scholarly journals Relationships between Pre-Stroke SARC-F Scores, Disability, and Risk of Malnutrition and Functional Outcomes after Stroke—A Prospective Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3586
Author(s):  
Masafumi Nozoe ◽  
Hiroki Kubo ◽  
Masashi Kanai ◽  
Miho Yamamoto
Keyword(s):  
Multivariate Analysis ◽  
Functional Outcomes ◽  
Primary Outcome ◽  
Screening Tool ◽  
High Specificity ◽  
Receiver Operating Curve ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Moderate Sensitivity ◽  
The Relationship

SARC-F is a screening tool for sarcopenia; however, it has not yet been established whether SARC-F scores predict functional outcomes. Therefore, we herein investigated the relationship between SARC-F scores and functional outcomes in stroke patients. The primary outcome in the present study was the modified Rankin Scale (mRS) 3 months after stroke. The relationship between SARC-F scores and poor functional outcomes was examined using a logistic regression analysis. Furthermore, the applicability of SARC-F scores to the assessment of poor functional outcomes was analyzed based on the area under the receiver operating curve (ROC). Eighty-one out of the 324 patients enrolled in the present study (25%) had poor functional outcomes (mRS ≥ 4). The results of the multivariate analysis revealed a correlation between SARC-F scores (OR = 1.29, 95% CI = 1.05–1.59, p = 0.02) and poor functional outcomes. A cut-off SARC-F score ≥ 4 had low-to-moderate sensitivity (47.4%) and high specificity (87.3%). The present results suggest that the measurement of pre-stroke SARC-F scores is useful for predicting the outcomes of stroke patients.

Abstract W P225: The Relationship between Leukocytosis and Time to Neurodeterioration

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Amelia K Boehme ◽  
James E Siegler ◽  
Karen C Albright ◽  
Alexander J George ◽  
Dominique Monlezun ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Poor Functional Outcome ◽  
Improve Outcome ◽  
Future Studies ◽  
Point Increase ◽  
Stroke Center ◽  
The Relationship

Background: Previous research has illustrated how leukocytosis after acute ischemic stoke (AIS) is related to poor functional outcome. A main predictor of poor functional outcome is neurodeterioration (ND). We sought to explore the relationship between leukocytosis and time to ND to identify a risk factor for a process that predicts poor functional outcome. Methods: Patients admitted to our stroke center (07/08-06/12) were retrospectively assessed. Leukocytosis was defined as WBC >11,000, ND was characterized as ≥ 2 point increase in NIHSS scale and poor functional outcome was classified as modified Rankin Scale (mRS) of 3-6. Patients were grouped into 2 categories: (1) the leukocytosis group- those who developed leukocytosis ≥24 hours after admission and those who presented with leukocytosis and remained at 24 hours and, (2) the non-leukocytosis group- those that did not have leukocytosis and those where the leukocytosis resolved within 24 hours of admission. Results: A cohort of AIS patients (N=476) with median age 64 years, 43% female and 69% Black were assessed. Of the patients with ND (27%), median time to ND was 43 hours. In the leukocytosis group (N=84), 42 (50.6%) of them developed ND. In the non-leukocytosis group (N=312), 75 (24.5%) developed ND. Leukocytosis within 24 hours of admission is predictive of earlier time to ND (p<0.0001; Figure 1). Adjusting for age, stroke severity, glucose, tPA and infection, the leukocytosis group had a 2 times greater risk for developing ND (HR 2.49, 95%CI 1.61-3.84, p<0.0001). Conclusion: Having leukocytosis persist from admission to 24 hours or developing leukocytosis within 24 hours of admission is a significant predictor of early ND, which often results in poor functional outcome. Identifying such a predictor can enable physicians to identify those at risk for ND and subsequent poor functional outcomes. Future studies are needed to identify if interventions targeting leukocytosis may improve outcome after stroke.

scholarly journals Restarting antiplatelet therapy after spontaneous intracerebral hemorrhage

Neurology ◽  
2018 ◽  
Vol 91 (1) ◽  
pp. e26-e36 ◽  
Author(s):  
Ching-Jen Chen ◽  
Dale Ding ◽  
Thomas J. Buell ◽  
Fernando D. Testai ◽  
Sebastian Koch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Primary Outcome ◽  
Modified Rankin Scale ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Secondary Outcomes

ObjectiveTo compare the functional outcomes and health-related quality of life metrics of restarting vs not restarting antiplatelet therapy (APT) in patients presenting with intracerebral hemorrhage (ICH) in the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study.MethodsAdult patients aged 18 years and older who were on APT before ICH and were alive at hospital discharge were included. Patients were dichotomized based on whether or not APT was restarted after hospital discharge. The primary outcome was a modified Rankin Scale score of 0–2 at 90 days. Secondary outcomes were excellent outcome (modified Rankin Scale score 0–1), mortality, Barthel Index, and health status (EuroQol–5 dimensions [EQ-5D] and EQ-5D visual analog scale scores) at 90 days.ResultsThe APT and no APT cohorts comprised 127 and 732 patients, respectively. Restarting APT was associated with lower rates of good functional outcome (36.5% vs 40.8%; p = 0.021) and lower Barthel Index scores at 90 days (p = 0.041). The 2 cohorts were then matched in a 1:1 ratio, and the matched cohorts each comprised 107 patients. No difference in primary outcome was observed between restarting vs not restarting APT (35.5% vs 43.9%; p = 0.105). There were also no differences between the secondary outcomes of the 2 cohorts.ConclusionRestarting APT in patients with ICH of mild to moderate severity after acute hospitalization is not associated with worse functional outcomes or health-related quality of life at 90 days. In patients with significant cardiovascular risk factors who experience an ICH, restarting APT remains the decision of the treating practitioner.

Intravenous Thrombolysis Is Associated with Less Disabling Stroke and Lower Mortality in Multiple-Pass Endovascular Thrombectomy

2021 ◽  
pp. 1-6
Author(s):  
Christopher Blair ◽  
Leon Edwards ◽  
Cecilia Cappelen-Smith ◽  
Dennis Cordato ◽  
Andrew Cheung ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Additional Benefit ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Multiple Pass ◽  
First Pass

<b><i>Background and Purpose:</i></b> The benefit of bridging intravenous thrombolysis (IVT) in acute ischaemic stroke patients eligible for endovascular thrombectomy (EVT) is unclear. This may be particularly relevant where reperfusion is achieved with multiple thrombectomy passes. We aimed to determine the benefit of bridging IVT in first and multiple-pass patients undergoing EVT ≤6 h from stroke onset to groin puncture. <b><i>Methods:</i></b> We compared 90-day modified Rankin Scale (mRS) outcomes in 187 consecutive patients with large vessel occlusions (LVOs) of the anterior cerebral circulation who underwent EVT ≤6 h from symptom onset and who achieved modified thrombolysis in cerebral ischaemia (mTICI) 2c/3 reperfusion with the first pass to those patients who required multiple passes to achieve reperfusion. The effect of bridging IVT on outcomes was examined. <b><i>Results:</i></b> Significantly more first-pass patients had favourable (mRS 0–2) 90-day outcomes (68 vs. 42%, <i>p</i> = 0.001). Multivariate analysis showed an association between first-pass reperfusion and favourable outcomes (OR 2.25; 95% CI 1.08–4.68; <i>p</i> = 0.03). IVT provided no additional benefit in first-pass patients (OR 1.17; CI 0.42–3.20; <i>p</i> = 0.76); however, in multiple-pass patients, it reduced the risk of disabling stroke (mRS ≥4) (OR 0.30; CI 0.10–0.88; <i>p</i> = 0.02) and mortality (OR 0.07; CI 0.01–0.36; <i>p</i> = 0.002) at 90 days. <b><i>Conclusion:</i></b> Bridging IVT may benefit patients with anterior circulation stroke with LVO who qualify for EVT and who require multiple passes to achieve reperfusion.

scholarly journals Impact of Delirium and Its Motor Subtypes on Stroke Outcomes

Stroke ◽  
2021 ◽  
Vol 52 (4) ◽  
pp. 1322-1329
Author(s):  
Ivã Taiuan Fialho Silva ◽  
Pedro Assis Lopes ◽  
Tiago Timotio Almeida ◽  
Saint Clair Ramos ◽  
Ana Teresa Caliman Fontes ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Dependence ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Increased Risk ◽  
And Behavior ◽  
The Relationship

Background and Purpose: Delirium is an acute and fluctuating impairment of attention, cognition, and behavior. Although common in stroke, studies that associate the clinical subtypes of delirium with functional outcome and death are lacking. We aimed to evaluate the influence of delirium occurrence and its different motor subtypes over stroke patients’ prognosis. Methods: Prospective cohort of stroke patients with symptom onset within 72 hours before research admission. Delirium was diagnosed by Confusion Assessment Method for the Intensive Care Unit, and its motor subtypes were defined according to the Richmond Agitation-Sedation Scale. The main outcome was functional dependence or death (modified Rankin Scale>2) at 90 days comparing: delirium versus no delirium patients; and between motor subtypes. Secondary outcomes included modified Rankin Scale score >2 at 30 days and 90-day-mortality. Results: Two hundred twenty-seven patients were enrolled. Delirium occurred in 71 patients (31.3%), with the hypoactive subtype as the most frequent, in 41 subjects (57.8%). Delirium was associated with increased risk of death and functional dependence at 30 and 90 days and higher 90-day mortality. Multivariate analysis showed delirium (odds ratio, 3.28 [95% CI, 1.17–9.22]) as independent predictor of modified Rankin Scale >2 at 90 days. Conclusions: Delirium is frequent in stroke patients in the acute phase. Its occurrence—specifically in mixed and hypoactive subtypes—seems to predict worse outcomes in this population. To our knowledge, this is the first study to prospectively investigate differences between delirium motor subtypes over functional outcome three months poststroke. Larger studies are needed to elucidate the relationship between motor subtypes of delirium and functional outcomes in the context of acute stroke.

scholarly journals Significant aortic stenosis associated with poorer functional outcomes in patients with acute ischaemic stroke undergoing endovascular therapy

2020 ◽  
Vol 26 (6) ◽  
pp. 793-799
Author(s):  
Nicholas JH Ngiam ◽  
Benjamin YQ Tan ◽  
Ching-Hui Sia ◽  
Bernard PL Chan ◽  
Gopinathan Anil ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Functional Outcomes ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Background and aim Bi-directional feedback mechanisms exist between the heart and brain, which have been implicated in heart failure. We postulate that aortic stenosis may alter cerebral haemodynamics and influence functional outcomes after endovascular thrombectomy for acute ischaemic stroke. We compared clinical characteristics, echocardiographic profile and outcomes in patients with or without aortic stenosis that underwent endovascular thrombectomy for large vessel occlusion acute ischaemic stroke. Methods Consecutive acute ischaemic stroke patients with anterior and posterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery and basilar artery) who underwent endovascular thrombectomy were studied. Patients were divided into those with significant aortic stenosis (aortic valve area <1.5 cm2) and without. Univariate and multivariate analyses were employed to compare and determine predictors of functional outcomes measured by modified Rankin scale at three months. Results We identified 26 (8.5%) patients with significant aortic stenosis. These patients were older (median age 76 (interquartile range 68–84) vs. 67 (interquartile range 56–75) years, p = 0.001), but similar in terms of medical comorbidities and echocardiographic profile. Rates of successful recanalisation (73.1% vs. 78.0%), symptomatic intracranial haemorrhage (7.7% and 7.9%) and mortality (11.5% vs. 12.6%) were similar. Significant aortic stenosis was independently associated with poorer functional outcome (modified Rankin scale >2) at three months (adjusted odds ratio 2.7, 95% confidence interval 1.1–7.5, p = 0.048), after adjusting for age, door-to-puncture times, stroke severity and rates of successful recanalisation. Conclusion In acute ischaemic stroke patients managed with endovascular thrombectomy, significant aortic stenosis is associated with poor functional outcome despite comparable recanalisation rates. Larger cohort studies are needed to explore this relationship further.

scholarly journals Machine learning to predict delayed cerebral ischemia and outcomes in subarachnoid hemorrhage

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011211
Author(s):  
Jude PJ Savarraj ◽  
Georgene W. Hergenroeder ◽  
Liang Zhu ◽  
Tiffany Chang ◽  
Soojin Park ◽  
...  
Keyword(s):  
Machine Learning ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Functional Outcomes ◽  
Delayed Cerebral Ischemia ◽  
Receiver Operating Curve ◽  
Modified Rankin Scale ◽  
Neurological Disability ◽  
Discharge Outcomes ◽  
Standard Models

Objective:To determine whether machine learning (ML) algorithms can improve the prediction of delayed cerebral ischemia (DCI) and functional-outcomes after subarachnoid hemorrhage (SAH).Methods:ML models and standard models (SM) were trained to predict DCI and functional-outcomes with data collected within 3 days of admission. Functional-outcomes at discharge and at 3-months were quantified using the modified Rankin scale (mRS) for neurological disability (dichotomized as ‘good’ (mRS≤3) vs ‘bad’ (mRS≥4) outcomes). Concurrently, clinicians prospectively prognosticated 3-month outcomes of patients. The performance of ML, SM and clinicians are retrospectively compared.Results:DCI status, discharge, and 3-month outcomes were available for 399, 393 and 240 subjects respectively. Prospective clinician (an attending, a fellow and a nurse) prognostication of 3-month outcomes was available for 90 subjects. ML models yielded predictions with the following AUC (area under the receiver operating curve) scores: 0.75 ± 0.07 (95% CI: 0.64 to 0.84) for DCI, 0.85 ± 0.05 (95% CI: 0.75 to 0.92) for discharge outcome, and 0.89 ± 0.03 (95% CI: 0.81 to 0.94) for 3-month outcome. ML outperformed SMs, improving AUC by 0.20 (95% CI: -0.02–0.4) for DCI, by 0·07 ± 0.03 (95% CI: -0.0018–0.14) for discharge outcomes, by 0.14 (95% CI: 0.03 –0.24) for 3-month outcomes and matched physician’s performance in predicting 3-month outcomes.Conclusion:ML models significantly outperform SMs in predicting DCI and functional-outcomes and has the potential to improve SAH management.

scholarly journals The Effect of Biometric Parameters on Spot Vision Screener Results

2021 ◽  
Author(s):  
meryem guler alıs ◽  
abdulkadir alıs
Keyword(s):  
Risk Factors ◽  
Negative Correlation ◽  
High Specificity ◽  
Spherical Equivalent ◽  
Biometric Parameters ◽  
Clinical Advantage ◽  
Moderate Sensitivity ◽  
The Relationship ◽  
Vision Screener

Abstract objective: Our aim in this study is to investigate the relationship between biometric parameters and spot vision screener [SVS]Materyal-Metods: 250 eyes of 125 children between the age of 6,77±1,59 included the study. The results of cyloplegic [CSVS] and noncycloplegic [NSVS] spot vision screener [Plusoptix p12,Germany] measurements and autorefractometer with cycloplegia [CA] were compared. The spherical equivalent [SE] differences of between CA and NSVS measurements with CA and CSVS measurements were compared with AL, ACD, CR, Mean K and AL / CR values. The relationship between them was examined.Results: According to the amblyopia risk factors [ARFs] based on the criteria from AAPOS 2013 guidelines , 33 eyes [13%] in the NSVS results and 34 eyes [13.6%] in the CSVS results were detected as amblyopic. According to CA results, NSVS had 67.3% sensitivity, 94.5% specificity, CSVS 69.4% sensitivity and 89.1% specificity in detecting amblyopia. When the SE differences of between CA and NSVS values were comparaed with biometric parameters a negative correlation was observed with ACD , AL and especially AL/CR ratio .Conclussion: Both NSVS and CSVS showed moderate sensitivity and high specificity in detecting AFRs based on the criteria from AAPOS 2013 guidelines. CSVS has no additional clinical advantage. Biometric parameters effect the NSVS results.

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