Death In Stroke Patients Research Articles

Performance of modeling and balancing approach methods when using weights to estimate treatment effects in observational time-to-event settings

In observational studies weighting techniques are often used to overcome bias due to confounding. Modeling approaches, such as inverse propensity score weighting, are popular, but often rely on the correct specification of a parametric model wherein neither balance nor stability are targeted. More recently, balancing approach methods that directly target covariate imbalances have been proposed, and these allow the researcher to explicitly set the desired balance constraints. In this study, we evaluate the finite sample properties of different modeling and balancing approach methods, when estimating the marginal hazard ratio, through Monte Carlo simulations. The use of the different methods is also illustrated by analyzing data from the Swedish stroke register to estimate the effect of prescribing oral anticoagulants on time to recurrent stroke or death in stroke patients with atrial fibrillation. In simulated scenarios with good overlap and low or no model misspecification the balancing approach methods performed similarly to the modeling approach methods. In scenarios with bad overlap and model misspecification, the modeling approach method incorporating variable selection performed better than the other methods. The results indicate that it is valuable to use methods that target covariate balance when estimating marginal hazard ratios, but this does not in itself guarantee good performance in situations with, e.g., poor overlap, high censoring, or misspecified models/balance constraints.

Dementia increases the risk of death in stroke patients: A retrospective cohort-based risk score model study

BackgroundThe relationship between dementia and the mortality of stroke is a significant concern for patients and careers. However, there are few research about it in China and a lack of reliable data on the risk of dementia. We aim to analyze and compare the risk of death in stroke patients with and without dementia. Further investigation into the predictive value of dementia for stroke death. MethodsAll patients with stroke who were identified among residents of Ningxia, between January 1, 2014 to December 31, 2021, set death or May 22, 2022 as the observation endpoint. All patients were screened by 1:4 propensity score matching (PSM). The association between dementia and all-cause mortality was evaluated using Cox regression with survival time. Evaluation of the predictive value of dementia using decision curve analysis (DCA) and clinical impact curve (CIC) curves. ResultMortality of stroke with dementia is 45.4% and without dementia is 13.8%, further calculated one-year mortality is higher in the patients with dementia than without dementia (17.3%vs. 5.4%, p < 0.001). Stroke patients with dementia had a 3.74 times higher risk of death (95% CI = 3.29,4.26) and had a shorter survival time than those without dementia. Dementia was an independent predictor of death in all models (hazard ratio [HR]=3.77,95%CI: 3.31-4.30, p < 0.001). DCA and CIC curves indicated that dementia has a high value in predicting the risk of death in stroke patients. ConclusionDementia is an independent risk factor for death and reduces survival time in stroke patients.

Selective ischemic-hemisphere targeting Ginkgolide B liposomes with improved solubility and therapeutic efficacy for cerebral ischemia-reperfusion injury

Cerebral ischemia-reperfusion injury (CI/RI) remains the main cause of disability and death in stroke patients due to lack of effective therapeutic strategies. One of the main issues related to CI/RI treatment is the presence of the blood-brain barrier (BBB), which affects the intracerebral delivery of drugs. Ginkgolide B (GB), a major bioactive component in commercially available products of Ginkgo biloba, has been shown significance in CI/RI treatment by regulating inflammatory pathways, oxidative damage, and metabolic disturbance, and seems to be a candidate for stroke recovery. However, limited by its poor hydrophilicity and lipophilicity, the development of GB preparations with good solubility, stability, and the ability to cross the BBB remains a challenge. Herein, we propose a combinatorial strategy by conjugating GB with highly lipophilic docosahexaenoic acid (DHA) to obtain a covalent complex GB-DHA, which can not only enhance the pharmacological effect of GB, but can also be encapsulated in liposomes stably. The amount of finally constructed Lipo@GB-DHA targeting to ischemic hemisphere was validated 2.2 times that of free solution in middle cerebral artery occlusion (MCAO) rats. Compared to the marketed ginkgolide injection, Lipo@GB-DHA significantly reduced infarct volume with better neurobehavioral recovery in MCAO rats after being intravenously administered both at 2 h and 6 h post-reperfusion. Low levels of reactive oxygen species (ROS) and high neuron survival in vitro was maintained via Lipo@GB-DHA treatment, while microglia in the ischemic brain were polarized from the pro-inflammatory M1 phenotype to the tissue-repairing M2 phenotype, which modulate neuroinflammatory and angiogenesis. In addition, Lipo@GB-DHA inhibited neuronal apoptosis via regulating the apoptotic pathway and maintained homeostasis by activating the autophagy pathway. Thus, transforming GB into a lipophilic complex and loading it into liposomes provides a promising nanomedicine strategy with excellent CI/RI therapeutic efficacy and industrialization prospects.

Analyzing and predicting the risk of death in stroke patients using machine learning.

Stroke is an acute disorder and dysfunction of the focal neurological system that has long been recognized as one of the leading causes of death and severe disability in most regions globally. This study aimed to supplement and exploit multiple comorbidities, laboratory tests and demographic factors to more accurately predict death related to stroke, and furthermore, to make inferences about the heterogeneity of treatment in stroke patients to guide better treatment planning. We extracted data from the Medical Information Mart from the Intensive Care (MIMIC)-IV database. We compared the distribution of the demographic factors between the control and death groups. Subsequently, we also developed machine learning (ML) models to predict mortality among stroke patients. Furthermore, we used meta-learner to recognize the heterogeneity effects of warfarin and human albumin. We comprehensively evaluated and interpreted these models using Shapley Additive Explanation (SHAP) analysis. We included 7,483 patients with MIMIC-IV in this study. Of these, 1,414 (18.9%) patients died during hospitalization or 30 days after discharge. We found that the distributions of age, marital status, insurance type, and BMI differed between the two groups. Our machine learning model achieved the highest level of accuracy to date in predicting mortality in stroke patients. We also observed that patients who were consistent with the model determination had significantly better survival outcomes than the inconsistent population and were better than the overall treatment group. We used several highly interpretive machine learning models to predict stroke prognosis with the highest accuracy to date and to identify heterogeneous treatment effects of warfarin and human albumin in stroke patients. Our interpretation of the model yielded a number of findings that are consistent with clinical knowledge and warrant further study and verification.

Advancement of epigenetics in stroke.

A wide plethora of intervention procedures, tissue plasminogen activators, mechanical thrombectomy, and several neuroprotective drugs were reported in stroke research over the last decennium. However, against this vivid background of newly emerging pieces of evidence, there is little to no advancement in the overall functional outcomes. With the advancement of epigenetic tools and technologies associated with intervention medicine, stroke research has entered a new fertile. The stroke involves an overabundance of inflammatory responses arising in part due to the body’s immune response to brain injury. Neuroinflammation contributes to significant neuronal cell death and the development of functional impairment and even death in stroke patients. Recent studies have demonstrated that epigenetics plays a key role in post-stroke conditions, leading to inflammatory responses and alteration of the microenvironment within the injured tissue. In this review, we summarize the progress of epigenetics which provides an overview of recent advancements on the emerging key role of secondary brain injury in stroke. We also discuss potential epigenetic therapies related to clinical practice.

Genome- and transcriptome-wide association studies show that pulmonary embolism is associated with bone-forming proteins

ABSTRACT Background Pulmonary embolism (PE) is a leading cause of death in stroke patients and a severe health burden worldwide. There is a pressing need to understand the mechanisms by which it occurs and to identify at-risk patients efficiently and accurately. Methods First, based on data from GWAS in European populations, we performed a linkage disequilibrium score regression (LDSC) analysis of plasma proteins and PE in 3,283 individuals and additionally analyzed the genetic association between PE and fracture. Then, we performed a TWAS on PE GWAS data using skeletal muscle and blood for gene expression references. Finally, we validated the genetic correlation between PE and human plasma proteins by co-matching the genes encoding the identified proteins and those identified using TWAS with the differentially expressed genes obtained from mRNA expression profiling of PE. Results We identified five plasma proteins associated with PE, including hydroxycarboxylic acid receptor 2, defensin 118, and bone morphogenetic protein (BMP) 7, as well as a relationship between PE and fracture. Comparison of genes encoding these proteins with genes obtained from TWAS and then with differentially expressed genes obtained from PE mRNA expression profiling revealed that PE was highly correlated with the BMP family of genes.

Statistical Analysis Plan for the Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA (SPRINT INDIA): A Randomized Controlled Trial

Background: Recurrent stroke is one of the major causes of death in stroke patients. Introducing stroke prevention education package to improve the lifestyle behavioral factors could reduce the vascular events. The Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package (SPRINT) study in India aims to assess the role of a stroke prevention education package to reduce recurrent strokes, myocardial infarction, and death in patients with stroke. The objective is to formulate the detailed statistical analysis plan for the SPRINT India prior to trial unblinding. Methods: The plan was developed by trial statisticians with the help of principal investigator and management team of the SPRINT study. The chosen primary and secondary outcome measures and knowledge of critical baseline data were used to construct the statistical analysis plan. All collected data will be thoroughly reviewed. Patient baseline characteristics will be summarized with relevant descriptive statistics. The findings are planned and explained for the most appropriate statistical comparison between the groups. Results: The final statistical analysis plan corresponds to established criteria and will allow for transparent and efficient reporting. Conclusions: The SPRINT trial statistical analysis plan is developed in order to avoid analysis bias arising from prior knowledge of findings and to explicitly summarize prespecified analyses.

Impact of the COVID-19 Pandemic in the Acute Stroke Admissions and Outcomes in a Philippine Tertiary Hospital

Background and Purpose: The COVID-19 pandemic has been continuing its global spread ever since its onset, and efforts to curb the infection in multiple reports have contrasting effects on stroke severity, admissions, and outcomes. In the Philippines, where the COVID-19 pandemic shows no signs of slowing down and has been in the world’s longest lockdown, we investigated the effect of the pandemic in the stroke admissions and outcomes in one of the largest tertiary hospitals in the Philippines. Methods: This is a retrospective, comparative study of all adult stroke patients admitted between pre-COVID-19 (February 2019–January 2020) and COVID-19 periods (February 2020–January 2021). The differences of stroke types, severity, classification, and discharge outcomes between pre-COVID-19 and during COVID-19 were analyzed in the study. Results: There is a decrease in total number of stroke admissions from 597 in the pre-COVID-19 period to 487 during the pandemic. Stroke patients take significantly longer time to seek hospital consultation from the onset of stroke symptoms, and significantly higher proportion of patients have moderate and severe stroke. The discharge outcome showed significantly higher proportions of dependency upon discharge (13%) and higher proportion of death in stroke patients from 7% pre-CO­VID-19 pandemic to 13% during the pandemic. Conclusions: There was reduction in total stroke admissions, mild and transient stroke during the pandemic. There were a significantly higher proportion of stroke patients having moderate and severe stroke. The discharge outcome of stroke patients is functionally poorer during the pandemic, and more stroke patients have died compared before the COVID-19 pandemic.

Aspiration Pneumonia and the Traditional Chinese Medicine Banxia Houpu Tang

Aspiration pneumonia is one of the most common reasons for death in stroke patients. Recently, a traditional herbal medicine banxia houpu tang is remarked to prevent the aspiration pneumonia. This review tells the history of study of banxia houpu tang for prevent aspiration pneumonia.

Impact of pulmonary embolism on in-hospital mortality of patients with ischemic stroke

BackgroundPulmonary embolism (PE) is a frequent complication in immobile stroke patients and an important cause of death in stroke patients. We aimed to investigate predictors of PE and the impact of PE on survival of ischemic stroke patients. MethodsPatients were selected by screening the German nationwide inpatient sample (2005–2017) for ischemic stroke (ICD-code I63) and stratified for occurrence of PE (ICD-code I26). Impact of PE on mortality and predictors for PE in ischemic stroke patients were analysed. ResultsOverall, 2,914,546 patients were hospitalized due to ischemic stroke (50.5% females; 69.3% aged ≥70 years) in Germany 2005–2017. Among these, 0.4% had PE and 7.2% died during hospitalization. In-hospital mortality rate of ischemic stroke patients with PE was substantially higher compared to those patients without PE (28.4% vs. 7.1%, P < 0.001). PE was strongly associated with in-hospital death (OR 5.786, 95%CI 5.515–6.070, P < 0.001). Important predictors of PE were cancer (OR 3.165, 95%CI 2.969–3.374, P < 0.001), coagulation abnormalities (OR 2.672, 95CI 2.481–2.878, P < 0.001), heart failure (OR 1.553, 95%CI 1.472–1.639, P < 0.001) and obesity (OR 1.559, 95%CI 1.453–1.672, P < 0.001).Systemic thrombolysis was not beneficial regarding survival in unselected ischemic stroke patients. In contrast, systemic thrombolysis was beneficial in ischemic stroke patients without PE, who had to undergo cardio-pulmonary resuscitation (OR 0.866, 95%CI 0.782–0.960, P = 0.006). ConclusionsPatients with ischemic stroke revealed still a high in-hospital mortality of 7.2% in Germany. While only a minority of 0.4% of the ischemic stroke patients suffered from occurrence of PE, PE was accompanied by a substantial increase regarding in-hospital mortality. Systemic thrombolysis was beneficial regarding short-term survival in ischemic stroke patients without PE, who had to undergo cardio-pulmonary resuscitation.

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

AbstractBackground and Aim Stroke is a sudden neurological disorder caused by disturbances in the brain blood flow and loss of normal brain function. Stroke is also the second leading cause of death worldwide. In the last two decades, among the various treatment options for stroke, hypothermia has shown the promise of improving the final outcome. This study aimed to investigate the effect of noninvasive hypothermia on the final outcome of patients with an acute stroke in Iran.Methods In a randomized clinical trial, 60 Iranian patients diagnosed with acute stroke were enrolled in 2018. Patients were selected by convenience sampling method and then randomized in two groups as experimental (n = 30) and control (n = 30). Mild hypothermia was applied using a cooling device for 72 hours on the patients’ heads and intervention results were compared with the control group. Data were collected by using Acute Physiology and Chronic Health Evaluation III (APACHE III), Full Outline of Un-Responsiveness (FOUR), and National Institutes of Health Stroke Scale (NIHSS), and later analyzed by Statistical Package for the Social Sciences (SPSS) software version 22.Results No significant difference was found in the mean scores of all three scales before and after the intervention in control group (p &gt; 0.05) but statistically significant difference was found in the mean scores of all three scales for the intervention group (p &lt; 0.05). The intervention group had an increased mean score in FOUR, while APACHE and NIHSS values dropped. Researchers found statistically significant difference between the mean scores after the intervention in the experimental group compared with the control group in all three scales (p &lt; 0.05).Conclusion The findings of this study indicate that hypothermia has a significant statistical and clinical effect on the acute stroke outcome and it can be argued that hypothermia therapy can increase the level of consciousness and reduce the risk of death in stroke patients.

Identification of Physical Activities in Post Stroke Patients

Introduction: The incidence of recurrent strokes is increasing accompanied by the absence of intensive monitoring of physical activity that needs to be more addressed. The aims of intensively monitoring of physical activity to reduce disruption/ disability for life, to decrease the economic burden of the family, and to reduce the risk of death in stroke patients. Objectives: The purpose of this study was to determine the physical activity of patients after stroke attack. Method: We used an observational study design by case control approach, without giving certain treatment to the subjects of this study. We collected the demographic data from the participants and the International Physical Activity Questionnaire was used to measure the physical activity. The study was conducted at Aisyiyah Islamic Hospital in Malang, the average population was 30 people per month and samples were taken using purposive sampling technique. Data was collected by IPAQ questionnaire consisting of activities carried out around the house, activities at work and recreation activities and observation sheets. Results: The results showed that most physical activity of stroke sufferers was in the mild category (68.3%. Dicussion: It is recommended that respondents continue to do physical activity to reduce the prevalence of stroke recurrence.

The effectivity of pharyngeal strengthening exercise, hyolaryngeal complex range of motion exercise, and swallowing practice in swallowing function of ischemic stroke patients with neurogenic dysphagia.

Dysphagia is associated with an increased risk of aspiration pneumonia which often results in death in stroke patients. Therefore, effective and efficient management is important. Behavioral therapy for swallowing rehabilitation based on the principles of neuroplasticity such as oropharyngeal strengthening and range of motion exercises are the alternative ones that often be used. This study aimed to assess the changes in swallowing function in ischemic stroke patients with neurogenic dysphagia after pharyngeal strengthening exercise, hyolaryngeal complex range of motion exercise and swallowing practice. Swallowing function was assessed using Penetration Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS) based on Flexible Endoscopic Evaluation of Swallowing before and after interventions. The interventions were given every day with a duration of 30–45 minutes for 4 weeks. There were six subjects who completed the study. The PAS before the interventions were 6.00±1.79 and after the interventions was 1.67±0.82 (P=0.003). Meanwhile, the FOIS score before the interventions was 3 (1–5) and after the interventions were 5.00±2.10 (P=0.041). There was an improvement of PAS and FOIS after the interventions. Therefore, the interventions can be suggested to be used as one of the treatments to improve swallowing function in ischemic stroke patients with neurogenic dysphagia.

Effects of different interventions on animal models of ischemic stroke: Protocol for an overview and a network meta-analysis.

Ischemic stroke often leads to lifelong disability or death in stroke patients. It is one of the most common causes of death and disability worldwide, so it is a global health problem. The objective of this protocol is to provide the methods for using overview and network meta-analysis to identify the more effective intervention for infarct volume and neurobehavioral score in animal models of ischemic stroke. A systematic literature search will be conducted in PubMed and Embase to obtain relevant systematic reviews on December 11, 2018. Assessing the Methodological Quality of Systematic Reviews (AMSTAR2) and SYRCLE's risk of bias tool will be used to assess quality of the included reviews and risk of bias of randomized controlled trials (RCTs) for animal studies. Infarct volume and neurobehavioral score will be chosen as primary and secondary outcomes. The relative effect size of the treatment will be calculated using the standardized mean difference (SMD) and 95% confidence interval (CI). R 3.5.1 through the GEMTC package will be used to perform a network meta-analysis to synthesize direct and indirect evidence. The results of this paper will be submitted to a peer-reviewed journal for publication. Our study can provide a reference for further clinical practice and can be compared with clinical trial results to obtain a more credible therapeutic effect of this intervention. Formal ethical approval is unnecessary, because this study is based on published researches. CRD42019126811.

A research progress on risk factors for stroke related infections

Stroke is the leading cause of death and disability in the world. It is the first disease that causes the death of Chinese residents, and hospital infection is the leading cause of death in stroke patients. This paper based on the research of the domestic and foreign articles, found that stroke predictor associated pneumonia, urinary tract infection mainly including the type, area, and the size of the brain injury, the patient′s age, sex, consciousness, swallowing and urination function, National Institute of Health Stroke Scale (NIHSS) score, trachea, invasive operation, indwelling catheter and diabetes mellitus, atrial fibrillation, cardiovascular disease, etc. Some results of the study are different, further validation and Meta-analysis are needed. This paper aims to provide a basis for nursing workers to assess the risk of infection in patients with cerebral apoplexy, so as to provide early prevention and intervention for high-risk patients. Key words: Stroke; Infection; Risk factors

Abstract WMP113: Translational Evaluation of Acid/Base and Electrolyte Alterations in Acute Large Vessel Stroke

Background and Purpose: Monitoring for hypotension, hyperglycemia, hypoxia, and dehydration is key to reducing early death in stroke patients. Evaluation of physiological predictors of infarct volume and mortality may provide opportunities for effective interventions to improve outcomes. The purpose of this study is: 1) to describe and compare the predictive effects of venous blood gas (VBG) on infarct volume and mortality in acute stroke in rats; 2) and we have begun to collect arterial blood gas (ABG) to compare differences obtained proximal and distal to the occluded intracranial thrombi in acute ischemic stroke patients. Methods: 3-month old Sprague-Dawey rats (n = 9) underwent permanent or transient middle cerebral artery occlusion (MCAO). Pre- and post-MCAO venous samples provided pH, pCO 2 , pO 2 , and electrolyte values (iCa 2+ , K + , and Na + ). Linear regression determined predictors of infarct volume from these values, and Cox regression analyzed VBG changes between tMCAO (n = 28) and pMCAO (n = 29) to determine predictors of mortality. We compared mean proximal and distal pH, pCO 2 , pO 2 , and electrolytes (iCa 2+ , K + , and Na + ) in stroke patients (n = 7) arterial samples using Wilcoxon Signed Ranks test. Results: Animal studies demonstrated pH and iCa 2+ are predictors of infarct volume, but not mortality. After pMCAO (n = 9), change in pH or iCa 2+ significantly predicted infarct volume [F(1,7) = 7.351, β = -0.716, p = 0.03] and [F(1, 7) = 6.782, β = -0.701, p = 0.035]; as pH and calcium decreased, infarct volume increased. These variables explained 44% and 42% of the total variance in these models. In human patients (n = 7), there were significant differences in blood samples proximal and distal to the intracranial thrombus for pCO 2 (p = 0.018), HCO 3- (p = 0.028), iCa 2+ (p = 0.043), K + (p = 0.028), and Na + (p = 0.044). Conclusions: In conclusion, there are acute changes in acid/base balance and electrolytes during stroke in rodent models and humans. In cross-species comparison ionized calcium changes were significant in both, with iCa 2+ changes predicting stroke volume in the rat model. These preliminary findings are novel, and warrant further exploration in human patients.

Abstract WP316: Efficacy and Safety of Usage of Tirofiban for Patients With Acute Ischemic Stroke- A Meta-Analysis

Background: Tirofiban, a Glycoprotein IIb/IIIa inhibitor, has been used as an adjunctive therapy (adjunct to alteplase or antiplatelet) for patients with acute ischemic stroke. We aimed to conduct a systematic review and meta-analysis assessing both the efficacy and safety of tirofiban usage in ischemic stroke patients. Methods: We searched PubMED with the terms “tirofiban", and" ischemic stroke". Inclusion criteria were 1) randomized or non-randomized studies with two study arms; 2) inclusion data on mortality and/or symptomatic intracerebral hematoma (sICH); 3) modified Rankin Scale (mRS) used as an outcome measurement at 90 days; and 4) publication in the English language. We extracted data and calculated a summary odds ratio for sICH, mortality, and favorable outcomes (defined as mRS of 0 ≤1). Results: Five studies with 617 subjects suffering acute ischemic stroke were included in the analysis. Three studies included mRS data at 3 months which demonstrated that the trend of non-significant favorable outcomes in the Tirofiban group were non-significant (ORs=1.29; 95% CI=0.55-3.31; P=0.56). Two studies included data on sICH and there was no difference in risk of sICH. (ORs=0.52; 95% CI=0.09-3.-3; p=0.46). Four studies contained data on patients who died after treatment and there was no difference in the risk of mortality (ORs=1.06; 95% CI: 0.28-3.97; p=0.94). Conclusion: Our meta-analysis suggests that Tirofiban as an adjunct therapy to acute ischemic stroke does not increase the risk of sICH or death in stroke patients, but also does not increase the rate of favorable outcomes.

Epigenetic regulation of inflammation in stroke

Despite extensive research, treatments for clinical stroke are still limited only to the administration of tissue plasminogen activator and the recent introduction of mechanical thrombectomy, which can be used in only a limited proportion of patients due to time constraints. A plethora of inflammatory events occur during stroke, arising in part due to the body’s immune response to brain injury. Neuroinflammation contributes significantly to neuronal cell death and the development of functional impairment and death in stroke patients. Therefore, elucidating the molecular and cellular mechanisms underlying inflammatory damage following stroke injury will be essential for the development of useful therapies. Research findings increasingly point to the likelihood that epigenetic mechanisms play a role in the pathophysiology of stroke. Epigenetics involves the differential regulation of gene expression, including those involved in brain inflammation and remodelling after stroke. Hence, it is conceivable that epigenetic mechanisms may contribute to differential interindividual vulnerability and injury responses to cerebral ischaemia. In this review, we summarize recent findings on the emerging role of epigenetics in the regulation of neuroinflammation in stroke. We also discuss potential epigenetic targets that may be assessed for the development of stroke therapies.

Research on the cause of death for severe stroke patients.

To explore the characteristics of mortality among severe stroke patients, analyse their causes of death and provide evidence for improving the survival rate of stroke patients. Stroke is an important fatal and disabling disease that poses a large burden on its patients, and its high death rates have caused substantial concern to the World Health Organization. A retrospective case-control study. A total of 188 patients who died of stroke in the neurological intensive care unit of the First Affiliated Hospital of Chongqing Medical University from January 2012-December 2015 were selected as cases. Additionally, 188 stroke survivors from the same neurological intensive care unit were randomly selected as paired cases. The clinical characteristics of the severe stroke patient deaths were analysed, and a univariate analysis was conducted to determine potential mortality risk factors. A logistic regression analysis was then conducted to determine the independent risk factors of mortality. We investigated a total of 231 cases of death in neurological intensive care unit patients, 188 of whom died of stroke. Therefore, the death rate from stroke accounted for 81.3% of the total population, with ischaemic, haemorrhagic and mixed strokes accounting for 47.19%, 26.84% and 7.36% of the patients, respectively. The leading cause of death was central nervous system-related causes (central respiratory and circulatory failure, brain herniation), followed by multisystemic causes. The independent risk factors of death among the neurological intensive care unit patients were as follows: brain herniation (OR=18.15), multiple organ failure (OR=13.12), dyslipidemia (OR=4.64), community-acquired lung infection (OR=4.15), use of mechanical ventilation (OR=3.37), hypoproteinemia (OR=2.29), history of hypertension (OR=2.03) and hospital-acquired pneumonia (OR=1.75). The most common cause of death in stroke patients was damage to the central nervous system. Independent risk factors were brain herniation, multiple organ failure, dyslipidemia, community-acquired lung infection, the use of mechanical ventilation, hypoproteinemia, a history of hypertension and hospital-acquired pneumonia. Clinicians should be aware of the presence and possible effects of these conditions. Early prevention, monitoring and intervention to modify controllable risk factors will improve patient prognosis. Clinicians should be aware of the multiple independent risk factors of death and implement timely treatment measures to reduce the incidence of death in severe stroke patients.

Activated Protein C Resistance Does Not Increase Risk for Recurrent Stroke or Death in Stroke Patients.

BackgroundActivated protein C (APC) resistance is the most common inherited prothrombotic disorder. The role of APC resistance in ischemic stroke is controversially discussed.ObjectivesThe aim of this single center follow up study was to investigate the effect of APC resistance on stroke recurrence and survival in stroke patients.Patients/MethodsWe retrospectively identified 966 patients who had had an ischemic stroke or transitory ischemic attack (TIA) and in whom laboratory tests for APC resistance had been conducted. These patients were contacted to determine the primary outcomes of recurrent ischemic stroke or death.ResultsA total of 858 patients with an average follow up time of 8.48 years were included. APC resistance did not influence cumulative incidence functions for stroke free and total survival. In multivariate analyses, crude and adjusted hazard ratios for recurrent stroke as well as for death where not significantly increased in patients with APC resistance. This also applies to the subgroups of young patients, patients with cryptogenic stroke and patients with atrial fibrillation.ConclusionAPC-resistance is not a risk factor for subsequent stroke or death in patients with a first ischemic stroke or TIA. Testing for APC-resistance in stroke patients therefore cannot be routinely recommended.