scholarly journals Influence of Age on Thrombolysis Outcome in Wake-Up Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2898-2900 ◽  
Author(s):  
Dulka Manawadu ◽  
Shankaranand Bodla ◽  
Jeff Keep ◽  
Lalit Kalra
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Reference Group ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Old Patients ◽  
Baseline Characteristics ◽  
Poor Outcomes ◽  
Better Than

Background and Purpose— Thrombolysis in patients >80 years remains controversial; we hypothesized that >80-year-old patients with wake-up ischemic stroke (WUIS) will benefit from thrombolysis despite risks because of poor outcomes with no treatment. Methods— The study included 68 thrombolysed patients with WUIS (33 [48%] >80 years), 54 nonthrombolysed patients with WUIS (21 [39%] >80 years), and 117 patients (>80 years old) thrombolysed within 4.5 hours of symptom onset (reference group). Mortality and modified Rankin Scale (mRS) were assessed at 90 days. Results— Baseline characteristics of thrombolysed and nonthrombolysed >80 and ≤80-year-old patients with WUIS were comparable. Thrombolysis outcomes in >80-year-old patients with WUIS were better than in nonthrombolysed >80-year-old patients with WUIS (90-day mortality: 24% versus 47%, P =0.034; mRS 0–2: 30% versus 5%, P =0.023; mRS 0–1: 15% versus 5%, P =0.24) and comparable with thrombolysed ≤80-year-old patients with WUIS. Thrombolysis was associated with odds ratio 0.27 (95% confidence interval, 0.05–0.97) for mortality and odds ratio 28.6 (95% confidence interval, 1.8–448) for mRS 0 to 2 at 90 days in >80-year-old patients with WUIS after adjusting for stroke severity and risk factors. Conclusions— Thrombolysis may be associated with greater benefit in >80-year-old patients with WUIS but a selection bias favoring thrombolysis in those most likely to benefit may significantly reduce interpretability of these findings.

scholarly journals Ultra-Early Intravenous Stroke Thrombolysis

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2913-2916 ◽  
Author(s):  
Daniel Strbian ◽  
Peter Ringleb ◽  
Patrik Michel ◽  
Lorenz Breuer ◽  
Jyrki Ollikainen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Treatment Time ◽  
Continuous Variable ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Excellent Outcome ◽  
Stroke Thrombolysis ◽  
Treatment Onset

Background and Purpose— We previously reported increased benefit and reduced mortality after ultra-early stroke thrombolysis in a single center. We now explored in a large multicenter cohort whether extra benefit of treatment within 90 minutes from symptom onset is uniform across predefined stroke severity subgroups, as compared with later thrombolysis. Methods— Prospectively collected data of consecutive ischemic stroke patients who received IV thrombolysis in 10 European stroke centers were merged. Logistic regression tested association between treatment delays, as well as excellent 3-month outcome (modified Rankin scale, 0–1), and mortality. The association was tested separately in tertiles of baseline National Institutes of Health Stroke Scale. Results— In the whole cohort (n=6856), shorter onset-to-treatment time as a continuous variable was significantly associated with excellent outcome ( P <0.001). Every fifth patient had onset-to-treatment time≤90 minutes, and these patients had lower frequency of intracranial hemorrhage. After adjusting for age, sex, admission glucose level, and year of treatment, onset-to-treatment time≤90 minutes was associated with excellent outcome in patients with National Institutes of Health Stroke Scale 7 to 12 (odds ratio, 1.37; 95% confidence interval, 1.11–1.70; P =0.004), but not in patients with baseline National Institutes of Health Stroke Scale>12 (odds ratio, 1.00; 95% confidence interval, 0.76–1.32; P =0.99) and baseline National Institutes of Health Stroke Scale 0 to 6 (odds ratio, 1.04; 95% confidence interval, 0.78–1.39; P =0.80). In the latter, however, an independent association (odds ratio, 1.51; 95% confidence interval, 1.14–2.01; P <0.01) was found when considering modified Rankin scale 0 as outcome (to overcome the possible ceiling effect from spontaneous better prognosis of patients with mild symptoms). Ultra-early treatment was not associated with mortality. Conclusions— IV thrombolysis within 90 minutes is, compared with later thrombolysis, strongly and independently associated with excellent outcome in patients with moderate and mild stroke severity.

Abstract WP220: The Effect of Self-Reported Optimism on the Incidence of Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ahmed Malik ◽  
Haseeb Rahman ◽  
Adnan Qureshi ◽  
Martha A Wojtowycz
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Standard Deviation ◽  
Confidence Interval ◽  
Stroke Prevention ◽  
Odds Ratio ◽  
Categorical Variables ◽  
The Mean ◽  
Baseline Characteristics

Purpose: The purpose of this study is to determine whether having an optimistic outlook on life decreases the risk of developing incident stroke. Methods: Participants who developed incident stroke in Americans’ Changing Lives study, and participants who did not develop incident stroke (dependent variable) in were compared for demographics, baseline characteristics, comorbidities, and optimistic outlook on life. Numbers and proportions of respondents in both groups were reported for all categorical variables, while mean and standard deviation were reported for age. All statistically significant variables from the above analyses were entered into a logistic regression analysis to ascertain the association between optimistic outlook on life and stroke. Results: Of the 98,577,928 participants, 73,040,055 did not have stroke at baseline. There were 599,190 who developed incident stroke and 1,104,751 who did not develop incident stroke. The mean age (standard deviation) was lower in those who developed incident stroke compared to those who did not [45.9 (13.8) vs. 46.4 (9.9) p<.0001], and participants with an optimistic outlook on life, were 0.20 times less likely to develop stroke as those who did not have an optimistic outlook on life [OR (Odds ratio) 0.20 95% CI (95% confidence interval) 0.20,0.21], after adjusting for confounders. Conclusions: People who have an optimistic outlook on life are less likely to develop incident stroke. The protective value of optimism lends credence to the value of targeting unconventional risk factors in stroke prevention.

scholarly journals Parental risk factors for congenital diaphragmatic hernia – a large German case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Felicitas Schulz ◽  
Ekkehart Jenetzky ◽  
Nadine Zwink ◽  
Charlotte Bendixen ◽  
Florian Kipfmueller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Environmental Risk ◽  
Odds Ratio ◽  
Alcohol Intake ◽  
Case Control Study ◽  
Case Control ◽  
Parental Risk Factors ◽  
Healthy Control ◽  
Control Study

Abstract Background Evidence for periconceptional or prenatal environmental risk factors for the development of congenital diaphragmatic hernia (CDH) is still scarce. Here, in a case-control study we investigated potential environmental risk factors in 199 CDH patients compared to 597 healthy control newborns. Methods The following data was collected: time of conception and birth, maternal BMI, parental risk factors such as smoking, alcohol or drug intake, use of hairspray, contact to animals and parental chronic diseases. CDH patients were born between 2001 and 2019, all healthy control newborns were born in 2011. Patients and control newborns were matched in the ratio of three to one. Results Presence of CDH was significantly associated with maternal periconceptional alcohol intake (odds ratio = 1.639, 95% confidence interval 1.101–2.440, p = 0.015) and maternal periconceptional use of hairspray (odds ratio = 2.072, 95% confidence interval 1.330–3.229, p = 0.001). Conclusion Our study suggests an association between CDH and periconceptional maternal alcohol intake and periconceptional maternal use of hairspray. Besides the identification of novel and confirmation of previously described parental risk factors, our study underlines the multifactorial background of isolated CDH.

scholarly journals Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mabel Aoun ◽  
Rabab Khalil ◽  
Walid Mahfoud ◽  
Haytham Fatfat ◽  
Line Bou Khalil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
National Study ◽  
Artery Disease

Abstract Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

Subclinical atherosclerosis in children and adolescents with congenital heart disease

2020 ◽  
pp. 1-8
Author(s):  
Silvia M. Cardoso ◽  
Michele Honicky ◽  
Yara M. F. Moreno ◽  
Luiz R. A. de Lima ◽  
Matheus A. Pacheco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Congenital Heart ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

Abstract Background: Subclinical atherosclerosis in childhood can be evaluated by carotid intima-media thickness, which is considered a surrogate marker for atherosclerotic disease in adulthood. The aims of this study were to evaluate carotid intima-media thickness and, to investigate associated factors. Methods: Cross-sectional study with children and adolescents with congenital heart disease (CHD). Socio-demographic and clinical characteristics were assessed. Subclinical atherosclerosis was evaluated by carotid intima-media thickness. Cardiovascular risk factors, such as physical activity, screen time, passive smoke, systolic and diastolic blood pressure, waist circumference, dietary intake, lipid parameters, glycaemia, and C-reactive protein, were also assessed. Factors associated with carotid intima-media thickness were analysed using multiple logistic regression. Results: The mean carotid intima-media thickness was 0.518 mm and 46.7% had subclinical atherosclerosis (carotid intima-media thickness ≥ 97th percentile). After adjusting for confounding factors, cyanotic CHD (odds ratio: 0.40; 95% confidence interval: 0.20; 0.78), cardiac surgery (odds ratio: 3.17; 95% confidence interval: 1.35; 7.48), and be hospitalised to treat infections (odds ratio: 1.92; 95% confidence interval: 1.04; 3.54) were associated with subclinical atherosclerosis. Conclusion: Clinical characteristics related to CHD were associated with subclinical atherosclerosis. This finding suggests that the presence of CHD itself is a risk factor for subclinical atherosclerosis. Therefore, the screen and control of modifiable cardiovascular risk factors should be made early and intensively to prevent atherosclerosis.

Abstract 3572: Clinical Outcomes of the “Stroke100 Club”

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amy K Guzik ◽  
Rema Raman ◽  
Kain Ernstrom ◽  
Dawn M Meyer ◽  
Ajeet Sodhi ◽  
...  
Keyword(s):  
Regression Models ◽  
Young Patients ◽  
Older Age ◽  
Advanced Age ◽  
Stroke Severity ◽  
Old Patients ◽  
Multivariable Regression ◽  
Independent Variable ◽  
Poor Outcomes ◽  
Multivariable Regression Models

Background: Patients with advanced age or high NIHSS have poorer tPA outcomes. When combined, old age (≥80yo) and elevated NIHSS (≥20) may have an even worse outcome. Patients who are also in this “Stroke100 Club” (any combination of age and NIHSS ≥100) by other means, have not been fully assessed. We evaluated discharge destination, 90-day mRS, sICH and death in treated and untreated Stroke100 Club patients. We further compared patients with age ≥ 80 and NIHSS ≥ 20 (“80/20s”), those who reached 100 without both characteristics (“non80/20s”) and ‘controls’. Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for AIS patients (with and without tPA). Multivariable regression models including the Stroke100 group as an independent variable was used. Outcomes were adjusted for baseline mRS. For comparing categorical outcomes between controls, “80/20s” and “non80/20s” subgroups, a Fisher’s exact was used. Results: The IV tPA subset included 257 patients (mean age 71, 52% male, 85% white, mean NIHSS 12). 53 were in the “Stroke100 Club” (28 80/20, 25 non80/20), with more women (68% p= 0.002), higher NIHSS (22.5 p<0.0001), older age (mean age 86.4 p<0.0001), higher pre stroke mRS (34.6% mRS 3-6 vs 7.84%, p<0.0001), more HTN (p=0.045) and more afib (p= 0.008). There were 284 non tPA patients (mean age 69.52, 54% male, 85% white, mean NIHSS 5.92). 21 were in the “Stroke100 Club” (14 80/20, 7 non80/20), with higher NIHSS (23 p<0.0001), older age (mean 86.2 p<0.0001), higher pre stroke mRS (45.5% 3-6 vs 9.5%, p= 0.0001), and more afib (p= 0.0002). Stroke100 Club 90day mRS(3-6) outcomes were worse in both tPA treated patients (OR=6.77, p= 0.0001) and nontreated patients (OR 31.57, p= 0.001). sICH rates (in tPA subjects) were not different (3.8% vs 3.4%, p> 0.99). Conclusions: There is a question of treatment outcome in patients with various permutations of stroke severity and advanced age. Our data corroborates the concern of poor outcomes for Stroke100 Club patients, but notes no increased sICH with tPA. Though outcome may be poor, withholding tPA should be discouraged as worse outcomes were not due to sICH. Young patients with severe strokes or old patients with mild strokes may have outcomes similar to the standard “80/20” Stroke100 patients, however further adjusted analysis is ongoing. In addition, further analyses are being done to compare tPA to non tPA patients.

Risk factors for blood-contaminated cerebrospinal fluid collection in dogs

2019 ◽  
Vol 186 (16) ◽  
pp. e8-e8
Author(s):  
Aran Nagendran ◽  
Daniel Sanchez-Masian ◽  
Erika Bersan ◽  
Camilla Jayne Cooper ◽  
Rita Gonçalves
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Body Condition Score ◽  
Fluid Collection ◽  
Final Diagnosis ◽  
Time Of Day ◽  
Blood Contamination ◽  
Potential Risk Factors

ObjectiveTo determine the risk factors for blood contamination during cerebrospinal fluid (CSF) collection in dogs.Study design and methodsThis is a prospective study of 170 CSF samples. Data collected included signalment of the patient, body condition score, site of CSF collection (cerebellomedullary cistern (CMC) or lumbar cistern (LC)), number of attempts, clinician expertise, final diagnosis, time of day, skull conformation and day of the week. Analysis of the CSF samples was then performed, and the presence of blood contamination (red blood cells >500/µl) was recorded. Logistic regression was used to quantify the association of potential risk factors of the procedure. Multivariate analysis was performed on the variables that were statistically significant.ResultsOf the 170 CSF samples, 53 per cent were collected from the CMC (n=90) and 47 per cent from the LC (n=80). Blood contamination was seen in 20 per cent (n=34) of the samples, 8.9 per cent (n=8) in CMC and 32.5 per cent (n=26) in LC samples. Increased odds of obtaining a contaminated CSF sample were associated with lower level of clinician expertise (odds ratio: 2.5; 95 per cent confidence interval: 0.9–6.7; P=0.046) and with LC versus CMC collection site (odds ratio: 8.1; 95 per cent confidence interval: 2.1–12.9; P=0.001).Clinical significanceThere is increased likelihood of blood contamination when collecting CSF from the LC compared with the CMC site. Increased clinician experience reduced the risk of CSF blood contamination, but none of the other variables examined significantly influenced this.

scholarly journals Prevalence and risk factors of Neospora caninum infection in ovine flocks of central-western Mexico

2019 ◽  
Vol 67 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Jesús Manuel Romo-Gallegos ◽  
Carlos Cruz-Vázquez ◽  
Leticia Medina-Esparza ◽  
Miguel Ramos-Parra ◽  
Dora Romero-Salas
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Animal Species ◽  
Neospora Caninum ◽  
Domestic Animal ◽  
Caninum Infection ◽  
Blood Samples ◽  
Western Mexico ◽  
The Mean

This study, carried out in 13 sheep flocks of central-western Mexico, aimed to identify the prevalence of anti-N. caninum antibodies, to develop a risk analysis of the infection and to estimate the prevalence of parasite DNA in blood. A total of 368 serum and blood samples were subjected to ELISA and PCR tests, respectively, and the association between the prevalence of antibodies and some management factors was estimated. The overall prevalence of anti-N. caninum antibodies was 13.5% [50/368; 95% confidence interval (CI) 10–17], ranging from 2.7 to 90% per flock, and 92% of the farms had seropositive animals. In ewes the prevalence was 14% (48/348, 95% CI 10–17) and in rams 10% (2/20; 95% CI 1– 33). The mean prevalence of Neospora DNA in blood was 27% (99/368, 95% CI 22–31), implying a range between 16 and 82%. In rams, the prevalence was 5% (1/20 95% CI 2–26), while in ewes it was 28% (98/348, 95% CI 23–33). The agreement between the tests was k = 0.19. The presence of other domestic animal species in the farms [odds ratio (OR) 4.4] and the consumption of placental debris, fetuses and stillborn lambs by dogs living in the farms (OR 5.8) were demonstrated to be risk factors.

Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

2020 ◽  
Vol 30 (11) ◽  
pp. 1659-1665
Author(s):  
Igor V. Polivenok ◽  
William M. Novick ◽  
Aleksander V. Pyetkov ◽  
Marcelo Cardarelli
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Operative Mortality ◽  
Perioperative Complications ◽  
Failure To Rescue ◽  
Middle Income ◽  
Paediatric Cardiac Surgery ◽  
Complications Rate

AbstractBackground:The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries.Aim:To evaluate perioperative complications rate, mortality related to complications, different patients’ demographics, and procedural risk factors for perioperative complication and post-operative death.Methods:Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery.Results:Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality – 8.1% among patients with only 1 perioperative complication, 35.3% – with 2 perioperative complications, and 42.1% – with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37).Conclusions:In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.

Comprehensive assessment of disability post-stroke using the newly developed miFUNCTION scale

2019 ◽  
Vol 15 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Charlotte Zerna ◽  
Tyler Burley ◽  
Theresa L Green ◽  
Sean P Dukelow ◽  
Andrew M Demchuk ◽  
...  
Keyword(s):  
Pilot Study ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Outcome Measure ◽  
Observer Agreement ◽  
International Classification Of Functioning ◽  
Modified Rankin Scale ◽  
Escape Trial

Background and Purpose The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial interobserver variability impairs outcome assessment as well as reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health, we developed a comprehensive, hierarchical assessment tool (miFUNCTION) to address the shortcomings of the modified Rankin Scale and deliver a more thorough understanding of disability following stroke. Methods The initial construct validity of miFUNCTION was established in a pilot study of patients at an outpatient stroke prevention clinic that had been diagnosed with stroke within 60 days. To further assess criterion validity, miFUNCTION was compared against the modified Rankin Scale and other outcome measures within the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial. Logistic regression analysis with miFUNCTION as an outcome was used to demonstrate the beneficial effect of endovascular treatment. Results The pilot study showed moderate inter-observer agreement (k = 0.585, p < 0.005) but near perfect correlation between miFUNCTION and modified Rankin Scale (ρ = 0.821, p < 0.05). The correlation of miFUNCTION and modified Rankin Scale was near perfect again in the ESCAPE trial (ρ = 0.944). Effect size of the multivariable models using modified Rankin Scale (adjusted odds ratio: 3.45, 95% confidence interval: 2.05–5.78) and miFUNCTION (adjusted odds ratio: 3.32, 95% confidence interval: 1.99–5.55) as an outcome measure for the ESCAPE trial patients was similar. Conclusions miFUNCTION is strongly associated with the degree of disability following stroke both in an outpatient setting and a clinical trial. Further work remains to assess sensitivity to change and to improve the inter-observer reliability of the scale.

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