Frequency Of Favorable Outcomes Research Articles

Ischemic stroke patients with low DWI ASPECTS scores require puncture to recanalization within 30 min for large vessel occlusion

The clinical benefits of faster recanalization in acute large vessel occlusion are well recognized, but the optimal procedure time remains uncertain. The aim of this study was to identify patient characteristics that necessitate puncture-to-recanalization (P-R) time within 30min to achieve favorable outcome. We evaluated the patients from a prospective, multicenter, observational registry of acute ischemic stroke patients. The study included patients who underwent endovascular therapy for ICA or MCA M1 occlusion and achieved successful recanalization. Patients were categorized into subgroups based on pre-treatment characteristics and the frequency of favorable outcomes was compared between P-R time<30min and≥30min. Interaction terms were incorporated into the models to assess the correlation between each patient characteristic and P-R time. A total of 1053 patients were included in the study. Univariate analysis within each subgroup revealed a significant association between P-R<30min and favorable outcomes in patients with DWI ASPECTS ≤6, age>85 and NIHSS ≥16. In the multivariable analysis, NIHSS, age, time from symptom recognition to puncture, and DWI ASPECTS were significant independent predictors of favorable outcomes. Notably, only DWI ASPECTS exhibited interaction terms with P-R<30min. The multivariable analysis indicated that P-R<30min was an independent predictor for favorable outcome in DWI ASPECTS ≤6 group, whereas not in DWI ≥7. P-R time<30min is predictive of favorable outcomes; however, the effect depends on DWI ASPECTS. Target P-R time<30min is appropriate for patients with DWI ASPECTS ≤6.

Ultra-early rt-PA administration should improve patient outcome on mechanical thrombectomy: Post hoc analysis of SKIP

BackgroundTo investigate whether ultra-early recombinant tissue-plasminogen activator (rt-PA) administration can improve patient outcomes on mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO). MethodsParticipants comprised rt-PA-eligible 204 patients with internal carotid artery or middle cerebral artery occlusion in the SKIP trial, who were randomly assigned to receive mechanical thrombectomy alone or combined intravenous thrombolysis (rt-PA: alteplase at 0.6 mg/kg) plus mechanical thrombectomy. We assessed associations between onset-to-puncture time and onset-to-rt-PA administration time and frequency of favorable outcome at 90 days and any intracerebral hemorrhage (ICH) at 36 h after onset. ResultsAs a cut-off onset-to-puncture time for favorable outcome, receiver operating characteristic curves defined 2.5 h (57% sensitivity, 62% specificity). For onset-to-puncture times ≤2.5 h and > 2.5 h, frequencies of favorable outcomes were 72% and 63% (p = 0.402) in patients with rt-PA therapy and 44% and 58% (p = 0.212) in patients without rt-PA therapy, respectively. In terms of onset-to-rt-PA administration time, frequencies of favorable outcomes among patients with ultra-early rt-PA administration at ≤100, >100 min after onset, and without rt-PA therapy with onset-to-puncture time ≤ 2.5 h, and with and without rt-PA therapy with onset-to-puncture time > 2.5 h were 84% and 64%, 63%, and 44% and 58%, respectively (p = 0.025). Frequencies of any ICH among those patients were 37% and 32%, 32%, and 63% and 40%, respectively (p = 0.006). ConclusionUltra-early rt-PA administration should improve patient outcomes on mechanical thrombectomy among patients with LVO. Relatively late rt-PA administration might increase the frequency of any ICH.

Efficacy and safety of non-immunogenic staphylokinase in the ischemic stroke in real-world clinical practice in the Sverdlovsk region

To compare the efficacy and safety of non-immunogenic staphylokinase (Fortelysine) and alteplase in patients with ischemic stroke (IS) in real-world clinical practice. A retrospective, observational, non-interventional study of data the register of the Territorial Compulsory Health Insurance Fund was conducted. The proportion of patients with a favorable outcome, the degree of disability at discharge from the hospital, the duration of hospitalization, the proportion of lethal outcome in the groups of Fortelysine and alteplase were evaluated. The effect of the Rankin scale points at the hospitalization, the choice of a medical organization, the month of hospitalization, the choice of a thrombolytic on achieving a favorable outcome was determined. The data of 1238 patients from 26 hospitals of the Sverdlovsk region were included. There were no statistically significant differences in the proportion of a favorable outcome between the groups of Fortelysine and alteplase (26% and 25% respectively, p=0.845). Mediana of duration of hospitalization in the Fortelysine group was one day less, which is statistically significant compared to the alteplase group (9 [7;12] and 10 [7;13] respectively, p<0.001). There were no differences in the frequency of mortality (11% and 13% respectively, p=0.331). The hospital, the year and month of hospitalization, the level of disability at the baseline have a statistically significant effect on the outcome of hospitalization. The choice of a thrombolytic drug did not have a statistically significant effect on the frequency of favorable outcome. The comparable efficacy and safety of Fortelysine and alteplase in IS has been proven in clinical study and confirmed by real-world clinical practice.

Integral neuroimaging criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage on the background of conservative therapy

The aim of the study was to develop criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of conservative therapy, taking into consideration the lesion localization in conjunction with neuroimaging parameters of the quantitative severity assessment of the damage to cerebral structures. Materials and methods. Prospective cohort examination of 314 patients in acute period of SSICH on the ground of conservative treatment. Clinical and neurological examination consisted of using the Full Outline of Unresponsiveness coma scale and NIHHS, neuroimaging with the help of computed tomography with detection of SSICH localization, volume of intracranial hemorrhage, secondary intraventricular hemorrhage and midline shift. Disease acute period outcome was evaluated on the 21st day by the Rankin scale. Results. It was detected that integrated neuroimaging SSICH’s type considering its localization and quantitative severity estimation of cerebral structure injury was closely associated with the disease acute period outcome on the ground of conservative therapy (χ2 Pearson = 308.6, Р &lt; 0.0001). Thus, mortality rate was the highest in patients with posteromedial type of thalamic hemorrhage (50.0 %), global type of thalamic hemorrhage (91.7 %) and massive type of striatocapsular hemorrhage (89.8 %). Unfavorable functional outcome as the modified Rankin scale score 4–5 on 21st disease day predominated among patients with posterolateral types of thalamic hemorrhage (76.5 %) and striacapsular hemorrhage (64.3 %). Whereas the frequency of favorable outcome was the highest among patients with anterior/dorsal type of thalamic hemorrhage (100.0 %), posteromedial (88.0 %), middle (95.0 %), lateral types of striatocapsular hemorrhage (61.9 %) and lobar (74.5 %) hemorrhage. Conclusions. Posteromedial type of thalamic hemorrhage, global type of thalamic hemorrhage and massive type of striatocapsular hemorrhage are the predictors of lethal outcome of the acute period of SSIСH on the background of conservative therapy. Criteria for unfavorable short-term functional outcome are posterolateral types of thalamic and striatocapsular hemorrhage, while anterior/dorsal type of thalamic hemorrhage, posteromedial/middle type of striatocapsular hemorrhage and lobar hemorrhage are associated with favorable outcome of the acute period of the disease.

Funding has no effect on clinical outcomes of total joint arthroplasty emerging technologies: a systematic review of bibliometrics and conflicts of interest

BackgroundThe use of new total joint arthroplasty technologies, including patient-specific implants/instrumentation (PSI), computer-assisted (CA), and robotic-assisted (RA) techniques, is increasing. There is an ongoing debate regarding the value provided and potential concerns about conflicts of interest (COI).MethodsPRISMA guidelines were followed. PubMed, MEDLINE, and Web of Science databases were searched for total hip and knee arthroplasties, unicompartmental knee arthroplasties (UKA), PSI, CA, and RA. Bibliometric data, financial COI, clinical/functional scores, and patient-reported outcomes were assessed.ResultsEighty-seven studies were evaluated, with 35 (40.2%) including at least one author reporting COI, and 13 (14.9%) disclosing industry funding. COI and industry funding had no significant effects on outcomes (P = 0.682, P = 0.447), and there were no significant effects of conflicts or funding on level of evidence (P = 0.508, P = 0.826). Studies in which author(s) disclosed COI had significantly higher relative citation ratio (RCR) and impact factor (IF) than those without (P < 0.001, P = 0.032). Subanalysis demonstrated RA and PSI studies were more likely to report COI or industry funding (P = 0.045). RA (OR = 6.31, 95% CI: 1.61–24.68) and UKA (OR = 9.14, 95% CI: 1.43–58.53) had higher odds of reporting favorable outcomes than PSI.ConclusionsAuthor COIs (about 40%) may be lower than previously reported in orthopedic technologies/techniques reviews. Studies utilizing RA and PSI were more likely to report COI, while RA and UKA studies were more likely to report favorable outcomes than PSI. No statistically significant association between the presence of COIs and/or industry funding and the frequency of favorable outcomes or study level of evidence was found.Level of evidenceLevel V Systematic Review

Minimal Invasive Surgery for Chronic Subdural Hematoma

Objective: To assess significant improvement in terms of the Glasgow Coma Scale in patients subjected to minimally invasive surgery for a chronic subdural hematoma.&#x0D; Materials and Methods: A total of 80 patients with chronic subdural hematoma (CSDH) were enrolled in a sequential fashion using a retrospective study design. The patients were treated with minimally invasive surgery (MIS) and assessed at the end of the 2nd postoperative day (POD) for any significant improvement in the Glasgow coma scale (GCS).&#x0D; Results: There were 76.25% male and 23.75% female patients. A maximum number of patients (42.5%) were found with a GCS ranging from 9/15 – 11/15 (Class B) followed by Class A having GCS 12-13 (36.25%) and then Class C with GCS 5 – 8 (21.25% patients). In 86.2% and 13.7&amp; of the patients, positive and negative outcomes were recorded. Maximum favorable surgical outcome was observed in 51-60 years of age group. In the majority of male patients, a favorable surgical outcome was reported. Similarly, a favorable surgical outcome was observed in Class B (GCS 9-11). There existed an insignificant difference between favorable surgical outcome vs. age groups, gender, and GCS class at baseline.&#x0D; Conclusion: This study found that CSDH using the MIS approach is linked to a high frequency of positive outcomes in terms of GCS improvement. A lower admission GCS score and older age are linked to a lower frequency of favorable outcomes and a higher likelihood of bad outcomes.

Tactics and techniques of choledochal sanation after papillotomy

Сholelithiasis ranks third in terms of the prevalence of diseases among the adult population. A complication such as choledocholithiasis occurs in up to 33% of patients with gallstone disease. Despite the improvement in treatment methods and the use of “gold” standards, the number of complicated forms of cholelithiasis has no tendency to decrease. Timely resolution of choledocholithiasis by a correctly chosen technique helps to reduce complications and increases the frequency of favorable outcomes of the disease, returning patients to social activity.That is why it is important to know and, if possible, to use various methods of rehabilitation of the common bile duct when performing modern endoscopic transpapillary interventions.

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry.

Background: Brain atrophy globally reflects the effects of preexisting risk factors and biological aging on brain structures and normally predicts poor outcomes in anterior circulation stroke. However, comparing with these patients, acute basilar artery occlusion (ABAO) impairs infratentorial regions frequently and might benefit from brain atrophy due to the resulting residual space to reduce tissue compression and thus improve prognosis, which raises doubts that current understandings for prognostic roles of brain atrophy are also applicable for ABAO. Therefore, this study aims to evaluate brain atrophy automatically from CT images and investigates its impact on outcomes of ABAO following endovascular treatment (EVT).Methods: A total of 231 ABAO who underwent EVT from the BASILAR registry were enrolled. Brain atrophy was quantified as the ratio of brain parenchymal volume to cerebrospinal fluid volume on baseline CT. The primary outcome was the modified Rankin Scale (mRS) score at 3 months.Results: The frequency of favorable outcomes (90-day mRS ≤ 3) was significantly lower in the severe atrophy group (P = 0.014). Adjusted logistic models revealed that severe brain atrophy was significantly negatively associated with favorable outcome incidence (P = 0.006), with no relationship with either in-hospital or 90-day overall mortality (all P > 0.05). Adding a severe atrophy index into the baseline model obviously enhanced its discriminatory ability in predicting the outcome by obviously increasing areas under the receiver operating characteristic curve, net reclassification improvement algorithm, and integrated discrimination improvement algorithm values (all P < 0.05).Conclusion: Severe brain atrophy did not improve in-hospital or overall mortality but impaired the long-term recovery after EVT. This objective and automated marker has the potential to be incorporated into decision-support methods for treating ABAO.

Is There an Association Between Authors' Conflicts of Interest and Outcomes in Clinical Studies Involving Autologous Chondrocyte Implantation?

Background:Autologous chondrocyte implantation (ACI) is an increasingly popular technique for the treatment of articular cartilage defects. Because several companies have financial interests in ACI, it is important to consider possible conflicts of interest when evaluating studies reporting outcomes of ACI.Purpose:To determine whether there is an association between authors’ financial conflicts of interest and the outcomes of ACI studies.Study Design:Cross-sectional study.Methods:A search of PubMed and MEDLINE databases for “autologous chondrocyte implantation” was performed. Clinical studies published after 2012 through May 15, 2019, and in English were included. Studies were determined to have financial conflicts of interest if any contributing author had relevant conflicts, either self-reported in the published study’s disclosures section or reported online in the American Academy of Orthopaedic Surgeons Disclosure database or the Centers for Medicare & Medicaid Services Open Payments database. The outcomes of each study were rated as favorable, equivocal, or unfavorable based on predefined criteria and then tested for association with conflicts of interest through use of the Fisher exact test.Results:A total of 79 studies met the inclusion criteria. Nearly all studies were of level 3 or 4 evidence. Conflicts of interest were established in 51.90% of studies (n = 41). Conflicts that were not self-reported by the authors were discovered in 18% of studies. The level of evidence was not associated with conflict of interest. No statistically significant difference was found in the rate of favorable outcomes between studies with conflicts (92.68%) and those with no conflicts (81.58%) (P = .126). Publications by US authors were more likely to have financial conflicts of interest (P = .003).Conclusion:Favorable results were reported in a majority of studies involving ACI. No statistical association was found between the frequency of favorable outcomes and the presence of financial conflicts of interest, country of authorship, or level of evidence. There was a trend toward more favorable outcomes in studies with conflicts of interest. Additionally, nearly 20% of publications had possible conflicts found online that were not self-reported. It is critical for orthopaedic surgeons to judiciously evaluate published studies and consider financial conflicts of interest before performing ACI techniques on patients.

Local tirofiban infusion for remnant stenosis in large vessel occlusion: tirofiban ASSIST study

BackgroundCompared with embolic occlusions, intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusions (LVOs) often require rescue treatment following mechanical thrombectomy (MT). Herein, we hypothesized that local tirofiban infusion can be effective and safe for remnant stenosis in LVO during endovascular treatment and can improve clinical outcomes.MethodsThis observational multicenter registry study (January 2011 to February 2016) included patients with ICAS who underwent endovascular treatment for LVO within 24 h after stroke onset. An underlying fixed focal stenosis at the occlusion site observed on cerebral angiography during and after MT was retrospectively determined as a surrogate marker of ICAS. Procedural and clinical outcomes were compared between the tirofiban and non-tirofiban groups.ResultsOf 118 patients, 59 received local tirofiban infusion. Compared to the non-tirofiban group, patients were older (non-tirofiban group versus tirofiban group; median, 63 years vs. 71 years, p = 0.015) and the onset-to-puncture time was longer (median, 275 min vs. 395 min, p = 0.036) in the tirofiban group. The median percent of residual stenosis prior to rescue treatment tended to be higher in the tirofiban group (80 [71–86] vs. 83 [79–90], p = 0.056). Final reperfusion success (modified Treatment In Cerebral Ischemic 2b–3) was more frequent (42.4%vs. 86.4%, p = 0.016) and post-procedure parenchymal hematoma type 2 and/or thick subarachnoid hemorrhages were less frequent (15.3%vs. 5.1%, p = 0.068) in the tirofiban group. The frequency of favorable outcomes 3 months after endovascular treatment (modified Rankin Scale 0–2) was significantly higher in the tirofiban group (32.2% vs. 52.5%, p = 0.025), and tirofiban administration was an independent predictor of favorable outcomes (odds ratio, 2.991; 95% confidence interval, 1.011–8.848; p = 0.048).ConclusionsLocal tirofiban infusion can be a feasible adjuvant treatment option for patients with ICAS-LVO.

Secular Trends in the Background of Intracerebral Hemorrhage from 2010 to 2015

ObjectiveDirect oral anticoagulants (DOACs) were recently introduced for the clinical use in stroke prevention, and they are reported to show a lower risk of intracerebral hemorrhage (ICH) compared to warfarin. We were interested to know whether there is any change in clinical backgrounds of ICH patients to date. MethodsFrom 2010 to 2015, ICH patients admitted to our hospital were consecutively screened (n = 658). Hematoma size was assessed by brain computed tomography images on admission. Outcome was measured by the modified Rankin Scale, and favorable outcome was defined as modified Rankin Scale 0-2. Biennial trends were compared in 3 periods, P1: 2010-2011, P2: 2012-2013, and P3: 2014-2015. ResultsThe percentage of ICH patients taking antithrombotics had been slightly decreasing (P = .245: [P1] 33.0%, [P2] 27.4%, and [P3] 26.2%). The frequency of patients taking antiplatelets had significantly decreased (P = .001: [P1] 50.7%, [P2] 44.3%, and [P3] 22.8%), and those taking DOACs had significantly increased (P = .001: [P1] 1.4%, [P2] 4.9%, and [P3] 19.3%). Frequency of favorable outcomes in patients taking antithrombotics was slightly increased in P3 compared to P1 and P2 (23.3%, 21.1%, and 21.3%, respectively). There was no significant difference in hematoma size between patients taking warfarin and DOACs. ConclusionsNumber of ICH patients taking antithrombotics has been slightly decreasing and the percentage taking DOACs among ICH has been increasing for 6 years.

Abstract WP32: Good Reperfusion Can Rescue Acute Ischemic Stroke Patients Treated With Endovascular Therapy Beyond 6 Hours After Onset.

Objective: Endovascular therapy (EVT) within 6 hours from ischemic stroke onset were recommended by 2015 AHA/ASA guideline. Effectiveness and factors for favorable outcome for EVT beyond 6 hours are unclear. We investigated whether onset to puncture time (O2P) beyond 6 hours is associated with outcome at 3 months and what is the favorable factors in patients treated with EVT beyond 6 hours. Methods: We performed a retrospective, single center analysis of patients with acute ischemic stroke who underwent EVT. The O2P, risk factors, reperfusion success rate and outcome at 3 month were assessed. First, all patients were classified into the two groups with EVT beyond 6 hours or not. Second, we compared any characteristics and favorable outcome between two groups. Finally, we investigated independent factors for favorable outcome in patients treated with EVT beyond 6 hours. Favorable outcome and good reperfusion were defined by modified Rankin scale ≤ 2 and thrombolysis in cerebral infarction (TICI) score ≥ 2B, respectively. Results: Of the 130 EVT cases, 124 cases with known onset time were enrolled (age; 75 [66-83] and 74 (60.5%) men). 98 (79%) were treated with EVT within 6 hours and 26 (21%) patients were beyond 6 hours. Absence of atrial fibrillation (11[42%] vs. 70[71%], p=0.01), high DWI-ASPECTS (9 [7-10] vs. 7 [6-9], p=0.01), no use of intravenous tissue plasminogen (1[4%] vs. 50[51%], p&lt;0.01) and low achievement of good reperfusion (14[54%] vs. 77[79%], p=0.01) were more frequently observed in beyond 6 hours group than within 6 hours group. However, favorable outcome was not different between two groups (beyond 6 hours group ;10(38%) vs. within 6 hours group; 43(44%), p = 0.66). In beyond 6 hours group, good reperfusion (9[90%] vs. 5[31%], p=0.01) and presence of hyperlipidemia (7[70%] vs. 3[19], p=0.02) were associated with favorable outcome. On multivariate analysis, only good reperfusion (OR 45.6, 95%CI 3.7-2271.4, p&lt;0.01) was the independent factor associated with favorable outcome. Conclusions: The frequency of favorable outcome in beyond 6 hours group was not lower than within 6 hours group. Good reperfusion can improve patient outcome in O2P within 6 hours as well as beyond 6 hours.

PREGNANCY AND CHILDBIRTH IN PATIENTS WITH RENAL ALLOGRAFT (CASE REPORT)

Relevance. Kidney transplantation is the method of choice for women of reproductive age with late stage of chronic kidney disease, who want to realize their childbearing function. Pregnancy and childbirth in patients with renal allografts are classified as an increased risk due to the more frequent complications compared to the general population. Progressive pregnancy is observed in 5–12 % of patients with renal allograft, the frequency of favorable outcomes in such cases is 65–92 %. Objective. To identify the most common complications in pregnancy in women with a transplanted kidney, to review the algorithms for maintaining this category of patients Material and methods . In the clinic of obstetrics and gynecology two patients with a renal allograft were examined and delivered, observed in common with specialists from the Research Institute of Surgery and Urgent Medicine. Results. Both patients were delivered by a cesarean section, the postoperative period proceeded without complications in both cases. Conclusions . This category of patients needs to be closely monitored throughout the pregnancy by a multidisciplinary team of specialists. This article describes the clinical cases of pregnancy in patients with a transplanted kidney.

Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease.

The objectives of this study were to compare the results of radiofrequency ablation (RFA) and stripping for large-diameter varicose target veins for the period of 1year, based on a composite end point; to analyze the pain severity on a digital rating scale for 7days after RFA and stripping; and to detect the factors affecting the level of postoperative pain using the cluster analysis. This was a multicenter retrospective cohort study. Two groups, stripping ≥14mm and RFA ≥14mm, of 129 varicose vein disease patients underwent surgical treatment in three specialized clinics. We eliminated symptomatic pathologic reflux with RFA in 64 patients and with stripping in 65 patients. In the postoperative phase, we evaluated the pain level, subcutaneous hemorrhage, and paresthesia. A composite end point with four components was used to analyze the results. These were three clinical adverse effects of the intervention (pain, hemorrhage, and paresthesia) and the technical outcome 1year after the surgical intervention. The frequency of favorable outcomes was 20 (30.8%) in the stripping ≥14mm group and 61 (95.3%) in the RFA ≥14mm group (P< .0001). The odds ratio for a favorable outcome between the RFA and the stripping groups was 45.8 (95% confidence interval, 44.5-47.0). The pain clusters that were moderate were created by patients after stripping. These clusters show a link between the pain level on the one hand and an increased body mass index and large vein diameter on the other hand. For large-diameter veins, RFA is superior to stripping in terms of favorable outcomes according to the composite end point chosen. Significant pain after stripping was linked to a large vein diameter and excess weight or adiposis.

FRI0415 Being younger and living with a partner are important determinants of sustained favorable outcome in early arthritis (EA): Results from the french espoir cohort

BackgroundThe relevant elements to evaluate health states in RA should include [1]: a) Remission according to the new criteria of ACR/EULAR b) A criterion representing good functional ability: HAQ≤0.5 and...

Outcome of Intravenous Thrombolysis in Stroke Patients Weighing over 100 kg

Background: Intravenous thrombolysis with alteplase for ischemic stroke is fixed at a maximal dose of 90 mg for safety reasons. Little is known about the clinical outcomes of stroke patients weighing >100 kg, who may benefit less from thrombolysis due to this dose limitation. Methods: Prospective data on 1,479 consecutive stroke patients treated with intravenous alteplase in six Swiss stroke units were analyzed. Presenting characteristics and the frequency of favorable outcomes, defined as a modified Rankin scale (mRS) score of 0 or 1, a good outcome (mRS score 0–2), mortality and symptomatic intracranial hemorrhage (SICH) were compared between patients weighing >100 kg and those weighing ≤100 kg. Results: Compared to their counterparts (n = 1,384, mean body weight 73 kg), patients weighing >100 kg (n = 95, mean body weight 108 kg) were younger (61 vs. 67 years, p < 0.001), were more frequently males (83 vs. 60%, p < 0.001) and more frequently suffered from diabetes mellitus (30 vs. 13%, p < 0.001). As compared with patients weighing ≤100 kg, patients weighing >100 kg had similar rates of favorable outcomes (45 vs. 48%, p = 0.656), good outcomes (58 vs. 64%, p = 0.270) and mortality (17 vs. 12%, p = 0.196), and SICH risk (1 vs. 5%, p = 0.182). After multivariable adjustment, body weight >100 kg was strongly associated with mortality (p = 0.007) and poor outcome (p = 0.007). Conclusion: Our data do not suggest a reduced likehood of favorable outcomes in patients weighing >100 kg treated with the current dose regimen. The association of body weight >100 kg with mortality and poor outcome, however, demands further large-scale studies to replicate our findings and to explore the underlying mechanisms.

External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: effect on preoperative grading and prognosis

The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis is described. Fifty-nine poor grade patients had an EVD placed preoperatively and underwent definitive aneurysm treatment between September 1996 and March 2002. Patients improving > or = one Hunt and Hess grade were considered responders. Case-control comparisons were completed for each responder, based on clinical grade; the pre-EVD grade and the post-EVD (response) grade were used to generate two independent control cohorts. Logistic regression was used to evaluate the relationship of 12-month modified Rankin disability score (mRS) to clinical grade. Nineteen (32%) responders were identified, and were less likely Grade V (p < 0.05), and more often had smaller (<13 mm, p < 0.01) and posterior circulation (p < 0.03) aneurysms. The frequency of favorable outcome (mRS < or= 3) was greater in responders than non-responders (68% vs. 28%, p < 0.001). Responders had a similar incidence of favorable outcome as response-grade controls (74%), and a higher incidence of favorable outcome than pre-EVD controls (47%). Regression analysis identified the post-EVD grade, but not the pre-EVD grade, as significantly predictive of long-term outcome (p < 0.04). Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages. When an EVD is placed preoperatively in a poor grade aSAH patient, the neurological status after EVD determines the clinical grade.