Predictor Of Good Clinical Outcome Research Articles

The use of medial joint opening rather than mechanical axis deviation to determine the clinical outcomes after high tibial osteotomy.

The aim of this study was to evaluate whether achieving medial joint opening, as measured by the change in the joint line convergence angle (∆JLCA), is a better predictor of clinical outcomes after high tibial osteotomy (HTO) compared with the mechanical axis deviation, and to find individualized targets for the redistribution of load that reflect bony alignment, joint laxity, and surgical technique. This retrospective study analyzed 121 knees in 101 patients. Patient-reported outcome measures (PROMs) were collected preoperatively and one year postoperatively, and were analyzed according to the surgical technique (opening or closing wedge), postoperative mechanical axis deviation (deviations above and below 10% from the target), and achievement of medial joint opening (∆JLCA > 1°). Radiological parameters, including JLCA, mechanical axis deviation, and the difference in JLCA between preoperative standing and supine radiographs (JLCAPD), an indicator of medial soft-tissue laxity, were measured. Cut-off points for parameters related to achieving medial joint opening were calculated from receiver operating characteristic (ROC) curves. Patients in whom the medial joint opening was achieved had significantly better postoperative PROMs compared with those without medial opening (all p < 0.05). Patients who were outliers with deviation of > 10% from the target mechanical axis deviation had significantly similar PROMs compared with patients with an acceptable axis deviation (all p > 0.05). Medial joint opening was affected by postoperative mechanical axis deviation and JLCAPD. The influence of JLCAPD on postoperative axis deviation was more pronounced in a closing wedge than in an opening wedge HTO. Medial joint opening rather than the mechanical axis deviation determined the clinical outcome in patients who underwent HTO. The JLCAPD identified the optimal postoperative axis deviation necessary to achieve medial joint opening. For patients with increased laxity, lowering the target axis deviation is recommended to achieve medial joint opening. The target axis deviation should also differ according to the technique of undergoing HTO.

Prognostic value of transthoracic echocardiography score for the prognosis of continuous ambulatory peritoneal dialysis patients

BackgroundWe devoted ourselves to proving that the initial transthoracic echocardiography score (TTES) had predictive significance for patients with continuous ambulatory peritoneal dialysis (CAPD).MethodsIn this retrospective analysis, 274 CAPD patients who had PD therapy were recruited sequentially. TTE exams were performed three months following the start of PD therapy. All patients were divided into two groups based on the strength of their TTES levels. TTES’s predictive value for CAPD patients was then determined using LASSO regression and Cox regression.ResultsDuring a median of 52 months, 46 patients (16.8%) died from all causes, and 32 patients (11.7%) died from cardiovascular disease (CV). The TTES was computed as follows: 0.109 × aortic root diameter (ARD, mm) − 0.976 × LVEF (> 55%, yes or no) + 0.010 × left ventricular max index, (LVMI, g/m2) + 0.035 × E/e’ ratio. The higher TTES value (≥ 3.7) had a higher risk of all-cause death (hazard ratio, HR, 3.70, 95% confidence index, 95%CI, 1.45–9.46, P = 0.006) as well as CV mortality (HR, 2.74, 95%CI 1.15–19.17, P = 0.042). Moreover, the TTES had an attractive predictive efficiency for all-cause mortality (AUC = 0.762, 95%CI 0.645–0.849) and CV mortality (AUC = 0.746, 95%CI 0.640–0.852). The introduced nomogram, which was based on TTES and clinical variables, exhibited a high predictive value for all-cause and CV mortality in CAPD patients.ConclusionTTES is a pretty good predictor of clinical outcomes, and the introduced TTES-based nomogram yields an accurate prediction value for CAPD patients.

Predictors of Good Clinical Outcome After Endovascular Treatment for Acute Ischemic Stroke due to Tandem Lesion in Anterior Circulation: Results from the ASCENT Study

PurposeEndovascular treatment (EVT) of tandem lesion (TL) in anterior circulation (AC) acute ischemic stroke (AIS) represents still a clinical challenge. We aimed to evaluate selected factors related to EVT and assess other possible predictors of good clinical outcome besides the generally known ones.MethodsAIS patients with TL in AC treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0–2 points in modified Rankin Scale (mRS) and achieved recanalization using the TICI scale. Symptomatic intracerebral hemorrhage (SICH) was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of mRS 0–2 with adjustment for potential confounders.ResultsIn total, 300 (68.7% males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7%) patients and 176 (58.7%) had mRS 0–2. Besides the age, admission NIHSS and SICH, admission glycemia (p = 0.005, OR: 0.884) the stent patency within the first 30 days after EVT (p = 0.0003, OR: 0.219), dual antiplatelet therapy (DAPT) started within 12 h after EVT (p < 0.0001, OR: 5.006) and statin therapy started within 24 h after stenting (p < 0.0001, OR: 5.558) were found as other predictors.ConclusionAdmission glycemia, start of DAPT within 12 h and statin therapy within 24 h after EVT, and stent patency within the first 30 days after EVT were found as other predictors of good three-month clinical outcome in AIS patients treated with EVT for TL.Graphical

Anatomic Reduction of Greater Tuberosity Fragment for Shoulder Hemiarthroplasty: a Predictor of Good Clinical Outcome.

Proximal humerus fractures account for four-five % of all fractures. Shoulder hemiarthroplasty is indicated for complex fractures with high complication rates when treated with ORIF. This study aims to evaluate the correlation between the proper intraoperative tuberosity reduction, and the mid-to-long-term clinical outcome in a series of patients treated with hemiarthroplasty after proximal humerus fracture. Forty-one patients with proximal humerus fractures who underwent hemiarthroplasty surgery between July 2009 and December 2019 were retrospectively reviewed. Quantitative analysis of the reduction of the tuberosities was performed on postoperative X-rays focusing on the distance between reconstructed greater tuberosity and the apex of the head of the prosthesis, (head-tuberosity distance), and contact between tuberosity and humerus diaphysis. The University of California Los Angeles Score (UCLA) was calculated for each patient. The mean time to surgery was 6.29 ± 2.8 days (range 2-18 days). Nine patients out of 41 (22%) had non anatomic tuberosity, and 32 (78%) were anatomic reduced. The UCLA score at the final follow-up was good and excellent (≥27) in 27 patients (66%), and poor (<27) in 14 (34%). A significant correlation was observed between proper tuberosity reduction and good/excellent UCLA scores (P<0.001). Hemiarthroplasty is a valid and reliable technique for the treatment of proximal humerus fracture not eligible for internal fixation, with high risk of failure. The proper tuberosity reconstruction, paying special attention to the HTD and the contact between the cortical of the humeral diaphysis and the reconstructed tuberosity, is essential to reach a good clinical outcome.

Predictors of good clinical outcome after endovascular treatment for acute ischemic stroke due to tandem lesion in anterior circulation: Results from the ascent study

Predictors of good clinical outcome after endovascular treatment for acute ischemic stroke due to tandem lesion in anterior circulation: Results from the ascent study

Evaluation of effectiveness and safety of the large-format pRESET 6-50 thrombectomy stent-retriever in the endovascular treatment of ischemic stroke: real-world experiences from two tertiary comprehensive stroke centers.

Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). First-pass (FP) reperfusion of the occluded vessel and fewer passes with stent retrievers show improvement in functional outcomes in stroke patients, while higher numbers of passes are associated with higher complication rates and worse outcomes. Studies indicate that a larger size of the stent-retriever is associated with a higher rate of first-pass reperfusion and improved clinical outcomes. In this retrospective study, we investigated the clinical performance of a recently developed and one of the largest stent-retrievers available in the treatment of LVO (pRESET 6-50, phenox GmbH, Bochum). All consecutive patients with ischemic stroke due to proximal large vessel occlusion treated with MT using the pRESET 6-50 stent-retriever in two tertiary stroke centers between 09/2021 and 07/2022 were included in this study. The reperfusion rate after MT was quantified by the modified thrombolysis in cerebral infarction (mTICI) score, and functional neurological outcome was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score and the major early neurological recovery (mENR) rate after 24 h. Successful FP reperfusion was defined as mTICI ≥ 2b. Successful and complete reperfusion were defined as mTICI ≥ 2b and mTICI ≥ 2c, respectively. In total, 98 patients (52 men and 46 women) with a median age of 75 (range 25-95 years) were included. A total of 70 (72%) patients presented with an occlusion of the middle cerebral artery (MCA) in the M1 segment, 6 (6%) patients with an occlusion of the M2 segment, 17 (17%) patients with an occlusion of the internal carotid artery (ICA), and 5 (5%) patients with an occlusion of the obstructed basilar artery (BA). Successful FP reperfusion was achieved in 58 patients (62%). Successful and complete reperfusion were achieved in 95 (97%) and 82 (83%) patients, respectively. The median National Institutes of Health Stroke Scale (NIHSS) in all treated patients improved from 17 to 7.5. Major early neurological recovery (mENR) was observed in 34 patients (35.1%). MT with the pRESET 6-50 stent-retriever achieves high successful first-pass and final reperfusion rates in patients with AIS and LVO. The results of this study support the thesis to use large-format stent-retriever in proximal vessel occlusion MT whenever feasible in order to improve high FP and final reperfusion rate, which are known predictors of good clinical outcome.

Predictors of good outcome in Acute stroke due to basilar artery occlusion from the PC-SEARCH Registry (S24.005)

Predictors of good outcome in Acute stroke due to basilar artery occlusion from the PC-SEARCH Registry (S24.005)

The Relationship Between Neuron-Specific Enolase and Clinical Outcomes in Patients Undergoing Mechanical Thrombectomy.

Neuron-specific enolase (NSE) is considered a biomarker for the severity of nervous system diseases. We sought to explore whether serum NSE concentration in ischemic stroke patients undergoing mechanical thrombectomy (MT) is related to 3-month functional outcome and symptomatic intracranial hemorrhage (sICH). We retrospectively collected the data of acute ischemic stroke patients with anterior circulation infarction receiving MT within 6 h in our stroke center. Favorable outcome and poor outcome at 3 months were defined as modified Rankin Scale (mRS) score 0-2 and 3-6, respectively. sICH was defined according to the Heidelberg bleeding classification. We used multivariate logistic regression model and receiver operating characteristic curves to investigate the correlation between NSE and clinical outcomes. Among the 426 patients enrolled, 40 (9.4%) patients developed sICH. Three-month favorable outcome in 160 (37.6%) and poor outcome in 266 (62.4%) patients were observed. Serum NSE levels was significantly correlated with 3-month mRS score (R = 0.473, P < 0.001). A cutoff value of 15.29 and 23.12 ng/mL for serum NSE was detected in discriminating 3-month poor outcome (area under the curve, 0.724) and sICH (area under the curve, 0.716), respectively. Multivariate analysis showed that high serum NSE levels were independently associated with 3-month poor outcome (odds ratio [OR] 5.049, 95% confidence interval [CI] 2.933-8.689, P<0.001) and sICH (OR 5.111, 95% CI 2.210-11.820, P < 0.001). Our study demonstrated that high serum NSE levels after receiving MT were independently associated with 3-month poor outcome and sICH in acute ischemic stroke patients. Serum NSE levels could be a good predictor of clinical outcomes for patients receiving MT.

Pooled blood volume measured by final flat-panel detector computed tomography predicts outcome after endovascular thrombectomy for acute ischemic stroke

BackgroundPooled blood volume (PBV), measured in real-time in the angiography room using an angiography system, correlates with cerebral blood volume (CBV). We examined the usefulness of PBV in endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). MethodsEVT for AIS in the anterior circulation (internal carotid artery (ICA) and middle cerebral artery (MCA)) was performed in 31 cases (13 males, 18 females, average age 75.7 years). PBV was acquired using a biplane flat-panel detector (FD) angiographic system. Then, we measured the average PBV value in the M1-6 regions similar to the Alberta Stroke Program Early CT score (ASPECTS) before and after EVT. We investigated factors associated with favorable outcome at 90 days after EVT. ResultsThere were 13 patients (41.9%) in the good outcome group (mRS (modified Rankin Scale) ≦2) and 18 patients (58.1%) in the poor outcome group (mRS>2). In univariate analysis, NIHSS (National Institutes of Health Stroke Scale) (odds ratio [OR] 0.74, 95% CI 0.57–0.87, p < 0.0001) and post PBV value (odds ratio [OR] 1.13, 95% CI 1.03–1.29, p = 0.0086) were significantly associated with good outcome. The good outcome group had significantly higher post-thrombectomy PBV value (3.69 ± 0.32 ml/100 g versus 2.78 ± 0.93 ml/100 g, P = 0.002) compared to that of the poor outcome group. The relationship between pre-thrombectomy PBV value and outcome at 90 days was not significant. ConclusionsPost-operative PBV value measured by FD-CT (computed tomography) correlated with 90-day outcome after EVT for AIS. FD-CT-PBV would be one of the good predictors of clinical outcome.

Construction of a pyroptosis-related lncRNAs signature for predicting prognosis and immunotherapy response in glioma.

Recent studies have proved that pyroptosis-related long non-coding RNAs (PRlncRNAs) are closely linked to tumor progression, prognosis, and immunity. Here, we systematically evaluated the correlation of PRlncRNAs with glioma prognosis. This study included 3 glioma cohorts (The Cancer Genome Atlas, Chinese Glioma Genome Atlas, and Gravendeel). Through Pearson correlation analysis, PRlncRNAs were screened from these 3 cohorts. Univariate Cox regression analysis was then carried out to determine the prognostic PRlncRNAs. A pyroptosis-related lncRNAs signature (PRLS) was then built by least absolute shrinkage and selection operator and multivariate Cox analyses. We systematically evaluated the correlation of the PRLS with the prognosis, immune features, and tumor mutation burden in glioma. A total of 14 prognostic PRlncRNAs overlapped in all cohorts and were selected as candidate lncRNAs. Based on The Cancer Genome Atlas cohort, a PRLS containing 7 PRlncRNAs was built. In all cohorts, the PRLS was proved to be a good predictor of glioma prognosis, with a higher risk score related to a poorer prognosis. We observed obvious differences in the immune microenvironment, immune cell infiltration level, and immune checkpoint expression in low- and high-risk subgroups. Compared with low-risk cases, high-risk cases had lower Tumor Immune Dysfunction and Exclusion scores and greater tumor mutation burden, indicating that high-risk cases can be more sensitive to immunotherapy. A nomogram combining PRLS and clinical parameters was constructed, which showed more robust and accurate predictive power. In conclusion, the PRLS is a potentially useful indicator for predicting prognosis and response to immunotherapy in glioma. Our findings may provide a useful insight into clinically individualized treatment strategies for patients.

Convergence of human and veterinary medicine: leveraging canine naturally occurring neurological disorders to develop regenerative treatments.

Convergence of human and veterinary medicine: leveraging canine naturally occurring neurological disorders to develop regenerative treatments.

Predictors of good clinical outcome in acute ischemic stroke patients after mechanical thrombectomy

Predictors of good clinical outcome in acute ischemic stroke patients after mechanical thrombectomy

ODP441 NErbB-2 and Androgen Receptor Regulate a Gene Signature Involved in Immune Response and Favorable Outcome in TNBC

Abstract Triple negative breast cancer (TNBC) has poor prognosis and neither established biomarkers nor therapeutic targets. On the one hand, the androgen receptor (AR), a steroid hormone receptor (SR) which is expressed in 10-53% of TNBC and proved to be critical for BC proliferation, has been proposed as a new target in TNBC. On the other, we and others have shown that membrane ErbB-2 migrates to the nucleus (nuclear ErbB-2, NErbB-2) where it binds DNA at HER-2 associated sequences (HAS) to regulate BC proliferation and migration. Since we have previously shown a functional interplay between growth factors and SR signaling pathways in BC, we propose the existence of an interaction between AR and ErbB-2 which is involved in NErbB-2+/AR+ BC growth. The experimental model used was the human TNBC cell line MDA-MB-453 which displays high expression levels of AR and NErbB-2. We have previously shown that dihydrotestosterone (DHT)-activated AR induces Src-mediated ErbB-2 rapid activation and its migration to the nucleus where it binds to HAS sites in the DNA. By coimmunoprecipitation and WB studies, we have now shown that this crosstalk involves ErbB-2 and AR physical association which is inhibited by the AR antagonist enzalutamide. By microarray and bioinformatics analysis we have also previously identified a set of differentially expressed genes (DEGs) in the presence of DHT and NErbB-2 eviction to define an independent predictor of better clinical outcome in TNBC. By using the Tumor Immune Estimation Resource (TIMER) we found a significant association of the expression of the gene signature and the abundance of tumor immune infiltrates, in accordance with the involvement of the gene signature in the immune response and interferon pathways. We have validated the regulation of the gene signature in MDA-MB-453 cells and found that in the presence of DHT, eviction of NErbB-2 significantly induces the mRNA expression of the genes CXCL10, HLA-A, NMI, STAT1 and TAP1, members of said gene signature. We have also identified AREs and HAS sites in STAT1, NMI and TAP1 and studied AR and ErbB-2 recruitment to the chromatin by ChIP assays. We found that DHT induces ErbB-2 binding to its HAS sites in STAT1 in regulatory regions. Our findings evidence that DHT-activated AR induces ErbB-2 rapid activation and its migration to the nucleus where it binds to HAS sites in regulatory regions of a set of genes involved in the immune response in TNBC. Presentation: No date and time listed

Left atrial strain and clinical outcome in patients with significant mitral regurgitation after surgical mitral valve repair.

BackgroundThis study aimed to investigate the prognostic value of left atrial (LA) strain in patients with significant mitral regurgitation (MR) after surgical mitral valve (MV) repair.MethodsA total of 169 patients (age 55 ± 15 years, 88 men) with moderate or severe MR on echocardiogram at least 6 months after surgical MV repair for primary MR were studied. Two-dimensional, Doppler, and speckle tracking echocardiography including MR quantitative measures, chamber size, and LA strain were comprehensively analyzed. The primary outcome was a composite of cardiovascular death, heart failure hospitalization, and MV reoperation.ResultsDuring a median of 44.4 months [interquartile range (IQR): 18.7–70.3 months] of follow-up, 44 patients (26%) experienced clinical events; these patients had greater MR volume, elevated mean diastolic pressure gradient and pulmonary artery systolic pressure, and enlarged chamber size compared with patients who did not experience events. Patients with events showed significantly lower LA strain [13.3% (IQR: 9.3–23.8%) vs. 24.0% (IQR: 13.1–31.4%), p = 0.003] and higher MR volume/LA strain [3.09 ml/% (IQR: 2.06–5.80 ml/%) vs. 1.57 ml/% (IQR: 1.04–2.72 ml/%), p < 0.001] than those without events. MR volume/LA strain was a good predictor of clinical outcomes (cut-off 1.57 ml/%, area under the curve 0.754, p < 0.001). On multivariable Cox proportional analysis, MR volume/LA strain was independently associated with clinical outcomes (hazard ratio: 1.269, 95% confidence interval: 1.109–1.452, p < 0.001) along with pulmonary artery systolic pressure.ConclusionA measure of LA mechanical function relative to MR volume is associated with clinical outcomes in patients with significant MR after surgical MV repair.

Role of fibroscan in assessing the extent of liver involvement among chronic hepatitis B and C cases

Chronic liver diseases (CLD) cause significant morbidity and mortality worldwide, accounting for approximately 2 million deaths annually. The majority of CLDs include alcoholic liver disease, chronic viral hepatitis, including hepatitis B and C, non-alcoholic fatty liver disease (NAFLD), and hemochromatosis. Of these, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases which is responsible for liver damage ranging from minor disorders to liver cirrhosis and hepatocellular carcinoma (HCC). Fibroscan is a novel non-invasive method for assessing hepatic fibrosis by measuring liver stiffness.&#x0D; The aim. The present study was conducted to know the prevalence of blood-born viral pathogens (HBV, HCV) among patients with chronic liver diseases (CLD) and also to assess the role of Fibroscan and liver function tests (LFT) in evaluating the extent of chronic liver disease.&#x0D; Material and methods: The present study comprised 100 chronic liver disease patients attending the gastroenterology department. All the chronic liver disease cases were tested for Hepatitis B and Hepatitis C viral infections using a rapid Immunochromatography assay. Simultaneously they were subjected to liver function tests and fibroscan to assess the extent of fibrosis by staging from F0 to F4.&#x0D; Results: When screened for bloodborne viral pathogens, 46 % were HBV positive, 10 % were HCV, and none were HIV positive. No co-infection was detected. HBV was identified as the most typical cause of CLD in about 46 %, followed by non-viral/non-infectious (alcoholic, metabolic, autoimmune) cause in 44 % and 10 %, the cause for CLD was HCV. As per fibroscan results, 80 % of HCV and 39 % of HBV patients were in the stage of cirrhosis/advanced fibrosis.&#x0D; Conclusion: HBV was the predominant cause of CLD. Liver stiffness has recently been shown to be a good predictor of clinical outcomes. A fibroscan will help in the decision-making process in staging the disease and choice of treatment in viral hepatitis cases

Blood pressure, heart rate, or the Rate Pressure Product: what is the best predictor of clinical outcome?

Blood pressure, heart rate, or the Rate Pressure Product: what is the best predictor of clinical outcome?

Prognostic value of ASPECTS on post-treatment diffusion-weighted imaging for acute ischemic stroke patients after endovascular thrombectomy: comparison with infarction volume.

To assess the prognostic value of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on post-treatment diffusion-weighted imaging (DWI) for acute ischemic stroke (AIS) patients after endovascular thrombectomy (EVT) and compare it with that of infarction volume. Ninety-eight consecutive AIS patients who underwent EVT and post-treatment DWI were retrospectively enrolled. ASPECTS and infarction volume were evaluated based on post-treatment DWI, respectively. Good clinical outcome was defined as modified Rankin Scale score of 0-2 at 90 days. Predictors of good clinical outcome were evaluated using univariate and multivariate logistic regression analysis. Prognostic value of post-treatment DWI ASPECTS and infarction volume were assessed and compared using receiver-operating-characteristic curves and the DeLong method. Favorable outcome was achieved in 62 (63.3%) patients. A strong correlation was found between post-treatment DWI ASPECTS and infarction volume (ρ = -0.847). Due to strong correlation and potential collinearity, two multivariate logistic regression models were respectively developed which included post-treatment DWI ASPECTS or infarction volume. As a result, post-treatment DWI ASPECTS (OR, 2.401; 95%CI, 1.567-3.678; p < 0.001) and infarction volume (OR, 0.982; 95%CI, 0.846-0.998; p = 0.002) were both independent predictors of good clinical outcome. Setting post-treatment DWI ASPECTS ≥ 6 as a cut-off value, optimal performance (AUC = 0.836; sensitivity, 87.1%; specificity, 66.7%) could be obtained in predicting good clinical outcome, which was comparable with that of infarction volume (cut-off volume, ≤ 94.87 ml; AUC = 0.821; sensitivity, 90.3%; specificity, 55.6%). Post-treatment DWI ASPECTS might be a potential surrogate of infarction volume and be effective in predicting the clinical outcome of AIS patients after EVT. • Post-treatment DWI ASPECTS correlated significantly with infarction volume. • A post-treatment DWI ASPECTS ≥ 6 best predicts good outcomes for AIS patients after EVT. • Post-treatment DWI ASPECTS has the potential in substituting infarction volume in predicting the clinical outcome of AIS patients.

Serum Bicarbonate: Reconsidering the Importance of a Neglected Biomarker in Predicting Clinical Outcomes in Sepsis.

BackgroundDespite being an important pathophysiological component, information on the predictive value of serum bicarbonate level in sepsis is limited.Study design and methodThis is a single-centered retrospective study involving 4176 patients admitted to the medical ICU (MICU) with a diagnosis of sepsis. Patients were divided into two groups based on the presence or absence of chronic kidney disease (CKD) on admission: CKD and non-CKD, respectively. Each group was then divided into three sub-groups based on serum bicarbonate level at presentation (in mEq/l)- low (<22), normal (22-28), and high (>28). We compared the clinical outcomes between the sub-groups in each group, with in-hospital mortality as the primary endpoint. Secondary endpoints included vasopressor-free days, ventilator-free days, ICU-free days, and hospital-free days.ResultIn both the CKD and non-CKD groups, low serum bicarbonate was associated with significantly increased in-hospital mortality. There was no difference in the mortality between the sub-groups with normal and high serum bicarbonate. When adjusted for other known predictors of mortality, the association of low serum bicarbonate with increased in-hospital mortality was statistically significant only in the patient group with a Sequential Organ Failure Assessment (SOFA) score of ≥9. Additionally, the SOFA score had a better predictive value for in-hospital mortality, ICU-free days, and ventilator-free days when the serum bicarbonate level was <22.InterpretationSerum bicarbonate is a good predictor of clinical outcomes in sepsis and can be used along with other markers of sepsis to predict clinical outcomes.

Effect of frailty on outcomes of endovascular treatment for acute ischaemic stroke in older patients.

frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. Few studies have examined the relationship between frailty, stroke and stroke interventions such as endovascular thrombectomy (EVT). we aimed to investigate the impact of frailty measured by clinical frailty scale (CFS) on clinical outcomes after EVT for acute ischemic stroke (AIS) in older patients ≥70years. in this retrospective cohort study, we included all consecutive AIS patients age ≥ 70years receiving EVT at a single comprehensive stroke centre. Patients with CFS of 1-3 were defined as not frail, and CFS > 3 was defined as frail. The primary outcome was modified Rankin Score (mRS) at 90days. The secondary outcomes included duration of hospitalisation, in-hospital mortality, carer requirement, successful reperfusion, symptomatic intracranial haemorrhage and haemorrhagic transformation. a total of 198 patients were included. The mean age was 78.1years and 52.0% were female. Frail patients were older, more likely to be female, had more co-morbidities. CFS was significantly associated with poor functional outcome after adjustment for age, NIHSS and time to intervention (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.04-2.28, P = 0.032). There was trend towards higher mortality rate in frail patients (frail: 18.3%; non-frail: 9.6%; P = 0.080). There were no significant differences in other secondary outcomes except increased carer requirement post discharge in frail patients (frail: 91.6%; non-frail: 72.8%; P = 0.002). frailty was associated with poorer functional outcome at 90days post-EVT in patients ≥ 70years.

Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional Physicians

PurposeTo test the hypothesis that interventional radiologists (IRs) and neurointerventional (NI) physicians have similar outcomes of endovascular stroke thrombectomy (EVT), which could be used to improve the availability of thrombectomy. Materials and MethodsEight hospitals providing EVT performed by IRs and NI physicians at the same institution submitted sequential retrospective data limited to the era of modern devices. Good clinical outcomes (a 90-day modified Rankin score [mRS] of 0–2) and technically successful revascularization (a modified thrombolysis in cerebral infarction score of ≥2b) were compared between the specialties after adjusting for treating hospital, patient age, stroke severity, Alberta stroke program early computed tomography score, time from symptom onset to door, and clot location. Propensity score matching was used to compare the outcomes. A total of 1,009 patients were evaluated (622 treated by IRs and 387 treated by NI physicians). ResultsThe median time from stroke onset to puncture was 245 versus 253 minutes (P = .49), the technically successful revascularization rate was 81.8% versus 82.4% (P = .81), and the good clinical outcome rate was 45.5% versus 50.1% (P = .16). After adjusting, the physician specialty was not a significant predictor of good clinical outcomes (odds ratio, 1.028; 95% confidence interval, 0.760–1.390; P = .86). After matching, an mRS of 0–2 was present in 47.7% of IR treated patients and 51.1% of NI treated patients (P = .366). ConclusionsThere were no significant differences in the successful revascularization rate and good clinical outcomes between IRs and NI physicians. The outcomes of EVT performed by IRs were similar to those of EVT performed by NI physicians, as determined using previously published trials and registries. This may be useful for addressing coverage and access to stroke interventions.