and functional outcome in patients with ischemic stroke. BDNF was measured in PBMC that were isolated from ischemic stroke patients ( n = 40) just before (day 0) and after (days 1 and 3) fibrinolysis. Three months after stroke, patients were stratified using the modified Rankin Scale (mRS) according to the unfavorable (mRS scores 3–6) and favorable (mRS scores 0–2) functional outcome. We used univariate and multivariate logistic regressions to assess the relationship between BDNF levels in PBMC and functional outcome. BDNF levels in PBMC decreased from day 0 to day 3 in patients with unfavorable outcome, while they remained stable in patients with favorable outcome. Patients with favorable outcome exhibited at day 3 higher PBMC-BDNF levels than patients with unfavorable outcome and the levels were associated with good outcome (odd ratio: 12.0; 95% confidence interval, 1.4–106.2, P = 0.023). PBMC-BDNF levels remained a predictor of stroke outcome after adjusting from cardiovascular risk, interval between admission and fibrinolysis, stroke severity from hospital admission to discharge, lymphocytes count, neutrophils/lymphocytes ratio at admission. Favorable functional outcome in ischemic stroke patients that benefited from fibrinolysis was predicted by a high BDNF level in PBMC, suggesting that PBMC might serve as a cellular vector to deliver BDNF to the ischemic brain. Impact statement There are a great number of arguments suggesting that BDNF could be involved in stroke recovery dependent of neuroplasticity. Methods that can enhance BDNF levels in the ischemic brain could therefore have great clinical value. Peripheral blood mononuclear cells (PBMC) that contain BDNF and infiltrate early and sustainably the ischemic brain might be used as a cellular vector to deliver BDNF to the ischemic brain and consequently promote recovery. This work is important in this field to show if this BDNF derived from BDNF could exert a positive action on stroke recovery. Our main results showed that a high BDNF level at day 3 after hospital admission was associated with a 12.4 fold increase in favorable outcome after adjusting for still recognized prognostic markers. The new information in this field is this finding identifies PBMC as an attractive cellular vector to deliver BDNF to the ischemic brain.

scholarly journals Predictors of the functional outcome after thrombolysis in an Egyptian patients’ sample

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
H. M. Eldeeb ◽  
D. H. Elsalamawy ◽  
A. M. Elabd ◽  
H. S. Abdelraheem
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Functional Outcome ◽  
Arterial Occlusion ◽  
University Hospital ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Predicting Factors ◽  
Egyptian Patients ◽  
Cerebrovascular Stroke

Abstract Background About 6.2 million individuals worldwide and approximately 200 Egyptians/100,000 citizens have cerebrovascular stroke annually, and only less than 1% of stroke patients received intravenous (IV) thrombolysis in 2014. Outcome of the ischemic stroke after IV thrombolysis varies, and there is lack of data about the predicting factors that contributes to the outcome of ischemic strokes after IV thrombolysis in Egypt. Objective The aim of this work is to study the predictors of the functional outcome of ischemic cerebrovascular stroke after IV thrombolysis in Egyptian patients. Patients and methods This is a prospective study that includes acute ischemic stroke patients who received IV thrombolysis at the Alexandria University Hospital during the year from February 2017 to February 2018, and they were evaluated initially by Rapid Arterial Occlusion Evaluation (RACE) scale and followed-up serially for 6 months after thrombolysis using the National Institutes of Health Stroke Scale (NIHSS) and modified ranking score (mRS). Results Forty-five patients are included; 56% had favorable functional outcome (mRS 0–2) after 6 months, 68% had ≥ 4 points improvement in NIHSS after 6 months, and 13% had hemorrhagic conversion with 18% mortality rate. High initial RACE scale and long hospital stay are associated with poor functional outcome 6 months after thrombolysis. Conclusion Stroke severity demonstrated by high initial RACE and the duration of hospital stay are the two most significant predictors with an impact on the functional outcome of ischemic cerebrovascular stroke after thrombolysis.

scholarly journals Can clinical risk factors predict functional recovery in ischemic stroke patients with pre-stroke depression?

2019 ◽  
Author(s):  
Leah Wormack ◽  
Brice Blum ◽  
Benjamin Bailes ◽  
Thomas Nathaniel
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Risk Factors ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
Clinical Risk ◽  
Predictive Variables ◽  
Stroke Population ◽  
Thrombolysis Therapy

Abstract Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 – 104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 –43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 –0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 –0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

Abstract TP63: Lacunarization After Endovascular Treatment: a Surrogate Marker of Good Functional Outcome

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Pedro Cardona ◽  
Helena Quesada ◽  
Blanca Lara ◽  
Nuria Cayuela ◽  
Xavier Ustrell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Surrogate Marker ◽  
Source Image ◽  
Stroke Patients ◽  
Good Functional Outcome ◽  
Lacunar Syndrome ◽  
Contrast Ct

Introduction: Multiple randomized trials have demonstrated that endovascular treatment (EVT) in selected stroke patients is associated with good clinical outcome (90 days mRankin 0-2: 44-60%). However the percentage of good functional outcome could be improved if we consider patients without cortical clinical impairment with presentation of classical lacunar syndrome despite non-lacunar radiological infarct. Methods: Consecutive patients with ischemic stroke who received endovascular reperfusion were retrospectively analyzed between May 2010 and April 2015. On admission NCCT (non-contrast CT) and CTASI (CT Angiography Source Image) were performed in stroke patients according to our hospital guidelines. We independently applied the ASPECT score in all baselines NCCT, CTASI and follow-up NCCT 24H, and magnetic resonance (MR) during hospitalization. Five pure clinical lacunar syndromes (CLS) were recorded within 24h exam after EVT in our stroke unit and 90 days follow-up Results: We review 428 thrombectomies of patients with acute ischemic stroke. Ninety-five percent of occlusions were located in middle cerebral artery or terminal internal carotid, (49% women, mean age 65+/-13 years; NIHSS at admission: 17; baseline mRS 0-1:96%). Successful recanalization (TICI 2b-3) was achieved in 81%. At 3 months good functional outcome (mRS 0-2) was seen in 51% and death occurred in 13%. CLS were indentified in 42% patients within 24h after EVT. This clinical syndromes were associated to ASPECT score in 24 NCCT and CTASI in patients with recanalization 2b-3 (p:0.003), but only 4% had a defined radiological lacunar stroke on MR. CLS turned out to be one of independence predictors of good outcomes (Rankin 0-2 at 90d) after adjustment for ages, sex and baseline NIHSS scores (OR 1.85; CI:1.4-3.1; p:0.001). Also CLS were still present in 34% of patients with Rankin>2 at 90d (Rankin 3:26%; Rankin 4:7%) Conclusions: These results suggest that a neurological exam 24h after EVT with identification of pure lacunar syndrome can predict favorable functional outcome at 90days. This group of patients presents radiological findings with an unusual location and size with regard to CLS. We suggest to consider patients with CLS as good outcome after EVT regardless 90d mRankin>2.

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