Long-term Prognosis Of Stroke Research Articles

Survival within 12 months after stroke in Madagascar

The data on the long-term prognosis of stroke are scarce in Madagascar. Our objective was to determine survival within 12months after a stroke event. A longitudinal study was carried out on a hospital cohort of subjects with stroke in Mahajanga in western Madagascar. We included in the study all subjects admitted to adult emergencies at Mahajanga University Hospitals during the year 2019 and diagnosed with stroke. A follow-up by telephone call or by descent at the home of the patients was carried out after at least 12months from the onset of the disease. We analyzed in-hospital mortality and survival within 12months after the stroke. At the end of the study period, 144 stroke cases were retained. Strokes accounted for 5.07% of emergency admission causes. Male gender accounted for 51.4% of the population. The average age of the subjects was 60.7years. In-hospital mortality was 32.6%. Survival at 1month was 50%, at 3months 48.4%, and at 12months 43%. High blood pressure was found as a risk factor for stroke in 79.9% of patients, 76.5% of whom were undertreated. Stroke mortality was high in our population. Most of the deaths occurred during the first month. Improved prevention and care are needed in Madagascar.

Incidence and Outcomes of Acute Cerebrovascular Events: Methodology of the Population-Based Normandy Stroke Study

Background: The number of strokes has been steadily increasing due to the aging of the population, and its management has changed dramatically in recent years. Nevertheless, there are few unbiased epidemiological studies to investigate the incidence of strokes and their long-term prognosis. Methods: The Normandy Stroke Study (NSS) is a prospective population-based study of all strokes and transient ischemic attacks in a large urban, suburban, and rural area in the Northwest of France. It was designed to meet the current gold standard in stroke epidemiological study by using multiple overlapping sources for case identification. It also aimed to assess the impact of socioeconomic disparities and long-term prognosis of stroke through an additional follow-up up to 3 years after the event to better understand the functional and cognitive prognostic of stroke as well as the quality of life in patients after stroke. Conclusion: NSS will provide important data on the epidemiology and long-term consequences of stroke at the population level and will help care providers adapt resource allocation.

Circulating Biomarkers in Long-Term Stroke Prognosis: A Scoping Review Focusing on the South African Setting.

Cerebrovascular disease, including both ischaemic and haemorrhagic strokes, remains one of the highest causes of global morbidity and mortality. Developing nations, such as South Africa (SA), are affected disproportionately. Early identification of stroke patients at risk of poor clinical prognosis may result in improved outcomes. In addition to conventional neuroimaging, the role of predictive biomarkers has been shown to be important. Little data exist on their applicability within SA. This scoping review aimed to evaluate the currently available data pertaining to blood biomarkers that aid in the long-term prognostication of patients following stroke and its potential application in the South African setting.This scoping review followed a 6-stage process to identify and critically review currently available literature pertaining to prognostic biomarkers in stroke.An initial 1191 articles were identified and, following rigorous review, 41 articles were included for the purposes of the scoping review. A number of potential biomarkers were identified and grouped according to the function or origin of the marker. Although most biomarkers showed great prognostic potential, the cost and availability will likely limit their application within SA.The burden of stroke is increasing worldwide and appears to be affecting developing countries disproportionately. Access to neuroradiological services is not readily available in all settings and the addition of biomarkers to assist in the long-term prognostication of patients following a stroke can be of great clinical value. The cost and availability of many of the reviewed biomarkers will likely hinder their use in the South African setting.

Using the Preparedness Assessment for the Transition Home After Stroke Instrument to Identify Stroke Caregiver Concerns Predischarge: Uncertainty, Anticipation, and Cues to Action.

The aim of the study was to better understand caregivers' concerns about long-term implications of stroke and the caregiving role after completing the Preparedness Assessment for the Transition Home After Stroke (PATH-s). In this qualitative study, cognitive interviews were conducted with 20 stroke caregivers who completed the PATH-s tool as part of an instrument validation study. Data were analyzed for salient themes related to their perceptions about stroke and the caregiving role. Interviews yielded robust narrative data describing how the PATH-s items aided caregivers in recognizing potential issues and concerns about stroke and the caregiving role. Caregivers experienced uncertainty about the long-term stroke prognosis, which provoked anticipation and cues to action to begin addressing their concerns. Completing the PATH-s helped caregivers identify concerns regarding the long-term implications of stroke and their caregiving role. It may serve as an important assessment tool to assist rehabilitation nurses to better understand and address caregiver needs predischarge.

Benefits and risks of intravenous thrombolysis in minor stroke and effects of combined urinary kallidinogenase on long-term prognosis of stroke

Objective To explore the clinical benefits and risks of intravenous thrombolysis combined with urinary kallidinogenase in the treatment of minor stroke. Methods The clinical data of 86 patients with minor stroke were retrospectively analyzed. Patients who received intravenous thrombolysis combined with urinary kallidinogenase were included in observation group (n=48), and those who received intravenous thrombolysis alone were included in control group (n=38). Before treatment and after 2 weeks of treatment, the imaging blood flow perfusion parameters [cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP)], and breath holding test indexes [cerebral vascular reactivity (CVR), breath holding index (BHI)] and serum biochemical indicators [vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF)] were compared between the two groups. The occurrence of adverse drug reactions during course of treatment and rehabilitation effects at 3 months after treatment [US National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS)] were analyzed in the two groups. Results After 2 weeks of treatment, the CBF, CVR, BHI and serum levels of VEGF and bFGF in the two groups were significantly higher than those before treatment, and the indexes in observation group were significantly higher than those in control group (P 0.05). At 3 months after treatment, there was no statistically significant difference in the effective rate of rehabilitation between the two groups (P>0.05), but the Mann-Whitney U rank sum test between-groups showed that the overall rehabilitation effects in observation group were significantly better than those in control group (P<0.05). Conclusions Intravenous thrombolysis has certain treatment effects in patients with minor stroke, and its safety is within the clinical controllable range. Combined with urinary kallidinogenase can obtain ideal long-term prognosis, and it is beneficial to the recovery of neurological function. Key words: Stroke; Thrombolytic therapy; Urinary kallidinogenase; Prognosis

Abstract 132: Predictive Value of Inflammation Markers With Stroke Recurrence and Cardiovascular Mortality

Background: Inflammation markers are associated with the risk of cardiovascular events, however, the relationships of inflammation markers with risk of post-stroke remain controversial. Objects: To investigated association of two clinical recorded inflammation markers, white blood cell count (WBC) and platelet count (PLTC) with first-onset stroke and long-term prognosis of stroke. Methods: A Chinese case-control study was conducted, comprising 2002 stroke cased (885 atherothrombosis, 565 lacunar stroke, 552 hemorrhagic stroke) and 1996 controls. Stroke patients were prospectively followed-up for a median of 4.5 years (range, 0.1-6.0). Results: The WBC and PLTS were higher in stroke patients than controls, however, the ratio of PLTS to WBC was lower in stroke patients than controls. During the follow-up, 369 recurrent strokes and 343 cardiovascular mortality were documented. Adjusted for cardiovascular disease, the increased ration of PLTC to WBC was negatively correlated with stroke recurrence (HR, 0.60, 95%CI 0.44 to 0.81, P =0.001), with no associations for PLTC and WBC. Compared with stroke patients with WBC in the first quartile (2.1-5.6х10 9 /L) , subjects in the fourth quartile (7.8-19.8х10 9 /L) had 2.10-fold risk for cardiovascular mortality (hazard ration [HR],2.10, 95% confidence interval [CI], 1.20 to 2.48, P =0.004), with no associations for PLTC. However, the increased ratio of PLTC to WBC decreased risk of cardiovascular mortality HR was 0.61 in the second quartile (2.09-17.60х10 9 /L), HR was 0.58 in the third quartile (17.61-24.04х10 9 /L) and HR was 0.48 in the fourth quartile (24.05-34.54х10 9 /L) (all P &lt;0.01). Conclusion: Higher WBC and PLTC are associated with poorer prognosis of stroke, and the ration of WBC to PLTC improved the predictive value for cardiovascular mortality and stroke recurrence.

Reliability of Telephone Interview for Assessment of Long-Term Stroke Outcomes: Evidence from Interrater Analysis

Background: A comprehensive evaluation of interrater reliability is crucial when it comes to multiple coders assessing the stroke outcomes using telephone interview. The reliability between telephone raters is important, as it could affect the accuracy of the findings published. Objective: This study aimed to establish the interrater reliability between multiple telephone interviewers when assessing long-term stroke outcomes. Methods: Patients alive at discharge selected in a retrospective cohort stroke project were recruited in this study. Their contact numbers were obtained from the medical record unit. The patients and/or proxies were interviewed based on a standardized script in Malay or English. Stroke outcomes assessed were modified Rankin Scale (mRS) and Barthel Index (BI) at 1-year post discharge. Fully crossed design was applied and 3 assessors collected the data simultaneously. Data was analysed using the software R version 3.4.4. Results: Out of 207 subjects recruited, 132 stroke survivors at the time of interview were analysed. We found a significant excellent interrater reliability between telephone interviewers assessing BI, with intraclass correlation coefficient at 0.996 (95% CI 0.995–0.997). Whereas substantial agreement between the telephone interviewers was revealed in assessing mRS, with Fleiss’, Conger’s and Light’s Kappa statistics reporting 0.719 and the Nelson’s model-based κ_m kappa statistic reporting 0.689 (95% CI 0.667–0.711). Conclusion: It is reliable to get multiple raters in assessing mRS and BI using the telephone system. It is worthwhile to make use of a telephone interview to update clinicians on their acute clinical management towards long-term stroke prognosis.

Association of Oxidized Low-Density Lipoprotein With Prognosis of Stroke and Stroke Subtypes

The association between oxidized low-density lipoprotein (oxLDL) and the long-term prognosis of stroke is unclear. The aim of this study is to investigate whether oxLDL levels contribute to the prognosis of stroke and stroke subtypes. All patients with ischemic stroke were recruited from the SOS-Stroke (Study of Oxidative Stress in Patients With Acute Ischemic Stroke) and classified into 5 different subtypes, according to the TOAST criteria (Trial of Org 10172 in Acute Stroke Treatment). We measured oxLDL levels and followed up with patients at 1 year after stroke onset. We analyzed the association between oxLDL and the clinical outcomes of death and poor functional outcome (modified Rankin Scale score of 3-6) of stroke and different stroke subtypes. Among the 3688 patients included in this study, 293 (7.94%) were deceased at the 1-year follow-up and 1020 (27.66%) had a poor functional outcome. Patients in the highest oxLDL quartile had a higher risk of 1-year stroke mortality (hazard ratio, 1.61; 95% confidence interval, 1.10-2.33; P<0.001) and a poor functional outcome (odds ratio, 1.48; 95% confidence interval, 1.15-1.89; P<0.001) compared with the lowest oxLDL quartile. In the subgroup analyses, oxLDL was only significantly associated with death and poor functional outcome in the large-artery atherosclerosis subgroup (P<0.05) and small-artery occlusion subgroup (P<0.05). High levels of oxLDL were associated with the high risk of death and poor functional outcome within 1 year after stroke onset, especially in large-artery atherosclerosis and small-artery occlusion stroke subtypes.

Lipoprotein(a), Ferritin, and Albumin in Acute Phase Reaction Predicts Severity and Mortality of Acute Ischemic Stroke in North Indian Patients

Inflammation plays a crucial role in the pathogenesis and prognosis of stroke. We studied the behavior of lipoprotein(a) [Lp(a)], ferritin, and albumin as acute phase reactants and their roles in the severity and mortality of stroke. We recruited 100 consecutive patients with acute ischemic stroke and 120 controls. Blood samples were drawn on days 1 and 7 and at both 3 and 6 months. Stroke was classified using Trial of Org 10172 in Acute Stroke Treatment classification. Stroke severity was assessed using the National Institutes of Health Stroke Scale. Prognosis at 6 months was assessed using the modified Rankin Scale, and mortality was assessed using the Kaplan-Meier analysis. Serum levels of interleukin-6 (IL-6), Lp(a), ferritin, and albumin were measured using enzyme-linked immunosorbent assay, immunoturbidimetry, and chemiluminescence commercial kits, respectively. Levels of IL-6, Lp(a), and ferritin were consistently higher among cases than controls (P < .0001). Serum Lp(a) levels peaked at day 7 after stroke and tapered thereafter. Albumin levels were lower than controls on admission day and increased subsequently. In our study, Lp(a) acted as an acute phase reactant while albumin acted as a negative acute phase reactant. There was no association between Trial of Org 10172 in Acute Stroke Treatment subtype and elevated serum levels of Lp(a), albumin, and ferritin. Lp(a) and ferritin were high in patients with severe stroke. Albumin was negatively correlated with stroke severity. Serum levels of Lp(a) ≥ 77 mg/dL, albumin ≤ 3.5 g/dL, and ferritin ≥ 370 ng/dL is associated with a significantly increased risk of having a poorer outcome in stroke. Serum levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL were also associated with increased mortality. High levels of Lp(a) and ferritin and low levels of albumin are associated with increased severity and poorer long term prognosis of stroke. Patients with admission levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL had increased mortality.

Can prolonged QTc and cTNT level predict the acute and long-term prognosis of stroke?

BackgroundPrevious studies in patients with stroke indicate that QTc prolongation and elevated cTNT are related to increased risk of all-cause and cardiovascular mortality. MethodsWe analysed the importance of electrocardiographic (ECG) abnormalities and elevated serum cardiac troponin (cTNT)—at baseline examination—as potential predictors for acute and long-term mortalities after stroke in a follow-up of 478 patients with a mean age of 78years. ResultsIn a multivariate analysis, strong predictors for poor prognosis during the acute phase were: elevated cTNT (p=0.001); stroke severity (p=0.004); ischemia on ECG (p=0.044); and age (p=0.050). Prolonged QTc interval was on the limit to statistical significance (p=0.050) when using multivariate analysis, while clearly significant in a Cox-regression (when corrected for missing cTNT values).One year after stroke, when adjusted for covariates (gender, diabetes mellitus, hypertension, and ischemic heart disease), elevated cTNT (p=0.001), stroke severity (p=0.014), and age (p=0.031) retained a significant relation with mortality. Moreover, atrial fibrillation was strongly correlated with poor survival (p=0.009). Cox regression confirmed the predictive value of QTc, cTNT, age, and stroke severity, as markers of acute mortality in relation to stroke. ConclusionProlonged repolarization time independently predicts poor prognosis during the acute phase, but not one year after stroke. In the absence of acute myocardial infarction, elevated initial cTNT is strongly related to poor outcome, both during the acute phase and one year after stroke.

Long-Term Stroke Prognosis in Relation to Medical Prevention and Lifestyle Factors

Background: Few studies have focused on the quality of secondary prevention among long-term stroke survivors. This study explores the intensity of medical intervention and the impact of lifestyle and other risk factors on the long-term stroke prognosis in a population-based setting of Swedish individuals with a history of stroke. Methods: A population-based cohort (n = 28,449) in Malmö, Sweden, was recruited during 1991–1996. Of them, 394 had a history of stroke, according to self-reported physician diagnosis and record linkage with the Stroke Register in Malmö. Information on medical intervention and lifestyle factors was collected from the questionnaire. The incidence of a cardiac event (CE) or recurrent stroke was followed for 7.5 years after the baseline examination. Results: The prevalence of hypertension was 79.4% in patients with a history of stroke. Only half of them received blood-pressure (BP)-lowering medication, and 11.5% of them achieved a BP <140/90 mm Hg. Most patients with hypercholesterolemia did not receive lipid-lowering medication. Antithrombotic agents were used by 38%. Nearly one third were still smoking, and two thirds were overweight or obese. Compared to subjects without a history of stroke, the risk of cardiovascular disease (CVD, i.e. CE or recurrent stroke) was significantly higher in stroke survivors. The increased CVD risk was significantly associated with elevated BP levels. No significant relationship was found between CVD risk and lifestyle risk factors reported at the time of baseline examination. Conclusions: There was a large gap between recommended secondary preventive measures and their implementation in subjects with a history of stroke. Achieving recommended hypertension control may prevent a substantial proportion of the CE and recurrent strokes in this group.

The protective effect of risk factors against stroke severity

We read with interest the article by Bang et al. [1]. Consistent with the finding that smoking is associated with a better prognosis in myocardial infarction [2,3], as well as in patients receiving thrombolysis for stroke [4], this study develops the concept further showing that the long term prognosis of stroke is better in smokers when compared to non-smokers. The explanation to this phenomenon is unclear and the authors' discussion focuses on the neuroprotective effects of nicotine and its impact on haemostasis and angiogenesis.

P216 Long-term prognosis of stroke in young adults. Study of 359 patients during a period of 27 years

P216 Long-term prognosis of stroke in young adults. Study of 359 patients during a period of 27 years

Incidence, etiology and long-term prognosis of stroke

In Germany, basic data on stroke morbidity are lacking. So far only routine mortality statistics have provided information on epidemiology of stroke. Therefore, a population-based register of stroke was set up in Germany to determine incidence and case fatality in a defined German population. The Erlangen Stroke Register is a prospective community-based study among the 101,450 residents of the city of Erlangen, Bavaria, Germany. All identified cases of first-ever strokes were followed-up to 12 months from onset of stroke. During 2 years of registration, 354 first-ever-in-a-lifetime strokes (FELS) were registered. The diagnosis and stroke type were confirmed by CT scan in 95 % of cases. Fifty-one percent of all FELS occurred in the age group > 75 years of age. After age-adjustment to the German standard population, the incidence rate was 182 per 100,000 (200 per 100,000 for men and 170 per 100,000 for women). Overall case fatality at 28 days was 19.4 %, at 3 months it was 28.5 %, and at 1 year 37.3 %. The first prospective community-based stroke register in Germany including all age groups revealed incidence rates of stroke similar to those reported from other population-based studies in western industrialized countries.