Independent Predictor Of Functional Outcome Research Articles

Abstract TMP60: Using CTP based Disconnectome Mapping to identify optimal candidates for endovascular treatment in acute ischemic stroke.

Background: Identifying optimal candidates for endovascular treatment (EVT) remains an ongoing priority to maximize treatment efficacy. The recent large core trials have called into question the use of infarct volume alone for selecting patients. This study aimed at exploring the feasibility of using routinely acquired Computed Tomography Perfusion (CTP) to capture how lesion location impacts brain connectivity and how this in turn affects the ability to benefit from EVT. Methods: Consecutive patients from a multi-centric stroke imaging registry were included in this study if they had a proven anterior circulation large vessel occlusion (LVO) and available baseline CTP data. Hypoperfusion (Tmax >6 seconds) and ischemic core (relative cerebral blood flow <30%) maps were automatically generated using e-CTP (Brainomix, UK) and used to derive disconnection maps via a DTI template. A voxel-based, multivariate method (Sparse Canonical-Correlation-Analysis – LESYMAPS) was used to explore associations between disconnection maps and NIHSS subitems in recanalized patients. The mismatch between Tmax and core disconnection volumes (disconnection mismatch volume) (Figure 1) was used to predict modified Rankin Scale (mRS) at 3-months using an ordinal shift regression adjusted for age, recanalization status and infarct volume. Results: One-hundred and seventy-one patients were included. The median NIHSS was 16 (11.5 to 22). The total NIHSS was associated with disconnection predominantly within the left basal ganglia, brainstem and corpus callosum. Upper and lower limb deficits (NIHSS 5a, 5b, 6a, 6b) were associated with corticospinal tract disconnection, with negative correlations within the contralateral tracts (Figure 2). Language deficits were associated with left hemisphere tract disconnection, also showing negative correlations within the contralateral tracts. The disconnection mismatch volume was an independent predictor of functional outcome at 3-months (Table 1). Conclusion: The results from this study showed that it is possible to use routinely acquired CTP to capture the effects of stroke lesion on brain connectivity and its impact on functional outcome following recanalization treatment. Such an approach could enable more nuanced treatment selection for patients based on specific neurological deficits.

Red cell distribution width and outcome in acute ischemic stroke patients

IntroductionSeveral biomarkers have proven prognostic value for acute ischemic stroke (AIS) patients. Red cell distribution width (RDW) has been associated with several diseases and all-cause mortality and suggested as an independent predictor of Ischemic Stroke severity and outcome. This study aimed to investigate RDW as an independent predictor of functional outcome and death in the 3 months following AIS. MethodsPatients with AIS were divided in four groups according to the quartile of the RDW value at admission. Baseline characteristics of patients in each RDW quartile were compared by Chi-square or Kruskal-Wallis tests, as applicable. We prospectively analyzed the patients for functional outcome in the 3 months following the event. Functional outcome (dichotomized as independent [0-2] or dependent [>2] according to the modified Rankin Scale score) and 90-day mortality was compared between the 4 groups. To conduct this evaluation, univariable and multivariable binary logistic regression analysis for functional independence and mortality at 3 months was conducted, considering the variables previously identified as potential confounders. ResultsThe study's final population was of 416 patients. The patients in higher RDW quartiles were older (p<0.001), had lower blood hemoglobin (p<0.001), higher C reactive protein levels (p=0.017), higher BNP values (p<0.001) and more frequently suffered from atrial fibrillation (p=0.015) and heart failure (p=0.004). Univariate analysis showed a negative association between RDW-Q4 and independence at 3 months (p=0.024), which wasn't verified in the multivariate analysis (p=0.871). Univariate analysis also identified a positive association between RDW-Q4 and 90-day mortality (p=0.049), which was not confirmed in the multivariate analysis (p=0.289). ConclusionsWhen adjusted to potential confounders, RDW does not predict functional outcome or death in the 90 days after acute ischemic stroke.

Lower serum uric acid to serum creatinine ratio as a predictor of poor functional outcome after mechanical thrombectomy in acute ischaemic stroke.

The ratio of serum uric acid (SUA) to serum creatinine (SCr), representing normalized SUA for renal function, is associated with functional outcome in acute ischaemic stroke (AIS) patients. However, its effect on AIS patients undergoing mechanical thrombectomy (MT) remains unknown. This study aimed to investigate the influence of the SUA/SCr ratio on clinical outcome in MT-treated AIS patients. Acute ischaemic stroke patients who underwent MT were continuously enrolled from January 2018 to June 2023. Upon admission, SUA and SCr levels were recorded within the initial 24 h. Stroke severity was determined using the National Institutes of Health Stroke Scale (NIHSS) score. Clinical outcome included poor functional outcome (modified Rankin Scale score >2) at 90 days, symptomatic intracranial haemorrhage and death. Amongst 734 patients, 432 (58.8%) exhibited poor functional outcome at 90 days. The SUA/SCr ratio exhibited a negative correlation with NIHSS score (ρ = -0.095, p = 0.010). Univariate analysis revealed a significant association between SUA/SCr ratio and poor functional outcome. After adjusting for confounders, the SUA/SCr ratio remained an independent predictor of functional outcome (adjusted odds ratio 0.348, 95% confidence interval 0.282-0.428, p < 0.001). Receiver operating characteristic curve analysis highlighted the ability of the SUA/SCr ratio to predict functional outcome, with a cutoff value of 3.62 and an area under the curve of 0.757 (95% confidence interval 0.724-0.788, p < 0.001). The SUA/SCr ratio is correlated with stroke severity and may serve as a predictor of 90-day functional outcome in AIS patients undergoing MT.

Predictors of Good Functional Outcomes in Posterior Circulation Stroke After Mechanical Thrombectomy With Stent Retrievers: An Individual Patient‐Data Pooled Analysis From the TRACK and NASA Registries

Background Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and potentially effective, predominantly in the non‐White population. The aim of this study was to identify predictors of good functional outcome in posterior circulation strokes in US population after mechanical thrombectomy from the TRACK (Trevo Stent‐Retriever Acute Stroke) and the NASA (North American Solitaire Stent Retriever Acute Stroke) registries from North America. Methods Patient‐level data from the TRACK and NASA registries were pooled, and patients with posterior circulation stroke were included in this analysis. Patients were dichotomized into those with 90‐day good functional outcome (modified Rankin scale [mRS] score 0–2) and poor functional outcome (mRS score ≥3). Baseline and procedural data were compared between the 2 cohorts. Multivariate logistic regression was performed to identify predictors of functional outcome. P &lt; 0.05 was considered significant. Results Of 119 posterior stroke patients (99 [83.2%] basilar artery, 16 [13.4%] vertebral artery, and 4 [3.4%] posterior cerebral artery), 110 patients had 90‐day mRS data available on follow‐up. Good functional outcome was observed in 44 patients (40%). Patients with mRS score 0–2 were less likely to have hypertension (61.4% versus 83.3%; P = 0.01), hyperlipidemia (38.6% versus 62.1%; P = 0.016), and diabetes (18.2% versus 36.4%; P = 0.040). Patients with mRS score 0–2 had a lower mean presentation National Institutes of Health Stroke Scale score (15.2±9.95 versus 22.6±9.50; P &lt; 0.001) and more likelihood of achieving Thrombolysis in Cerebral Infarction 3 (79.5% versus 42.2%; P &lt; 0.001). There was no difference between 2 cohorts in time to puncture, use of balloon guide catheter, use of general anesthesia, and number of passes. On multivariate analysis, higher presentation National Institutes of Health Stroke Scale and hypertension were associated with worse functional outcomes. Complete recanalization and the receipt of intravenous tissue‐type plasminogen activator were associated with higher odds of achieving good functional outcomes. Conclusion In this pooled analysis of the NASA and TRACK registries, patients with posterior circulation stroke achieving good outcomes were more likely to have lower presentation National Institutes of Health Stroke Scale and fewer comorbidities. Use of intravenous tissue‐type plasminogen activator, hypertension, final Thrombolysis in Cerebral Infarction 3, and lower baseline National Institutes of Health Stroke Scale score were independent predictors of functional outcome.

Factors influencing the prognosis of patients with acute cerebral infarction who received usual care: a multicenter prospective cohort study

[Purpose] The prognostic factors for patients with acute stroke who received usual care (mobilization ≥48 h after admission) remain unclear. This study aimed to investigate the prognostic factors that predict functional outcomes using evaluations performed immediately after onset in patients with acute cerebral infarction who received usual care from admission until discharge. [Participants and Methods] Participants with acute cerebral infarction admitted to five acute care hospitals in Tokyo and Saitama, Japan and prescribed physical therapy were included. Participants information, functional evaluations, and progress were recorded during the first physical therapy session, mobilization, and discharge. Participants who received usual care were assigned to either the good- or poor-outcome group based on the Modified Rankin Scale at discharge. [Results] In total, 161 Participants receiving usual care (mobilization ≥48 h after admission) were included. Reinfarction and the First National Institutes of Health Stroke Scale score were identified as independent predictors of functional outcome at hospital discharge in participants who received usual care (median, 22.0 d). The cutoff NIHSS score was 4. [Conclusion] Our results provided evidence that the National Institutes of Health Stroke Scale score and reinfarction are useful predictors of functional outcomes in participants who received usual care.

Prognostic value of the baseline magnetic resonance score in patients with acute posterior circulation ischaemic stroke after mechanical thrombectomy

To investigate the prognostic value of the composite posterior circulation Acute Stroke Prognosis Early Computed tomography (CT) Score (ASPECTS)-Collaterals (pcASCO) score, which combines diffusion-weighted imaging (DWI) posterior circulation ASPECTS (pcASPECTS) and the magnetic resonance angiography (MRA)-collateral circulation score at baseline among patients with acute posterior circulation ischaemic stroke after mechanical thrombectomy. Patients with acute posterior circulation ischaemic stroke who underwent mechanical thrombectomy were analysed retrospectively. The DWI-pcASPECTS and MRA-collateral circulation score before treatment and the modified Rankin Scale (mRS) at 90 days after treatment were used as the endpoints. An mRS ≤2 was defined as a good prognosis, and an mRS ≥3 was defined as a poor prognosis. Multivariate logistic regression was used to analyse independent predictors of functional outcome 90 days after mechanical thrombectomy. Mechanical thrombectomy was performed in 57 patients; 38 patients had a good prognosis, 19 patients had a poor prognosis, and 33 patients were successfully recanalised. Univariate logistic regression found that National Institute of Health Stroke Scale (NIHSS) score (OR: 1.18, p<0.001), pcASPECTS (OR: 1.91, p=0.028) and pcASCO score (OR: 0.51, p=0.001) were factors of good functional outcome. Receiver operating characteristic curve (ROC curve) analysis showed that the diagnostic efficiency of the NIHSS and pcASCO was better (AUC=0.88, 0.83, p<0.05) than that of the pcASPECTS (AUC=0.65). The prediction model was established by age, NIHSS, and pcASCO, and the diagnostic efficiency of the prediction model was better (AUC=0.94). The composite MR-pcASCO score can be used as an important predictor of the prognosis of patients with acute posterior circulation ischaemic stroke after mechanical thrombectomy.

Large diameter hemicraniectomy does not improve long-term outcome in malignant infarction

IntroductionIn malignant cerebral infarction decompressive hemicraniectomy has demonstrated beneficial effects, but the optimum size of hemicraniectomy is still a matter of debate. Some surgeons prefer a large-sized hemicraniectomy with a diameter of more than 14 cm (HC > 14). We investigated whether this approach is associated with reduced mortality and an improved long-term functional outcome compared to a standard hemicraniectomy with a diameter of less than 14 cm (HC ≤ 14).MethodsPatients from the DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY) registry who received hemicraniectomy were dichotomized according to the hemicraniectomy diameter (HC ≤ 14 cm vs. HC > 14 cm). The primary outcome was modified Rankin scale (mRS) score ≤ 4 after 12 months. Secondary outcomes were in-hospital mortality, mRS ≤ 3 and mortality after 12 months, and the rate of hemicraniectomy-related complications. The diameter of the hemicraniectomy was examined as an independent predictor of functional outcome in multivariable analyses.ResultsAmong 130 patients (32.3% female, mean (SD) age 55 (11) years), the mean hemicraniectomy diameter was 13.6 cm. 42 patients (32.3%) had HC > 14. There were no significant differences in the primary outcome and mortality by size of hemicraniectomy. Rate of complications did not differ (HC ≤ 14 27.6% vs. HC > 14 36.6%, p = 0.302). Age and infarct volume but not hemicraniectomy diameter were associated with outcome in multivariable analyses.ConclusionIn this post-hoc analysis, large hemicraniectomy was not associated with an improved outcome or lower mortality in unselected patients with malignant middle cerebral artery infarction. Randomized trials should further examine whether individual patients could benefit from a large-sized hemicraniectomy.Clinical trial registration informationGerman Clinical Trials Register (URL: https://www.drks.de; Unique Identifier: DRKS00000624).

Fasting blood glucose-to-glycated hemoglobin ratio for evaluating clinical outcomes in patients with ischemic stroke.

Stress hyperglycemia frequently occurs in patients with acute ischemic stroke (AIS). The influence of stress hyperglycemia on the outcomes of patients with AIS remains ambiguous. Data from our institution on patients with AIS between June 2020 and June 2021 were retrospectively analyzed. The severity of the stroke was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, and the primary endpoint was functional outcomes. Stress hyperglycemia was measured by the glucose-to-HbA1c ratio. In the multivariable analysis, two models that retained or excluded the NIHSS were adopted to explore the relationship between stress hyperglycemia and outcomes. The receiver operating characteristic curve (ROC) was calculated to determine an optimized cutoff value. The optimal cutoff value was 1.135. When all patients were included, model 1 did not find an association between the glucose-to-HbA1c ratio and functional outcomes. In model 2, the glucose-to-HbA1c ratio×10 (Glucose-to-HbA1c ratio ×10) was the independent predictor of functional outcomes (OR 1.19, 95% CI 1.07-1.33, p < 0.01). Separately, in patients without diabetes, the glucose-to-HbA1c ratio×10 was the independent predictor of functional outcomes in both model 1 (OR 1.37, 95% CI 1.08-1.73, p = 0.01) and model 2 (OR 1.48, 95% CI 1.22-1.79, p < 0.01), but not in patients with diabetes. In addition, the glucose-to-HbA1c ratio×10 was the independent predictor of stroke severity (OR 1.16, 95% CI 1.05-1.28, p < 0.01). The glucose-to-HbA1c ratio was associated with more severe AIS. Specifically, the glucose-to-HbA1c ratio was associated with the functional outcomes in patients without diabetes but not in patients with diabetes.

Abstract Number ‐ 38: Outcome Predictors in Posterior Circulation Stroke After Mechanical Thrombectomy: Pooled Analysis from NASA and TRACK

Introduction Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and effective. However, many people still have poor outcomes despite treatment. The aim of this study was to identify the predictors of good functional outcome in posterior circulation strokes after mechanical thrombectomy from the Trevo Stent‐Retriever Acute Stroke TRACK and the North American Solitaire Stent Retriever Acute Stroke (NASA) registries. Methods Patient‐level data from the TRACK and NASA registries were pooled and patients with posterior circulation stroke were included in the analysis. Patients were dichotomized into those with 90‐day good functional outcome (mRS≤2) and poor functional outcome (mRS&gt;2). Baseline and procedural data were compared between the two cohorts. Multivariate logistic regression was then performed to identify predictors of functional outcome. P‐value &lt; 0.05 was considered significant. Results Out of 119 posterior stroke patients (99 BA, 16 VA, and 4 PCA), a total of 110 patients had mRS data available on follow‐up. Good functional outcome was observed in 44 patients (37%). Patients with mRS≤2 were less likely to have hypertension (61.4% versus 83.3%, p = 0.01), dyslipidemia (38.6% versus 62.1%, p = 0.016), and diabetes (18.2% versus 36.4%, p = 0.040). Patients with mRS≤2 had a lower mean baseline NIHSS (15.2±9.95 versus 22.6±9.50, p&lt; .001). Time to puncture, utilization of BGC, general anesthesia use, number of passes, and successful recanalization (TICI≥ 2B) were not significantly different between the two cohorts. On multivariate analysis, higher baseline NIHSS was associated with worse functional outcome (OR:0.91, CI:0.87‐0.96, P&lt; .001). Use of IV tPA was associated with higher odds of achieving good functional outcomes (OR:2.82, CI:1.06‐7.51, P:0.038). Conclusions In this pooled analysis of the NASA and TRACK Registries, posterior circulation patients achieving good outcome were more likely to have a lower baseline NIHSS and less comorbidities. Use of IV‐tPA and lower baseline NIHSS were independent predictors of functional outcome.

Endovascular treatment in patients with middle cerebral artery occlusion of different aetiologies.

The purpose of this study was to evaluate differences in endovascular treatment (EVT) outcomes in M1 segment middle cerebral artery occlusion (MCAO) patients with different pathologic subtypes. Patients with MCAO who received EVT from July 2014 to December 2020 were categorized into three groups: embolism without internal carotid artery steno-occlusion (MCAO-E), in situ atherosclerotic thrombosis (MCAO-AS) and embolism from tandem ICA steno-occlusion (MCAO-T). Baseline characteristics, EVT-related factors and clinical outcomes were compared between groups. Multivariable regression analyses were performed to evaluate the relationship between aetiologic classification and outcomes at 90days after stroke. Among eligible patients (n = 220), MCAO-E (n = 129, 58.6%) was the most common aetiology, followed by MCAO-AS (n = 47, 21.4%) and MCAO-T (n = 44, 20.0%). Patients with MCAO-E were significantly older but had a lower rate of dyslipidaemia and smoking history than those with MCAO-AS. Although patients with MCAO-AS and MCAO-T more often required rescue balloon angioplasty and stenting (p < 0.001), no significant difference in the rate of final recanalization was found. Patients in the MCAO-AS group obtained better functional outcomes (90-day modified Rankin Scale score, 0-2) (p = 0.002) and lower mortality than in the MCAO-E group (p = 0.009). On multivariable logistic regression, we failed to find that stroke subtype was an independent predictor of functional outcomes and mortality. Patients with acute MCA M1 occlusion stroke due to different pathogeneses had comparable successful recanalization rates and functional independence at 90days. The optimal management for MCAO patients with different aetiologies requires further research.

Irregular shape as an independent predictor of prognosis in patients with primary intracerebral hemorrhage

The utility of noncontrast computed tomography markers in the prognosis of spontaneous intracerebral hemorrhage has been studied. This study aimed to investigate the predictive value of the computed tomography (CT) irregularity shape for poor functional outcomes in patients with spontaneous intracerebral hemorrhage. We retrospectively reviewed all 782 patients with intracranial hemorrhage in our stroke emergency center from January 2018 to September 2019. Laboratory examination and CT examination were performed within 24 h of admission. After three months, the patient's functional outcome was assessed using the modified Rankin Scale. Multinomial logistic regression analyses were applied to identify independent predictors of functional outcome in patients with intracerebral hemorrhage. Out of the 627 patients included in this study, those with irregular shapes on CT imaging had a higher proportion of poor outcomes and mortality 90 days after discharge (P < 0.001). Irregular shapes were found to be significant independent predictors of poor outcome and mortality on multiple logistic regression analysis. In addition, the increase in plasma D-dimer was associated with the occurrence of irregular shapes (P = 0.0387). Patients with irregular shapes showed worse functional outcomes after intracerebral hemorrhage. The elevated expression level of plasma D-dimers may be directly related to the formation of irregular shapes.

Sodium Levels and Outcomes Following Endovascular Thrombectomy for Ischemic Stroke

Background Hyponatremia has been associated with worse outcomes in patients with ischemic stroke. Previous studies measured sodium levels at variable times after stroke onset. Patients treated with endovascular thrombectomy have sodium levels measured close to stroke onset. Our aim was to evaluate the association between admission sodium levels and outcome following endovascular thrombectomy. Methods Consecutive patients undergoing endovascular thrombectomy with admission sodium levels were identified from a prospective registry. The primary outcome was functional independence, defined as a modified Rankin scale score of 0, 1, or 2 at 3 months. Secondary outcomes included early neurological recovery (reduction in National Institutes of Health Stroke Scale score ≥8 points from baseline or score of 0–1 at 24 hours), ordinal shift of modified Rankin scale scores at 3 months, symptomatic intracranial hemorrhage, 7‐day mortality, and 3‐month mortality. Results A total of 710 patients were included (42.5% women; mean±SD age, 66.4±14.9 years). The mean±SD admission sodium level was 139±3 mmol/L. Multivariable logistic regression analysis demonstrated that higher admission sodium level (per 1‐mmol/L increase) was an independent predictor of functional independence (odds ratio [OR], 1.06 [95% CI, 1.01–1.11]; P =0.03), early neurological recovery (OR, 1.07 [95% CI, 1.01–1.13]; P =0.02), and 3‐month modified Rankin scale scores (OR, 0.94 [95% CI, 0.89–0.99]; P =0.02). The Youden optimal prognostic cutoff for functional independence was an admission sodium level of ≥136 mmol/L ( P =0.04). There were no associations between sodium levels and symptomatic intracranial hemorrhage, 7‐day mortality, or 3‐month mortality. Conclusions Admission sodium levels are an independent predictor of functional outcomes following endovascular thrombectomy. Whether admission sodium levels would be of value in decision‐support tools for endovascular thrombectomy should be evaluated in future studies.

Neurological Predictors of Functional Outcome in Cortical Venous Sinus Thrombosis.

Objectives Cerebral venous sinus thrombosis (CVST) has a wide clinical spectrum. Despite favorable prognosis, identifying CVST patients with a possible poor functional outcome can be challenging. This study aims to establish the neurological predictors of outcome in CVST. Materials and Methods We analyzed 70 patients of CVST and categorized them into three groups: Group I with isolated intracranial hypertension; Group II—focal syndrome of neurological deficit; Group III—subacute encephalopathy. Demographic, disease characteristics, and radiological parameters were also analyzed for prediction of hospital course. Functional outcome was assessed by modified Rankin scale (mRS) dichotomized as good (mRS: 0–2) or poor outcome (mRS ≥ 3). Statistical Analysis Univariate and multivariate logistic regression analyses were performed to find out the independent effects of prognostic factors to be used for outcome prediction. Results The mean age was 36.71 ± 14.9 years with 40 (68.8%) males. Most common presenting complaints were headache 35 (50%), hemiparesis 14 (20%), and seizures 12 (17.4%). Group I included 44 (62.9%), group II 17 (24.3%) and group III 12 (12.9%) patients. During hospitalization 28 (40%) patients needed intensive care unit (ICU) care, among them 7 (10%) required ventilation. There were eight times more chances of ICU care (odds ratio [OR]: 7.4; 2.5–24.4) and 23 times more need for ventilation (OR: 23; 2.5–88.9) whenever patients were in group II or III. Good outcome (mRS < 2) was noted in 52 (74.2%) patients. Headache was associated with good functional outcome, whereas hemiparesis with poor outcome. Neurological grouping was the independent predictor of functional outcome; patients with focal neurological deficit (group II) were 20 times more likely to have dependent life at the time of discharge ( p < 0.05) with the mortality rate of 2.9%. Conclusions Neurological grouping is a practical tool for prediction of function outcomes. Early anticipation of prognosis helps in decision-making in the clinical practice.

Предиктори потреби у сторонній допомозі у повсякденному житті серед пацієнтів, які перебували на стаціонарному лікуванні в інтегрованому інсультному блоці

Актуальність. Інсульт залишається провідною причиною інвалідності, але якісна медична допомога може поліпшити результати лікування. Мета дослідження: визначити предиктори збереження потреби у сторонній допомозі у пацієнтів з інсультом, які виписані з інтегрованого інсультного блоку (ІІБ). Матеріали та методи. Учасниками дослідження стали пацієнти з мозковим інсультом, які у 2010–2018 рр. перебували на стаціонарному лікуванні в Інсультному центрі (ІЦ), що розташований у багатопрофільній лікарні та функціонує за принципами ІІБ. Усі пацієнти були ретельно обстежені та отримували належне лікування, у кожного з них при надходженні та перед випискою було проведено оцінювання за основними інсультними шкалами. Дані пацієнтів проспективно вносились до спеціального реєстру. Як результат лікування розглядали прикінцеву оцінку за індексом Бартел (ІБ): при ІБ ≥ 85 балів ефект лікування вважався досягнутим, у разі ІБ ≤ 80 балів — недосягнутим. Для оцінки ступеня впливу 40 факторних ознак на ймовірність неповного функціонального відновлення був використаний метод побудови та аналізу логістичних моделей регресії. Результати. У дослідження були включені 677 пацієнтів віком від 20 до 95 років (медіана — 65,9 року), із них 271 (40,4 %) жінка. У 80,8 % пацієнтів був діагностований ішемічний, а у 19,2 % — геморагічний інсульт. Медіана оцінки за NIHSS при надходженні становила 10 балів. Терміни госпіталізації до ІЦ коливались від &lt; 24 год (17,5 % пацієнтів) до понад 180 днів (17,2 % пацієнтів), 59,7 % учасників були госпіталізовані протягом перших 30 днів від початку захворювання. Згідно з результатами однофакторного аналізу, статистично значущий зв’язок з ризиком недосягнення ефекту лікування мали 27 факторних ознак, зокрема тип та підтип інсульту, вік, наявність фібриляції передсердь, інсульт в анамнезі, тяжкий неврологічний дефіцит, когнітивні порушення та значна функціональна неспроможність при госпіталізації, окремі неврологічні порушення (пригнічення свідомості, дисфагія, геміанопсія, геміпарез) та підвищений рівень маркерів запалення (С­реактивний білок, швидкість осідання еритроцитів) у крові. Відповідно до результатів багатофакторного аналізу, сильний та незалежний зв’язок з ризиком недосягнення бажаного ефекту лікування мали вік пацієнта (відношення шансів (ВШ) 1,06; 95% довірчий інтервал (ДІ) 1,03–1,10 в середньому на кожен додатковий рік; р &lt; 0,001), повторний інсульт (ВШ 2,8; 95% ДІ 1,3–6,2; р = 0,01), початкові оцінки за ІБ (ВШ 0,97; 95% ДІ 0,95–0,98 в середньому при зменшенні оцінки на кожний бал; р &lt; 0,001), модифікованою шкалою Ренкіна (ВШ 1,7; 95% ДІ 1,0–2,8 в середньому при збільшенні оцінки на кожний бал; р = 0,05) та індексом мобільності Рівермід (ВШ 0,87; 95% ДІ 0,76–0,99; р = 0,05), а також початкова оцінка сили рук у відповідних розділах NIHSS (ВШ 1,5; 95% ДІ 1,1–1,9 в середньому на кожний додатковий бал; р = 0,003) та пізня госпіталізація до ІЦ (при надходженні пізніше 180 днів від початку захворювання ВШ 9,6; 95% ДІ 3,1–29,4; р &lt; 0,001). Площа під кривою операційних характеристик AUC = 0,95 (95% ДІ 0,93–0,97) свідчить про відмінну узгодженість моделі прогнозування. Висновки. Найбільший вплив на збереження потреби у сторонній допомозі після лікування в ІІБ мають вік пацієнта, тяжкість початкових порушень та період захворювання. Незалежні предиктори збереження функціональної неспроможності можуть допомогти кращому оцінюванню прогнозу та оптимізації прийняття рішень щодо лікувальної тактики.

Predictors of Functional Outcome at Three Months Post Stroke in a Third Level Hospital in Ouagadougou Burkina Faso

Aim/Background: The aim of our study was to identify the predictive factors of functional outcome at 3 months post stroke, at Tingandogo University Hospital, in Ouagadougou, Burkina Faso, in order to contribute to the improvement of the functional prognosis of patients suffering from stroke. Materials and methods: This involved a hospital study, longitudinal prospective and anaytical, of patients hospitalized for stroke, from March 2015 to February 2016, at the Tingandogo University Hospital, in Ouagadougou, then followed in outpatient neurology, for at least 3 months, after discharge from hospital. The sociodemographic, clinical and CT characteristics of the patients on admission, the mortality at 3 months, and the evaluation of the functional outcome of the survivors at 3 months by the modified Rankin score (mRS) were analyzed. Motor functional outcome was considered favorable if mRS ≤ 2 and unfavorable if mRS ≥ 3. Multivariate analysis with logistic regression made it possible to identify independent predictors of functional outcome at 3 months post-stroke. Results: A total of 232 patients were collected, i.e. 62.9% of cerebral infarction and 37.1% of intracerebral hemorrhage, with a male predominance (62.93%), an average age of 60.9 years +/- 14.5 years. On admission, 6% of patients were in a coma and 35.8% had severe to very severe neurological impairment. Motor physiotherapy indicated in 77.3% of patients was but only performed in 47.4% At 3 months post stroke, 27 patients had died (31%). Among the 160 surviving patients, 91 patients (56.9%) were autonomous or independent (mRS≤2) and 69 patients (43.1%) were still dependent (mRS≥3). The independent predictors of unfavorable functional outcome (mRS≥3) at 3 months post-stroke were: age ≥ 60 years (p = 0.007), pre-stroke disability (p = 0.032), severe neurological deficit at admission (p = 0.018), impaired alertness on admission (p = 0.005) and large infarcts (p=0.004). Conclusion: Advanced age, pre-stroke disability, clinical and CT markers of the extent of brain damage, influence functional outcome at 3 months post-stroke in our context. Improving the quality of care for all patients, even the oldest, and better access to quality functional rehabilitation will help improve the functional prognosis of stroke patients.

Are Outcomes of Acute Meniscus Root Tear Repair Better Than Debridement or Nonoperative Management? A Systematic Review

Background: Meniscus root tears (MRTs) are defined as radial tears within 1 cm of the meniscus root insertion or an avulsion of the meniscus root itself. They lead to altered joint loading because of the failure to convert axial (compressive) loads into hoop stresses. Untreated MRTs can result in altered joint biomechanics and accelerated articular cartilage degeneration and the development of osteoarthritis (OA), yet optimal management remains unclear. Purpose: To review treatment outcomes after acute MRTs by surgical repair, debridement, meniscectomy, or nonoperative treatment. Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the evidence from human clinical studies was conducted with electronic searches of the PUBMED, Medline, EMBASE, and the Cochrane Library databases. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed synthesis of the evidence. Results: Eleven studies of low to moderate methodological quality were identified. All treatment options improved functional scores after >12 months. Arthroscopic repair may be associated with better functional outcomes when compared with partial meniscectomy and nonoperative management at 12-month follow-up. Radiographic progression of OA occurred in all treatment groups; there was some evidence that this was delayed after repair when compared with other treatments. Baseline severity of meniscal extrusion, varus malalignment, and pretreatment degeneration were predictors of poor functional outcomes. Age was not found to be an independent predictor of functional outcome. Conclusion: The current level 3 and 4 evidence suggests that arthroscopic repair may result in slower progression of radiological deterioration compared with meniscectomy and nonoperative management. The current literature does not support the exclusion of patients from MRT repair on the basis of age. Patients undergoing acute MRT treatments (repair, debridement, or nonoperative) can be expected to experience improvement in functional outcomes after >12 months. The strength of conclusions are limited because of the paucity of high-quality studies on this subject. Further studies, preferably randomized sham controlled trials with function-oriented rehabilitation programs, are needed to compare treatment strategies and stratification of care based on the risk of meniscal extrusion. Registration: CRD42018085092 (PROSPERO).

Tear size, general health status and smoking influence functional outcome at 5 years following arthroscopic rotator cuff repair.

There is limited medium-term outcome data regarding the predictors of functional outcome and patient satisfaction after arthroscopic rotator cuff repair. 287 patients that underwent arthroscopic rotator cuff repair under a high-volume single surgeon were contacted at a minimum of 4 years following surgery. Patient demographics, tear size and co-morbidities were pre-operatively recorded. The Oxford shoulder score, EuroQol 5-dimensional score and patient satisfaction were recorded at final follow-up. 234 (81.5%) patients completed follow-up at a mean of 5.5 (4-9) years. There were 126 males and 108 females with a mean age of 60 (range 25-83) years. The majority of patients (n = 211, 90%) were satisfied with their final outcome. Multivariate linear regression analysis (R 2 = 0.64) identified that increasing tear size (p = 0.04), worsening general health assessed by the EuroQol 5-Dimensional (p < 0.001), and smoking (p = 0.049) were associated with a worse Oxford shoulder score. Logistic regression analysis (R 2 = 0.13) identified that worsening general health assessed by the EuroQol 5-Dimensional (p < 0.001), and smoking (p = 0.01) were associated with an increased risk of patient dissatisfaction. General health status and smoking are independent predictors of functional outcome and patient satisfaction at medium-term follow-up following arthroscopic rotator cuff repair.

The new Hematoma Maturity Score is highly associated with poor clinical outcome in spontaneous intracerebral hemorrhage.

The purpose of this study was to analyze the new combined indicators on noncontrast computed tomography (NCCT) to predict functional outcome at discharge, compared to previously individual radiological NCCT signs. Patients with spontaneous intracerebral hemorrhage (ICH) who underwent baseline CT scan were retrospectively analyzed. Black hole (BH) sign, blend sign (BS), island sign (IS), swirl sign (SwS), Barras classification, any hypodensity, any irregularity, and two combined novel indicators-Combined Barras Total Score (CBTS) and Hematoma Maturity Score-were assessed independently by two radiologists blinded to clinical information. Patients were trichotomized depending on the disability or dependency at discharge according to the Modified Rankin Scale (mRS): no symptoms or no significant/mild disability (mRS 0-2); moderate or severe disability (mRS 3-5); and mortality (mRS 6). One hundred fourteen patients with spontaneous ICH confirmed by NCCT were included in the analysis. Multivariable statistical analysis was adjusted for anticoagulation, hematoma volume, ventricular expansion, hypertension, blood glucose level at admission, age, and history of atrial fibrillation and demonstrated that any hypodensity (OR 4.768, p 0.006), any irregularity (OR 4.768, p 0.006), CBTS ≥ 4 (OR 3.205, p 0.025), and the new Hematoma Maturity Score (Immature) (OR 5.872, p 0.006) are independent predictors of functional outcome at discharge. The new concept of the Hematoma Maturity Score was the radiological sign on NCCT with the highest impact on clinical outcome in comparison with the rest of the evaluated radiological signs. • This is the first manuscript where density and shape characteristics of the ICH had been evaluated together and integrated in a new Hematoma Maturity Score. • The new Hematoma Maturity Score is the radiological sign on NCCT with the highest impact on clinical outcome at discharge.

SERUM ALBUMIN LEVELS AND ITS CORRELATION WITH SHORT TERM OUTCOME IN ACUTE ISCHEMIC STROKE PATIENTS

Aim:The study was undertaken with the aim to establish the denite correlation between serum albumin levels and outcome of ischemic stroke. Methodology: The present observational study was conducted on 100 acute ischemic stroke patients meeting inclusion and exclusion criteria. All patients were investigated for hypoalbuminemia and their stroke severity was assessed by NIHSS score on day 1 and day 7. The relationship between admission albumin levels, NIHSS values and outcome of those patients was ascertained. Results: There was increased prevalence of hypoalbuminemia in AIS patients and there was signicant correlation between NIHSS score on day 1&amp;7, mortality and hypoalbuminemia in AIS patients and there was signicant association between high NIHSS score and mortality in AIS patients. Conclusion: serum albumin is an independent predictor of functional outcome following an acute ischemic stroke and serum albumin level is inversely correlated with severity of stroke at presentation.

Abstract P317: White Matter Hyperintensity Lesion Burden Modulates Functional Outcome After Acute Ischemic Stroke

Introduction: As a radiographic signature of end-stage small vessel disease, white matter hyperintensity (WMH) burden impacts recovery and outcomes after acute ischemic stroke (AIS). In this study, we sought to investigate the effect of WMH volume (WMHv) on stroke severity and functional outcomes independent of the infarct size and topography. Methods: We analyzed 503 AIS patients with MRI data obtained on admission for index stroke enrolled in the multi-center MRI-GENIE study (cohort 1), followed by validation of the findings in an independent single-site study of 555 AIS patients (cohort 2). Stroke severity (NIHSS score) at index stroke and the long-term outcome (3-6 months mRS score) were modeled via Bayesian linear regression. Models included WMHv, age, sex, a 10-dimensional spatial ischemic lesion representation, acute infarct (DWI) volume, and common vascular risk factors (hypertension, diabetes mellitus, atrial fibrillation, coronary artery disease). Results: Cohorts did not differ significantly in major clinical characteristics [cohort 1: age: 65.0±14.6, 41% female, NIHSS: 5.5±5.4, mRS: 1(iqr 2); cohort 2: age: 65.0±14.8, 38% female, NIHSS: 5.0±6.0, mRS: 1(iqr 3), p &gt;0.05 for all comparisons]. WMHv did not substantially affect AIS severity ( Fig A ); in contrast, it emerged as an independent predictor of functional outcome in both datasets ( Fig B ). Conclusions: When accounted for AIS lesion topography and stroke volume, total WMH lesion burden did not appear to modulate initial stroke severity but was associated with worse functional post-stroke outcomes. Future studies are needed to explore potential origins of these detrimental effects of pre-existing WMH burden on recovery after AIS.