Deterioration In Acute Ischemic Stroke Research Articles

Urinary Microalbumin predicts early neurological deterioration in acute ischemic stroke: A study based on etiological classification

IntroductionTo investigate the correlation between urinary microalbumin (U-Alb) levels and early neurological deterioration (END), as well as its predictive ability, in patients with acute ischemic stroke (AIS) under different etiological subtypes. Materials and methodsWe consecutively enrolled AIS patients within 72 h of onset, collecting relevant clinical characteristics and baseline laboratory data including U-Alb. END was defined as an increase of ≥4 points in NIHSS score within 72 h of onset, and TOAST criteria were used for stroke etiologic typing. Binary logistic regression analysis was employed to clarify the association between baseline U-Alb and the occurrence of END under different stroke etiological subtypes. ROC analysis was conducted to evaluate its predictive ability under different etiological subtypes. ResultsFinally, 615 patients were included, with 104 (16.9 %) developed END. Binary logistic regression analysis revealed that baseline U-Alb was independently associated with END occurrence (OR = 1.009, 95 % CI 1.002-1.016, p = 0.009). ROC analysis revealed that U-Alb had the best predictive ability for patients with small artery occlusion (AUC=0.707, p < 0.001), followed by large artery atherosclerosis (AUC = 0.632, p = 0.006), with corresponding optimal diagnostic cutoff points of 31.11 and 25.71 mg/L, respectively. However, U-Alb was not an independent risk factor for END in cardioembolic stroke patients (OR = 1.011, 95 % CI 0.980-1.043, p = 0.478). MAU was associated with stroke progression(p = 0.023), and U-Alb was positively correlated with increased infarct volume (r = 0.516, p < 0.01). ConclusionU-Alb is closely associated with END in AIS patients, serving as a potential indicator for predicting END, especially among those with small artery occlusion mechanisms.

Serum Lipoprotein(a) as Predictive Factor for Early Neurological Deterioration of Acute Ischemic Stroke After Thrombolysis.

This study aimed to explore the relationship between serum lipoprotein(a) (LP(a)) levels and early neurological deterioration (END) in patients with acute ischemic stroke (AIS) after thrombolysis. In total, 236 patients with AIS after thrombolysis were enrolled in this study. Serum LP(a) levels were measured on admission after thrombolysis. END was defined as an increase of at least two points in the NIHSS score within 48 hours after thrombolysis. Binary logistic regression analysis was used to assess the association between serum LP(a) levels and END. Overall, patients with END had higher LP(a) than those without END (high LP(a): 38.3% vs 22.2%, intermediate LP(a): 40.3% vs 41.8%, low LP(a): 21.3% vs 36.0%, p<0.005). In the multivariate analysis, high LP(a) (defined as LP(a) level≥ 300 mg/L) was an independent risk factor for END post-thrombolysis (OR=3.154, 95% CI=1.067-9.322, p=0.038). Our findings demonstrated that LP(a) was an independent risk factor for END post-thrombolysis and that LP(a) level≥ 300 mg/L could be associated with END post-thrombolysis in this study population.

The predictive value of serum F-actin on the severity and early neurological deterioration of acute ischemic stroke: Predictive value of F-actin in stroke

BackgroundF-actin is involved in the progression of ischemic stroke and is associated with the disruption of the blood-brain barrier. In this article, we evaluated serum F-actin as a biomarker in stroke severity and early neurological deterioration (END) in acute ischemic stroke. MethodsIn this study, serum F-actin was measured in consecutively collected 140 AIS patients and 144 healthy controls matched in gender and age by ELISA. Early neurological deterioration (END) was defined as the deterioration of neurological dysfunction within 72 hours of admission, with an increase of ≥ 4 points in the NIHSS score. Severe stroke was defined as a NIHSS score>8 at admission. ResultsThe serum F-actin level in AIS was significantly higher than healthy controls (p = 0.041). In large-artery atherosclerosis stroke and cardioembolic stroke, serum F-actin were significantly higher than that in small artery occlusion stroke (padjust = 0.019, padjust < 0.001, respectively).F-actin level above the critical value (>1.37 µg/L) was significantly associated with severe stroke (OR, 3.015; 95 %CI, 1.014–8.963; p = 0.047) . In addition, elevated level of F-actin was significantly associated with END (OR, 1.323; 95 % CI, 1.001-1.747, p = 0.049). When the level of F-actin was above the critical value (>2.17 µg/L), its association with END remained significant (OR, 6.303; 95 %CI, 2.160-18.394; p < 0.001) . ConclusionF-actin is an important blood biomarker in the early stage of AIS, and high levels of F-actin are valuable in determining the severity of stroke and predicting early neurological deterioration.

Safety and efficacy of tirofiban in preventing neurological deterioration in acute ischemic stroke (TREND): Protocol for an investigator-initiated, multicenter, prospective, randomized, open-label, masked endpoint trial.

Antithrombotic therapy prevents adverse ischemic events following acute ischemic stroke (AIS). Intravenous tirofiban provides desirable antiplatelet effects, especially in patients who are vulnerable to neurological deterioration (ND). The aim of the study was to test the hypothesis that intravenous administration of tirofiban, initiated within 24 h of ictus and continued for consecutive 72 h, would be more effective than aspirin in reducing the risk of ND within 72 h of enrollment among patients with potentially atherothrombotic ischemic stroke. The Safety and Efficacy of Tirofiban in Preventing Neurological Deterioration in Acute Ischemic Stroke (TREND) trial is an investigator-initiated, multicenter, prospective, randomized, open-label, masked endpoint study. Its eligibility criteria included AIS secondary to potential atherosclerosis, a National Institutes of Health Stroke Scale (NIHSS) score ranging from 4 to 20 points, ineligibility for recanalization therapy, and administration within 24 h postsymptom onset. Randomization was performed at a 1:1 ratio to allocate 420 patients into two groups to receive an intravenous tirofiban bridge to oral antiplatelet drugs or direct oral antiplatelet drugs. The primary outcome is the proportion of patients with a ≥4-point increase in NIHSS score within 72 h of intervention compared to the score at enrollment. The key secondary outcomes include changes in NIHSS score, modified Rankin scale (mRS) score at 90 days, and dichotomized mRS scores (0-2 vs. 3-6 and 0-1 vs. 2-6) at 90 days. The safety variables are symptomatic intracerebral hemorrhage, any intracerebral hemorrhage, and systemic hemorrhage within 72 h after randomization and 90-day mortality. The TREND trial may identify the suitability of intravenous tirofiban as a routine clinical strategy to prevent ND in patients with AIS within 24 h of the onset of symptoms. http://www.clinicaltrials.gov (identifier: NCT04491695).

A novel nomogram predicting early neurological deterioration after intravenous thrombolysis for acute ischemic stroke

ObjectivesIntravenous thrombolysis therapy (IVT) with recombinant tissue plasminogen activator has proven to be a beneficial treatment for acute ischemic stroke (AIS) patients when administered within 4.5 h after a stroke. This study aimed to investigate an available and inexpensive predictive tool for early neurological deterioration in AIS. MethodsPatients admitted to our department with acute stroke who were given IVT with recombinant tissue plasminogen activator within 4.5 h of stroke onset were included in the study. The NIH stroke scale (NIHSS) was used to assess patients’ neurological state prior to IVT and for 24 h after. Early neurological deterioration was defined as occurring if the NIHSS total score increased by ≥ 4 or the NIHSS individual score increased by ≥ 2 compared to baseline. Patients were randomly assigned to training or validation cohorts. ResultsOf the 266 AIS patients receiving IVT who were screened, 217 were deemed eligible for the study. Multivariate logistic regression analysis identified smoking history, NIHSS score, homocysteine level, and neutrophil to lymphocyte ratio as independent factors for predicting early neurological deterioration. ROC analysis was used to assess the quality of the resulting nomogram. The AUC for the training dataset was 0.826 (95 % CI, 0.719–0.932), and for the validation dataset was 0.887 (95 % CI, 0.763–1.000). ConclusionThe robustness of this nomogram suggests that it may be a reliable tool for evaluating the progression of AIS after IVT.

High Immature Platelet Fraction is Associated with Early Neurological Deterioration in Acute Ischemic Stroke (P3-5.007)

<h3>Objective:</h3> To investigate the association between the level of immature platelet fraction (IPF) and the prevalence of early neurological deterioration (END) in acute ischemic stroke patients. <h3>Background:</h3> Early neurological deterioration (END) in acute ischemic stroke is a common event. However, the underlying pathophysiological bases are heterogenous and hard to explain. Immature platelet fraction (IPF) is the useful marker of increased platelet production and turnover which could occur in patients with increased platelet activation. High value of IPF was reported in acute coronary syndrome. <h3>Design/Methods:</h3> A total 1655 of acute ischemic stroke patients in single tertiary academic center was enrolled from January 2013 to October 2018 via stroke registry. IPF levels were quantified by whole blood flow cytometry with automated assays (Sysmex XE-2100™). High IPF was defined as the IPF level was more than 5%. Early neurological deterioration was defined as an increment change of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥2 points within the first week after admission. <h3>Results:</h3> A total of 72 patients (4.4%) experienced END. END was more prevalent in the patients with high IPF [13 (11.7%) vs 59 (3.8%), p&lt;0.0001]. Multivariate logistic regression analysis showed high IPF was an independent predictor of the prevalence of END (adjust odds ratio = 1.32; 95% confidence interval = 1.03–1.70). <h3>Conclusions:</h3> A high IPF levels was associated with the prevalence of END in acute ischemic stroke patients. Future investigation might be needed to evaluate the effective treatment of the high IPF in acute phase of ischemic stroke. <b>Disclosure:</b> Bang-Hoon Cho has nothing to disclose. The institution of Sung-Wook Yu has received research support from Yuhan.

Fibrinogen as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke - Evidence From the Indian Population.

Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen - a key component of the coagulation pathway, is controversial. To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke. Single-centre prospective observational study. 141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome. Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], P = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], P < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], P < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], P < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], P = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], P = .038). The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.

Homocysteine as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke

Background: Ischemic stroke (AIS) is on the rise owing in part to a longer average life expectancy. It's called early neurological deterioration (END) when symptoms deteriorate immediately after the stroke, and it's connected with a decreased probability of recovery. As homocysteine levels rise, so does the risk of neurotoxicity and other conditions that contribute to thrombosis. There are a number of ways that homocysteine may be hazardous, including direct toxicity and endothelium damage, according to experiments. If homocysteine could predict early neurological impairment after an ischemic stroke, this research would have been a success. Patients with acute ischemic stroke were included in the trial at Mataria teaching Hospital (AIS). The participants in the study were, on average, 63 years old and 12 months old. Two-thirds of the participants were men (60.0 percent ). The majority of individuals had hypertension (86.0 percent). One-fifth of research participants had diabetes mellitus (52.0 percent ) More over a third of the participants admitted to smoking cigarettes (44.0 percent ). More than one-third of the participants had dyslipidemia and coronary artery disease (approximately a quarter). The average HbA1c level in this research was 5.8%, with a standard variation of 1.3 percentage points.. It varied from a low of 2 to a high of 176, with an average of 11.5. Some 42.0 percent of the participants had elevated homocysteine concentrations. Age (P-value = 0.657), gender (P-value = 0.368), hypertension (P-value = 0.075), diabetes mellitus (P-value = 0.086), smoking (P-value = 0.171), and dyslipidemia (P-value = 0.726) were found to be non-significant variations across the groups. There was a statistically significant association between early neurological deterioration and a higher median CRP (47.5) compared to those with no decrease (10). Homocysteine levels were greater in individuals with early neurological degeneration (786%) than in those without deterioration (278%) (P = 0.001). Age (P=0.056), gender (P=0.815), high blood pressure (P=0.009), diabetes mellitus (P=0.603), or high cholesterol (P=0.863) were not linked to low homocysteine levels. HbA1C (P=0.507), CRP (P=0.643), or elevated lipid profiles (P=0.603) did not vary across the groups. Because of our investigation, we discovered a substantial connection between elevated levels of homocysteine and END. Homocysteine levels in acute stroke patients might be used as a prognostic indicator for such individuals.

Fasting blood glucose as a predictor of progressive infarction in men with acute ischemic stroke

ObjectiveBlood glucose is related to early neurological deterioration in acute ischemic stroke, but multiple mechanisms are involved in early neurological deterioration, such as progressive infarction. This study aimed to determine whether fasting blood glucose (FBG) is an independent predictor of progressive infarction.MethodsFrom April 2017 to December 2020, we retrospectively enrolled 477 patients with acute ischemic stroke within 48 hours of onset. Demographic characteristics, clinical information, neuroimaging characteristics, and laboratory data were collected after admission.ResultsWe found that 147 (30.8%) patients had progressive infarction. Multiple regression analysis showed that high FBG concentrations (>7.66 mmol/L) were independently associated with progressive infarction. Sex subgroup analysis showed that high FBG concentrations were an independent predictor of progressive infarction in male patients (odds ratio, 2.559; 95% confidence interval, 1.279–5.121). In a receiver operating characteristic curve analysis, FBG concentrations were a predictor of progressive infarction in all cases, especially in male patients. The cutoff value of FBG in all patients and men was 7.155 mmol/L.ConclusionsFBG is an independent predictor of progressive infarction in patients with acute ischemic stroke within 48 hours of onset, especially in men. Patients with FBG concentrations ≥7.155 mmol/L are more likely to develop progressive infarction.

Immature platelet fraction is associated with early neurological deterioration in acute ischemic stroke

Early neurological deterioration (END) in acute ischemic stroke occurs frequently. This phenomenon has a heterogeneous pathomechanism. Immature platelet fraction (IPF) is known as the useful marker of increased platelet production and turnover which could occur in patients with increased platelet activation. We investigated whether the IPF is associated with the prevalence of END in acute ischemic stroke patients.

External Validation of the WORSEN Score for Prediction the Deterioration of Acute Ischemic Stroke in a Chinese Population.

Background: Early neurological deterioration (END) has been recognized as a serious neurological complication after acute ischemic stroke. However, to date, the WORSEN score was the only one scoring system specifically developed to detect END events in acute ischemic stroke patients. The purpose of this study was to investigate the WORSEN score's utility in China, and to determine the potential predictors of END in acute stroke patients.Methods: Consecutive patients with acute ischemic stroke admitted to the Department of Neurology, Aerospace Center Hospital between March 2015 to February 2017 were recruited into the study's cohort and divided into two groups: patients with and without END. END was defined as either an increase in two or more NIHSS points, an increment of at least one point in motor power or a description of fluctuating of clinical symptoms in medical reports during the first 7 days after admission. Severe END was defined as an increase of NIHSS ≥ 4 points from baseline during the first 7 days after admission.Results: Three hundred fifty four patients with acute ischemic stroke were enrolled in the present study and 67.5% were male. END occurred in 90 of these patients and severe END occurred in 55 of these patients. Logistic regression analysis showed that an initial NIHSS score ≥8, diameter of infarction, striatocapsular infarction, and TOAST type of large arterial atherosclerosis were independent predictors for END. The area under the ROC curve (AUC) of the WORSEN score for the prediction of END was 0.80 (95%CI 0.75–0.84), with a sensitivity of 62.22%, a specificity of 88.26%, positive predictive values of 64.37% and negative predictive values of 87.27%. Meanwhile, the AUC of the WORSEN score for the prediction of severe END was 0.82 (95%CI 0.78–0.86), with a sensitivity of 70.91%, specificity of 83.95%, positive predictive values of 44.83% and negative predictive values of 94.01%.Conclusion: END is a relatively common neurological complication in patients with acute ischemic stroke. Our findings showed that the WORSEN score had a good predictive value for identifying patients with END in a Chinese population. Moving forward, multi-center studies are required for further validations

Abstract WP251: Sleep Apnea and Early Neurological Deterioration in Acute Ischemic Stroke

Background and Purpose: Evidence of an association between sleep apnea (SA) and early neurological deterioration (END) in acute phase ischemic stroke is scant. We investigated the prevalence of SA and the impact of SA severity on END in acute ischemic stroke (AIS) patients. Methods: We prospectively enrolled consecutive AIS patients admitted to our stroke unit within 72 hours of symptom onset. SA severity was assessed with ApneaLink - a validated portable respiratory monitor. SA was defined as an apnea-hypopnea index (AHI) of ≥ 5/hour. END was defined as an incremental increase in the National Institutes of Health Stroke Scale (NIHSS) score by ≥ 1 point in motor power, or ≥ 2 points in the total score within the first week after admission. Results: Of the 305 patients studied, 254 (83.3%) patients had SA (AHI ≥ 5/hour), and of these, 114 (37.4%) had mild SA (AHI 5-14/hour), 59 (19.3%) had moderate SA (AHI 15-29/hour), and 81 (26.6%) had severe SA (AHI ≥ 30/hour). Thirty-six (11.8%) patients experienced END: 2 of the 51 (3.9%) patients without SA and 34 of the 254 (14.4%) patients with SA. Multivariable regression analysis showed AHI independently predicted END (odds ratio 1.024; 95% confidence interval 1.006 to 1.042; p = 0.008). Conclusions: SA is common in the acute phase of ischemic stroke, and SA severity is associated with the risk of END.

Association of stroke severity, leukocytosis, and infarction size with early neurological deterioration in acute ischemic stroke

BackgroundAbout one-third of patients with acute ischemic stroke will endure early neurological deterioration (END), which leads to increased mortality and functional disability. A better understanding of risk factors for END is still required.ObjectiveThe aim of this study was to determine the risk factors of END in ischemic stroke patients.Patients and methodsOne hundred and twenty patients with first ever ischemic stroke were included in this study. All patients were clinically evaluated to determine the risk factors. END was assessed using the National Institute of Health Stroke Scale (NIHSS) after acute ischemic stroke. Laboratory and radiological investigations were done for all patients.ResultsIn all, 35% patients showed clinical END after stroke onset and 65% patients were stable or improved. END patients had statistically significant high body temperature, increased leukocyte count, serum blood glucose, triglycerides, NIHSS at admission, high-sensitivity C-reactive protein, and infarction size. Multivariable logistic regression analysis for different variables showed that leukocyte count, stroke severity using NIHSS, and lesion size were independent factors associated with neurological deterioration.ConclusionStroke severity, white blood cell, and lesion size of infarction were the only independent factors associated with END.

Sleep Apnea and Early Neurological Deterioration in Acute Ischemic Stroke

Background and purposeEvidence of an association between sleep apnea (SA) and early neurological deterioration (END) in acute phase ischemic stroke is scant. We investigated the prevalence of SA and the impact of SA severity on END in acute ischemic stroke (AIS) patients. MethodsWe prospectively enrolled consecutive AIS patients admitted to our stroke unit within 72 hours of symptom onset. SA severity was assessed with ApneaLink—a validated portable respiratory monitor. SA was defined as an apnea-hypopnea index (AHI) of greater than or equal to 5 per hour. END was defined as an incremental increase in the National Institutes of Health Stroke Scale (NIHSS) score by greater than or equal to 1 point in motor power, or greater than or equal to 2 points in the total score within the first week after admission. ResultsOf the 305 patients studied, 254 (83.3%) patients had SA (AHI ≥ 5 per hour), and of these, 114 (37.4%) had mild SA (AHI 5-14 per hour), 59 (19.3%) had moderate SA (AHI 15-29 per hour), and 81 (26.6%) had severe SA (AHI ≥ 30 per hour). Thirty-six (11.8%) patients experienced END: 2 of the 51 (3.9%) patients without SA and 34 of the 254 (14.4%) patients with SA. Multivariable regression analysis showed AHI independently predicted END (odds ratio 1.024; 95% confidence interval 1.006 to 1.042; P = .008). ConclusionsSA is common in the acute phase of ischemic stroke, and SA severity is associated with the risk of END.

Lp-PLA2 as a risk factor of early neurological deterioration in acute ischemic stroke with TOAST type of large arterial atherosclerosis

ABSTRACTIntroduction: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well-known risk factor of atherosclerotic vascular diseases. Nevertheless, its role in the acute phase of ischemic stroke is still unclear. The aim of this study is to identify the relationship between Lp-PLA2 levels and early neurological deterioration (END) in acute ischemic stroke patients with Trial of Org 10 172 in Acute Stroke Treatment (TOAST) subtype of large arterial atherosclerosis (LAA).Methods: We enrolled Chinese patients with first ever acute ischemic stroke admitted to Neurology Department of Shenzhen Second People’s Hospital within 48 h from onset of symptoms during January – November 2015. Demographic and laboratory information were collected while END was defined as an increase in the National Institute of Health Stroke Scale score by ≥ 1 point in motor power, or ≥ 2 points in the total score within 10 days after admission.Results: Overall 181 patients were involved; END was diagnosed in 30 patients within 10 days after admission. The odds ratio for END increased with increasing levels of Lp-PLA2 (intermediate level, OR = 1.96, 95%CI 1.02–4.27, p = 0.041; high level, OR = 2.99, 95%CI 1.26–5.73, p = 0.023).Conclution: Intermediate and high level of Lp-PLA2 was identified as independent predictor of END in multivariate analysis. Lp-PLA2 could be valued as a risk factor of END in patients with acute ischemic stroke with TOAST subtype of LAA.

Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population: A prospective cohort study

Background and purposePoorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population. MethodsThis was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and <200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3–6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives. ResultsThe primary outcome occurred in 216 of 305 patients (70.8%) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9%) in the blood glucose <200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6%) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5%) in the blood glucose <200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073–1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079–1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977–3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138–3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively. ConclusionsThe study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.

Polymorphism in beta fibrinogen -455 g/a gene was associated with diabetic in severe ischemic stroke patients

There is a association of polymorphism in the promoter region of the beta fibrinogen gene -455 G/A with enhancement plasma fibrinogen level. Diabetes mellitus is a risk factor for early neurologic deterioration in acute ischemic stroke. The prothrombotic fibrinogen protein is frequently elevated in patients with diabetes and may be association with poorer prognosis. This study evaluated the association of beta fibrinogen gene -455 G/A promoter polymorphism on modified Ranking Scale of Ischemic Stroke patients treated with diabetic and nondiabetic group. In a Cohort study design comprises 200 consecutive patients diabetic and a nondiabetic who, three months using completed a detailed outcome stroke. Of 200 samples genotype distribution were 27.1% for GG+GA and 0% for AA with diabetic and than 4.4% for GG+GA and 0.05% diabetic patients. Fibrinogen levels were higher in diabetic than nondiabetic group patients (307.7 + 106.3 vs 278 + 84 gr/dl, p=0.002). Fibrinogen level was found to be an independent predictor for diabetic patients. On Genotype GG+GA were associated wth diabetic and nondiabetic group patients. Modified Rankin Scale on day 90 were found associated with diabetic and nondiabetic patients. Conclusion: Elevated fibrinogen level is dose-dependently associated with 90 days outcome severity stroke with diabetic following ischemic stroke

Analysis for usefulness of worsen score; The predicting score for the deterioration of acute ischemic stroke

Background: Early neurological worsening associated with increased mortality and long-term functional disability.

Analysis of the Usefulness of the WORSEN Score for Predicting the Deterioration of Acute Ischemic Stroke

Early neurological worsening is associated with increased mortality and long-term functional disability. We developed the WORSEN score for predicting whether patients with stroke will deteriorate during the week after stroke onset and investigated its usefulness. We retrospectively investigated the cases of 478 patients who were admitted to Juntendo University Hospital between April 2007 and March 2009. Neurological deterioration was defined as a worsening of 4 points or higher on the National Institute of Health Stroke Scale score within 1 week of admission. Based on a previous study, we developed the WORSEN score, which was derived from the following factors: wrong (poor) blood sugar control (W), old myocardial infarction (O), radiological findings (R), infarct size (S), elevated low-density lipoprotein cholesterol (E), and neurological findings (N). Next, we investigated the utility of this scoring system in 456 other patients who were admitted to Juntendo University Hospital and Juntendo Urayasu Hospital between October 2013 and December 2014. First, we checked the utility of the WORSEN score for detecting worsening in cases of stroke. In the first patient group, deterioration was noted in 32.5% of the patients with scores higher than 3 points (sensitivity: .704 and specificity: .744). For checking reproductivity on using the second group, deterioration was detected in 36.1% of the patients with WORSEN scores higher than 3 points (sensitivity: .740 and specificity: .835). Careful attention should be paid to patients with acute stroke with high WORSEN scores. The WORSEN score might become a valuable tool for detecting the neurological deterioration of ischemic stroke.

CYP Genetic Variants, CYP Metabolite Levels, and Neurologic Deterioration in Acute Ischemic Stroke in Chinese Population

The mechanisms of neurologic deterioration (ND) are not fully understood. The aim of the present study was to evaluate the relationship between CYP genetic variants and CYP metabolite levels with ND in acute ischemic stroke patients. Eleven single nucleotide polymorphisms (SNPs) of seven CYP genes were genotyped in 396 patients with acute ischemic stroke. The CYP plasma metabolite levels (20-hydroxyeicosatetraenoic acid [HETE], total epoxyeicosatrienoic acids [EETs], and dihydroxyeicosatrienoic acids [DiHETEs]) were also assessed. The primary outcome was ND within 10 days on admission. ND was defined as an increase of two or more points in the National Institutes of Health Stroke Scale score. Among 396 patients, 101 patients (25.5%) experienced ND. The plasma levels of 20-HETE and DiHETEs were significantly higher and the EET levels were significantly lower in patients with ND compared to patients without ND. Univariate analyses revealed that old age, diabetes mellitus (DM), higher fasting glucose, and higher hemoglobin A1c (HbA1c) were associated with ND. CYP2C8 rs17110453 CC, EPHX2 rs751141 GG, and CYP4A11 rs9333025 GG were independently associated with ND after adjusting age, DM, fasting glucose, and HbA1c (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.02-3.72; OR: 3.01, 95% CI: 1.29-7.13; OR: 2.75, 95% CI: 1.17-6.24, respectively). Also, these polymorphisms were associated with CYP metabolite levels in patients with ND. ND is fairly common in acute ischemic stroke. Specific CYP gene SNPs are associated with CYP plasma metabolite levels, which may explain their associations with ND. Further studies are needed to validate our findings.