Mortality In Ischemic Stroke Patients Research Articles

Association between stress hyperglycemia ratio with short-term and long-term mortality in critically ill patients with ischemic stroke.

Hyperglycemia on admission is associated with poor prognosis in ischemic stroke (IS) patients. We aimed to investigate the relationship between stress hyperglycemia ratio (SHR) and short-term or long-term mortality in IS patients in the ICU and to explore whether this relationship is influenced by diabetes status. We collected patients with severe IS requiring ICU admission in the Medical Information Mart for Intensive Care (MIMIC-IV) database and calculated SHR. Outcomes included 30-day, 90-day, and 1-year mortality. The association between SHR and mortality in patients with critical IS was elucidated using Multivariate Cox regression and subgroup analysis for diabetes. A total of 1376 patients were recruited. After adjusting for potential confounders, patients in the third and fourth quartiles had a significantly increased risk of death at 30 days, 90 days, and 1 year compared to the first quartile of SHR (Q3 vs. Q1: HR 1.56-1.80, all p < 0.02; Q4 vs. Q1: HR 1.75-2.15, all p < 0.001; all p for trend < 0.001). In addition, the highest quartile of SHR was significantly associated with short-term or long-term mortality compared with the first quartile, regardless of diabetes status. Our results suggest that stress hyperglycemia, defined by the glucose/HbA1c ratio, is associated with increased short-term and long-term mortality in patients with ischemic stroke, independent of the patient's diabetes status.

Acute and Chronic Kidney Dysfunction and Prognosis following Thrombectomy for Ischemic Stroke

Introduction: Patients with chronic kidney disease (CKD) have an increased risk of stroke, and CKD seems associated with worse outcome after a stroke. The main objective of our study RISOTTO was to evaluate the influence of CKD and acute kidney injury (AKI) on the clinical outcome and mortality of ischemic stroke patients after thrombolysis and/or thrombectomy. Methods: This multicenter cohort study included patients in the acute phase of ischemic stroke due to large artery occlusion managed by thrombectomy. Functional outcome at 3 months was assessed by the modified Rankin Scale (mRS). Results: 280 patients were included in the analysis. Fifty-nine patients (22.6%) had CKD. At 3 months, CKD was associated with similar functional prognosis (mRS 3–6: 50.0% vs. 41.7%, p = 0.262) but higher mortality (24.2% versus 9.5%, p = 0.004). In univariate analysis, patients with CKD had a higher burden of white matter hyperintensities (Fazekas score: 1.7 ± 0.8 vs. 1.0 ± 0.8, p = 0.002), lower initial infarct volume with equivalent severity, and lower recanalization success (86.4% vs. 97.0%, p = 0.008) compared to non-CKD patients. Forty-seven patients (20.0%) developed AKI. AKI was associated with poorer 3-month functional outcome (mRS 3–6: 63.8% vs. 49.0%, p = 0.002) and mortality (23.4% versus 7.7%, p = 0.002). In multivariate analysis, AKI appeared as an independent risk factor for poor functional outcome (mRS 3–6: adjOR 2.79 [1.11–7.02], p = 0.029) and mortality (adjOR 2.52 [1.03–6.18], p = 0.043) at 3 months, while CKD was not independently associated with 3-month mortality and poor neurological outcome. Conclusions: AKI is independently associated with poorer functional outcome and increased mortality at 3 months. CKD was not an independent risk factor for 3-month mortality or poor functional prognosis.

Risk Factors of In-Hospital Mortality of Ischemic Stroke Patients in Gunung Jati General Hospital

Background: Stroke is the leading cause of death and the most significant contributor to disabilities worldwide. Predicting the mortality of stroke patients and giving optimal care remain challenges in developing countries like Indonesia. In this study, we aimed to identify factors associated with in-hospital mortality after acute ischemic stroke.&#x0D; Methods: The study conducted a retrospective cohort of cerebral infarct patients administered in 2022 to Gunung Jati General Hospital, West Java, Indonesia. This study included hospitalized patients with a clinical history of stroke confirmed by a CT scan or MRI. The clinical data, radiology, and laboratory tests were collected at admission or within 24 hours after admission.&#x0D; Results: This study involved a total of 92 ischemic stroke patients with a median age of 62. The most prevalent comorbidities were dyslipidemia (93.5%), hypertension (83.7% of patients), and concomitant infection (50%). Patients who experienced in-hospital mortality had a significantly higher number of comorbidities, such as chronic kidney disease, concomitant infection, and atrial fibrillation. Statistically higher neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were also shown in non-survived patients. Ischemic stroke patients with concomitant infection and atrial fibrillation, respectively, had 6.679 (aOR: 6.679, 95% CI 1.802-27.029) and 6.904 times (aOR: 6.904, 95% CI 1.290-36.959) greater to have in-hospital mortality.&#x0D; Conclusion: Concomitant infection and atrial fibrillation were associated with in-hospital mortality in ischemic stroke patients at Gunung Jati General Hospital. The findings indicated the importance of identifying timely management for improving better outcomes.&#x0D;

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a multi-center study

Background and objectivesEndovascular thrombectomy (EVT) improves long-term outcomes and decreases mortality in ischemic stroke patients. However, a significant proportion of patients do not benefit from EVT recanalization, a phenomenon known as futile recanalization or reperfusion without functional independence (RFI). In this study, we aim to identify the major stroke risk factors and patient characteristics associated with RFI.MethodsThis is a retrospective cohort study of 297 consecutive patients with ischemic stroke who received EVT at three academic stroke centers in China from March 2019 to March 2022. Patient age, sex, modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS), Alberta stroke program early CT score (ASPECTS), time to treatment, risk factors and comorbidities associated with cerebrovascular diseases were collected, and potential associations with futile recanalization were assessed. RFI was successful reperfusion defined as modified thrombolysis in cerebral infarction (mTICI) ≥ 2b without functional independence at 90 days (mRS ≥ 3).ResultsOf the 297 initial patients assessed, 231 were included in the final analyses after the application of the inclusion and exclusion criteria. Patients were divided by those who had RFI (n = 124) versus no RFI (n = 107). Older age (OR 1.041, 95% CI 1.004 to 1.073; p = 0.010), chronic kidney disease (OR 4.399, 0.904–21.412; p = 0.067), and higher 24-h NIHSS (OR 1.284, 1.201–1.373; p &amp;lt; 0.001) were independent predictors of RFI. Conversely, an mTICI score of 3 was associated with a reduced likelihood of RFI (OR 0.402, 0.178–0.909; p = 0.029).ConclusionIn conclusion, increased age, higher 24-h NIHSS and lack of an mTICI score of 3 were independently associated with RFI and have potential prognostic values in predicting patients that are less likely to respond to EVT recanalization therapy.

Association between lactate/albumin ratio and 28-day all-cause mortality in ischemic stroke patients without reperfusion therapy: a retrospective analysis of the MIMIC-IV database.

The lactate/albumin ratio (LAR) has been used as a novel prognostic indicator for aneurysmal subarachnoid hemorrhage, traumatic brain injury, sepsis, heart failure, and acute respiratory failure. However, its potential in predicting all-cause mortality in patients with ischemic stroke (IS) has not been evaluated. Therefore, this study aimed to elucidate the correlation between LAR and 28-day all-cause mortality in IS patients without reperfusion therapy. This retrospective cohort study used data from the Medical Information Mart for Intensive Care (MIMIC-IV) (v2.0) database. It included 568 IS adult patients admitted to the intensive care unit (ICU). The correlation between LAR and ICU 28-day all-cause mortality rate was analyzed using multiple COX regression analysis and Kaplan-Meier survival analysis. Restricted cubic spline (RCS) curves were used to assess the relationship between LAR and 28-day mortality. In addition, a subgroup analysis was performed to investigate the impact of other influencing factors on outcomes. The primary outcome was the ability of LAR to predict 28-day mortality in IS patients. Among the 568 patients with IS, 370 survived (survival group) and 198 died (non-survival group) within 28 days of admission (mortality rate: 34.9%). A multivariate COX regression analysis indicated that LAR was an independent predictor of all-cause mortality within 28 days after admission for patients with IS (hazard ratio: 1.32; 95% confidence interval: 1.03-1.68; P = 0.025). We constructed a model that included LAR, age, race, sex, white blood cell count, Sequential Organ Failure Assessment (SOFA) score, and anion gap (AG) and established a prediction model with an area under the curve (AUC) value of 71.5% (95% confidence interval: 67.1%-75.8%). The optimal cutoff value of LAR that separated the survival group and the non-survival group based on the Youden index was 0.55. The Kaplan-Meier survival curves plotted using this critical value showed that patients with LAR ≥ 0.55 had a significantly higher 28-day all-cause mortality rate than patients with LAR < 0.55 (P = 0.0083). LAR can serve as an independent predictor of all-cause mortality within 28 days after admission for patients with IS.

Diagnostic Accuracy of NIHSS Score in Predicting in-Hospital Mortality in Patients of Ischemic Stroke taking Actual in-Hospital Mortality as Gold Standard

Abstract: Objective: To determine the diagnostic accuracy of NIHSS score for predicting in-hospital mortality among patients of ischemic stroke taking in-hospital mortality as gold standard. Material &amp; Methods: The present cross-sectional study was carried out from May 2020 to November 2020 at Medicine Department, Services Institute of Medical Sciences Lahore. A total of 142 patients aged 30-70 years of both sex with ischemic stroke patients as per-operational definition of duration ?24 hours were enrolled. Patients of hemorrhagic stroke, cardiac disease and CRF were excluded. After taking informed consent, NIHSS score was evaluated in each patient and in hospital mortality will be noted. All patients were followed by the researcher herself and in hospital mortality was noted. Results: Mean age was 53.5+9.2 years with74 (52.11%) females. Mean disease duration was 6.8+1.7 hours and mean NIHSS score was 24.3+7.1. NIHSS score was evaluated in each patient and found 75 True Positive while 06 False Positive. In the 61 NIHSS score negative patients, in-hospital mortality was seen in 06 (False Negative) while 55 (True Negative) did not have in-hospital mortality (p-value &lt;0.001). The Specificity, Sensitivity, Negative Predictive Value (NPV), Positive Predictive Value (PPV) and diagnostic accuracy of NIHSS score to predict in-hospital mortality among patients of ischemic stroke taking in-hospital mortality as gold standard was 92.59%, 90.16%, 92.59%, 90.16% and 91.55% respectively. Conclusion: Diagnostic accuracy of NIHSS score in predicting in-hospital mortality in ischemic stroke patients is quite high.

Prognostic value of inflammation biomarkers for 30-day mortality in critically ill patients with stroke.

To explore the values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), neutrophil to albumin ratio (NAR), prognostic nutritional index (PNI), systemic immune inflammatory index (SII) and red cell distribution width to albumin ratio (RA) for evaluating the risk of 30-day mortality of ischemic stroke or hemorrhagic stroke patients. In this cohort study, the data of 1,601 patients diagnosed with stroke were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Among them, 908 were hemorrhagic stroke patients and 693 were ischemic stroke patients. Demographic and clinical variables of patients were collected. Univariate and multivariable Cox regression were performed to evaluate the predictive values of NLR, PLR, SII, NAR, RA, and PNI for 30-day mortality in hemorrhagic stroke or ischemic stroke patients. The receiver operator characteristic (ROC) curves were plotted to assess the predictive values of NLR, NAR, and RA for 30-day mortality of hemorrhagic stroke patients. At the end of follow-up, 226 hemorrhagic stroke patients and 216 ischemic stroke patients died. The elevated NLR level was associated with increased risk of 30-day mortality in hemorrhagic stroke [hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.06-1.29]. The increased NAR level was associated with elevated risk of 30-day mortality in hemorrhagic stroke (HR = 1.16, 95% CI: 1.02-1.30). The high RA level was linked with increased risk of 30-day mortality (HR = 1.44, 95% CI: 1.23-1.69). No significant correlation was observed in these inflammation biomarkers with the risk of 30-day mortality in ischemic stroke patients. The area under the curves (AUCs) of NLR, RA, and NAR for evaluating the risk of 30-day mortality of hemorrhagic stroke patients were 0.552 (95% CI: 0.503-0.601), 0.644 (95% CI: 0.590-0.699) and 0.541 (95% CI: 0.490-0.592). NLR, NAR, and RA were potential prognostic biomarkers for predicting 30-day mortality of hemorrhagic stroke patients, which might provide clinicians an easy and cheap way to quickly identify patients with high risk of mortality.

Abstract TP197: Obstructive Sleep Apnea Associated With Lower All-Cause Mortality In Ischemic Stroke Patients

Introduction: Obstructive sleep apnea (OSA) is a sleep disorder associated with cardiovascular risk factors similar to those associated with cerebral infarction (CI). Our aim was to characterize patient demographics and to investigate the effect of OSA in CI. Methods: Retrospective cohort study using 2019 National Inpatient Sample. Adults with diagnoses of CI and OSA were included. Primary outcome was all-cause mortality, and secondary outcomes were length of stay (LOS) and total charge in USD. Results: Out of 700175 CI patients, 49735 had OSA. Compared to Non-OSA-CI cohort, OSA-CI cohort were younger (67.38 vs 69.67 years,p&lt;0.001) and had fewer females (37.36% vs 50.09%,p&lt;0.001), Black (15.50% vs 17.38%,p&lt;0.001), Hispanic (5.21% vs 8.26%,p&lt;0.001), API (1.91% vs 3.15%,p&lt;0.001), Medicaid (7.79% vs 10.26%,p&lt;0.001), alcohol abuse (3.53% vs 4.75%,p&lt;0.001), dementia (7.25% vs 12.06%,p&lt;0.001), drug abuse (2.56% vs 3.33%,p&lt;0.001), systolic heart failure (0.55% vs 6.36%,p&lt;0.001), atrial fibrillation (1.12% vs 10.25%,p&lt;0.001). OSA-CI cohort had more White (72.59% vs 65.58%,p&lt;0.001), depression (17.25% vs 10.97%,p&lt;0.001), chronic pulmonary disease (28.79% vs 16.25%,p&lt;0.001), complicated hypertension (45.72% vs 33.57%,p&lt;0.001), complicated diabetes mellitus (36.67% vs 23.80%,p&lt;0.001), hypothyroidism (16.19% vs 14.02%,p&lt;0.001), and obesity (43.22% vs 12.87%,p&lt;0.001). OSA-CI cohort had lower all-cause mortality rate (4.32% vs 6.50%,p&lt;0.001), mortality OR 0.73 (95%CI 0.65-0.81,p&lt;0.001), lower mean LOS (6.17 vs 6.67 days,p&lt;0.001), lower mean total hospitalization charge ($91,762.00 vs $99,993.00,p&lt;0.001). Conclusion: Among patients admitted with CI, the presence of OSA was associated with lower all-cause mortality, odds of mortality, mean LOS and mean total hospitalization charge. OSA had a higher prevalence in younger White males and was associated with more depression, hypertension, diabetes mellitus, and obesity.

Effect of mean heart rate on 30-day mortality in ischemic stroke with atrial fibrillation: Data from the MIMIC-IV database.

The relationship of mean heart rate (MHR) with 30-day mortality in ischemic stroke patients with atrial fibrillation in the intensive care unit (ICU) remains unknown. This study aimed to investigate the association between MHR within 24 h of admission to the ICU and 30-day mortality among patients with atrial fibrillation and ischemic stroke. This retrospective cohort study used data on US adults from the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 1.0) database. Patients with ischemic stroke who had atrial fibrillation for and first time in ICU admission were identified from the MIMIC-IV database. We used multivariable Cox regression models, a restricted cubic spline model, and a two-piecewise Cox regression model to show the effect of the MHR within 24 h of ICU admission on 30-day mortality. A total of 1403 patients with ischemic stroke and atrial fibrillation (mean [SD] age, 75.9 [11.4] years; mean [SD] heart rate, 83.8[16.1] bpm; 743 [53.0%] females) were included. A total of 212 (15.1%) patients died within 30 days after ICU admission. When MHR was assessed in tertials according to the 25th and 50th percentiles, the risk of 30-day mortality was higher in participants in group 1 (< 72 bpm; adjusted hazard ratio, 1.23; 95% CI, 0.79-1.91) and group 3 (≥82 bpm; adjusted hazard ratio, 1.77; 95% CI, 1.23-2.57) compared with those in group 2 (72-82 bpm). Consistently in the threshold analysis, for every 1-bpm increase in MHR, there was a 2.4% increase in 30-day mortality (adjusted HR, 1.024; 95% CI, 1.01-1.039) in those with MHR above 80 bpm. Based on these results, there was a J-shaped association between MHR and 30-day mortality in ischemic stroke patients with atrial fibrillation admitted to the ICU, with an inflection point at 80 bpm of MHR. In this retrospective cohort study, MHR within 24 h of admission was associated with 30-day mortality (nonlinear, J-shaped association) in patients with ischemic stroke and atrial fibrillation in the ICU, with an inflection point at about 80 bpm and a minimal risk observed at 72 to 81 bpm of MHR. This association was worthy of further investigation. If further confirmed, this association may provide a theoretical basis for formulating the target strategy of heart rate therapy for these patients.

Stacking ensemble learning model to predict 6-month mortality in ischemic stroke patients

Patients with acute ischemic stroke can benefit from reperfusion therapy. Nevertheless, there are gray areas where initiation of reperfusion therapy is neither supported nor contraindicated by the current practice guidelines. In these situations, a prediction model for mortality can be beneficial in decision-making. This study aimed to develop a mortality prediction model for acute ischemic stroke patients not receiving reperfusion therapies using a stacking ensemble learning model. The model used an artificial neural network as an ensemble classifier. Seven base classifiers were K-nearest neighbors, support vector machine, extreme gradient boosting, random forest, naive Bayes, artificial neural network, and logistic regression algorithms. From the clinical data in the International Stroke Trial database, we selected a concise set of variables assessable at the presentation. The primary study outcome was all-cause mortality at 6 months. Our stacking ensemble model predicted 6-month mortality with acceptable performance in ischemic stroke patients not receiving reperfusion therapy. The area under the curve of receiver-operating characteristics, accuracy, sensitivity, and specificity of the stacking ensemble classifier on a put-aside validation set were 0.783 (95% confidence interval 0.758–0.808), 71.6% (69.3–74.2), 72.3% (69.2–76.4%), and 70.9% (68.9–74.3%), respectively.

Long-term mortality in ischemic stroke patients with concomitant chronic obstructive pulmonary disease

BackgroundLong-term mortality in ischemic stroke patients with concomitant COPD has been largely unexplored. This study aimed to compare long-term all-cause mortality in ischemic stroke patients with and without COPD. MethodsThis was a retrospective cohort study of ischemic stroke patients with and without COPD in the Geisinger Neuroscience Ischemic Stroke database to examine all-cause mortality up to 3 years using Kaplan-Meier estimator and Cox proportional hazards model. ResultsOf the 6,589 ischemic stroke patients included in this study, 5,525 (83.9%) did not have COPD (group A). Group B (n=1,006) consisted of patients with COPD diagnosis by ICD-9/10-CM codes. COPD patients in Group C (n=233) were diagnosed by spirometry, and in Group D (n=175) by both ICD-9/10-CM codes and spirometry confirmation. The survival probabilities at three years in Group B, C, and D were significantly lower than in Group A. Group B (HR=1.262, 95% CI 1.122–1.42, p<0.001) and group C (HR=1.251, 95% CI 1.01–1.55, p=0.041) had significantly lower hazard of mortality compared to group A. There was no significant difference in survival between COPD subtypes of chronic bronchitis and emphysema. Patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2 stage had an increased mortality hazard compared to the GOLD 1 stage. ConclusionsWhile ischemic stroke patients with preexisting COPD have worse long-term survival than those without COPD, the results largely depended on the definition of COPD used. These results suggest that ischemic stroke patients with COPD need more personalized medical care to decrease long-term mortality.

Admission Serum Calcium Level and Short-Term Mortality After Acute Ischemic Stroke: A Secondary Analysis Based on a Norwegian Retrospective Cohort.

BackgroundDisturbed serum calcium levels are related to the risk of stroke. However, previous studies exploring the correlation between serum calcium and the clinical outcome of ischemic stroke (IS) have shown inconsistent results.ObjectThe study aimed to investigate the relationship between admission serum calcium and 30-day mortality in patients with IS.MethodsA total of 876 IS patients from a Norwegian retrospective cohort were included for secondary analysis. The exposure variable and the primary outcome were albumin-corrected serum calcium (ACSC) at baseline and all-cause mortality within 30 days after the first admission, respectively. Multivariable logistic regression analysis was used to estimate the risk of 30-day mortality according to ACSC levels. Moreover, the potential presence of a non-linear relationship was evaluated using two-piecewise linear regression with a smoothing function and threshold level analysis. The stability of the results was evaluated by unadjusted and adjusted models.ResultsThe result of multiple regression analysis showed that ACSC at baseline was positively associated with the incidence of 30-day mortality after adjusting for the potential confounders (age, gender, serum glucose, hypertension, atrial fibrillation/atrial flutter, renal insufficiency, heart failure, chronic obstructive pulmonary disease, pneumonia, paralysis, and aphasia) (OR = 2.43, 95% CI 1.43–4.12). When ACSC was translated into a categorical variable, the ORs and 95% CIs in the second to the fourth quartile vs. the first quartile were 1.23 (0.56, 2.69), 1.16 (0.51, 2.65), and 2.13 (1.04, 4.38), respectively (P for trend = 0.03). Moreover, the results of two-piecewise linear regression and curve-fitting revealed a linear relationship between ACSC and 30-day mortality.ConclusionACSC is positively associated with 30-day mortality in IS patients, and the relationship between them is linear.

The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients

High serum glucose to potassium ratio (GPR) at admission is implicated for a poor outcome in acute brain injury, acute intracranial hemorrhage, and aneurysmal subarachnoid hemorrhage. However, the relationship between GPR and the outcome of ischemic stroke (IS) remains unknown. In all, 784 IS patients from a large emergency Norwegian cohort were included for secondary analysis. The exposure and outcome were GPR at baseline and all-cause mortality within 30 days after the first admission. Multivariable logistic regression analysis was performed to estimate the risk of 30-day mortality based on GPR levels. In addition, we examined whether there was a nonlinear relationship between admission GPR and 30-day mortality using two-piecewise linear regression with a smoothing function and threshold level analysis. The results of multivariable regression analysis showed that GPR at baseline was positively associated with the 30-day mortality (OR 2.01, 95% CI 1.12, 3.61) after adjusting for potential confounders (age, gender, department, serum sodium, serum albumin, serum-magnesium, hypertension, heart failure, chronic renal failure, and pneumonia). When GPR was translated to a categorical variable, the ORs and 95% CIs in the tertiles 2 to 3 versus the tertile 1 were 1.24 (0.60, 2.56) and 2.15 (1.09, 4.24), respectively (P for trend = 0.0188). Moreover, the results of the two-piecewise linear regression and curve fitting revealed a linear relationship between GPR and 30-day mortality. In IS patients, GPR is positively correlated with 30-day mortality, and the relationship between them is linear. The GPR at admission may be a promising predictor for the short-term outcome in IS patients.

Malnutrition and Risk of Mortality in Ischemic Stroke Patients Treated With Intravenous Thrombolysis.

Background and PurposeMalnutrition is highly prevalent in ischemic stroke patients. We aimed to investigate whether malnutrition indexes may be useful in predicting mortality at 90 days in ischemic stroke patients treated with intravenous thrombolysis.MethodsWe retrospectively analyzed consecutive patients who underwent thrombolytic therapy at three comprehensive stroke centers. Malnutrition was assessed using the controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI).ResultsOf 979 patients (mean age, 66.8 years; males, 63.6%) included in this study, 91 (9.3%; 95% confidence interval [CI]: 8.4–10.2%) died at 3-month follow up. According to the CONUT, GNRI, and PNI scores, 9.9, 33.7, and 7.0% of patients were moderately or severely malnourished, respectively; 64.0% were at least mildly malnourished by at least 1 malnutrition index. In the multivariate regression model after adjusting for potential confounders, malnutrition (severe risk versus normal nutritional status) was significantly associated with an increased risk of mortality for CONUT scores (adjusted odds ratio [OR] 16.16, 95%CI, 7.86-67.11; P < 0.001), GNRI scores (adjusted OR 9.82, 4.10-23.51; P < 0.001) and PNI scores (adjusted OR 12.74, 5.56-29.19; P < 0.001). Similar results were found when the malnutrition scores were analyzed as continuous variables. Adding the three malnutrition indexes to models containing conventional risk factors significantly improved risk reclassification for 3-month mortality.ConclusionOur study showed that malnutrition may be associated with a higher risk of mortality at 3 months in ischemic stroke after intravenous thrombolysis.

Relationship Between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Ischemic Stroke Patients with Atrial Fibrillation: An Analysis from the MIMIC-IV Database.

AimTo investigate the association between the hemoglobin-to-red cell distribution width (RDW) ratio (HRR) and all-cause mortality in ischemic stroke patients with atrial fibrillation (AF).DesignThis study was a retrospective cohort analysis. In total, 1018 ischemic stroke patients with AF were enrolled using the Medical Information Mart for Intensive Care database, (MIMIC)-IV. The patients were divided into four groups according to the HRR values. The primary outcome was 180-day all-cause mortality.MethodsMultivariate Cox proportional risk regression models were used to examine the association between HRR and all-cause mortality. The non-linear relationship between HRR and all-cause mortality was confirmed using a Cox proportional risk regression model fitted by cubic spline function and smooth curve fitting.ResultsA total of 246/1018 patients (24.17%) died. The serum HRR values were negatively associated with 180-day all-cause mortality (hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.68–0.94). A two-piecewise regression model was used to obtain a threshold inflection point value of 9.74. The HR and the 95% CI on the left inflection point were 0.73 and 0.61–0.87 (p = 0.0005); on the right inflection point they were 1.06 and 0.82–1.38 (p = 0.6383).ConclusionThe relationship between all-cause mortality and the HRR values was non-linear in ischemic stroke patients with AF. All-cause mortality and HRR values were negatively correlated when the HRR value was ≤9.74.

Effect of telestroke practices on short-term mortality in ischemic stroke patients

Objective This study aimed to evaluate the effect of telestroke practices on patient prognosis and mortality by comparing the data of patients that presented before and during a period when tele-stroke application was in use. Method Stroke patients presenting from October, 2018 to October, 2019 for whom WhatsApp was used for telestroke purposes, were evaluated as the telestroke group. The previous year it was a pre-telestroke group. The two groups were compared in terms of factors affecting prognosis and mortality. All statistical analyses were performed using SPSS version 16.0 for Windows. Results A total of 727 patients clinically and radiologically confirmed to have ischemic stroke were included in the study. There were 252(34.6%) patients in the pre-telestroke group and 475(65,4%) patients in the telestroke group. Both rtPA and thrombectomy treatment were significantly higher in the telestroke group(p&amp;lt;0.001). In the first 24-hour evaluation, the rate of discharge increased and hospital admission and mortality decreased in the telestroke group(p&amp;lt;0.001). There was no statistically significant difference between the groups in terms of poor prognosis and 30-day mortality(p=0.470 and p=0.625, respectively). Conclusion Telestroke practices not only provide access to the relevant clinical branch for early consultation but also facilitate timely treatment thus leading to improvement in prognosis.

Effect of monocyte-to-high-density cholesterol ratio on mortality in patients with ischemic stroke and atrial fibrillation: preliminary findings

Acute ischemic stroke (AIS) is one of the most common neurological emergencies, especially in elderly patients with high morbidity and mortality. The objective of this study is to evaluate the use of monocyte and high-density lipoprotein cholesterol (HDL-C) values, which play important roles in the inflammatory process after ischemia, in the prediction of 30-day mortality in patients. This is a retrospective, cross-sectional, observational study on demographic characteristics, vital signs and laboratory parameters of adult patients who were diagnosed with AIS and had atrial fibrillation (AF) rhythm in their electrocardiograms (ECGs) were retrospectively abstracted from hospital registry. The relationship of the laboratory values (i.e., monocyte count, blood HDL-C level and monocyte HDL-cholesterol ratio (MHCR)) were analyzed. Among 92 patients enrolled in the study, 54 (58.7%) were male, 31 (33.7%) of the patients had a yellow triage code, 61 (66.3%) were recorded as red. Sixty-nine patients (75%), had a history of chronic disease. While 86 (93%) of the patients were hospitalized to the wards, 5 (6%) were admitted into the intensive care unit and one patient (1%) was referred to another institution. The minimum duration of signs and symptoms varied between 1 hour and 240 hours (median 12 hours). Length of stay in the emergency department varies between 1 hour and 26 hours (median 4 hours). Monocyte counts of the patients were in the range of 310 to 1510 × 109/µL, (median 685 × 109/µL). Blood HDL-C level is in the range of 12–84 mg/dL, (median 40 mg/dL). The MHCR was in the range of 5.95–89.1 (median 18.2 and mean 19.7 ± 10.6). MHCR is not effective in predicting 30-day mortality in ischemic stroke patients due to AF who presented to the emergency department. It would be more appropriate to design more comprehensive, multicenter and prospective studies on this subject.

Classical Risk Factors for Ischemic Stroke are not Associated with Inpatient Post-Stroke Mortality in Sickle Cell Disease

ObjectivesSickle cell disease is a common haemoglobinopathy that significantly increases the risk of ischemic stroke. Because the risk factors for ischemic stroke onset and mortality in non-sickle cell disease patients have been largely elucidated, this paper aims to analyze risk factors for ischemic stroke mortality in sickle cell disease patients, which remain largely unknown. Materials/MethodsThe National Inpatient Sample database (2016–2017) was used to develop a multivariable regression model for risk quantification of known ischemic stroke risk factors for in-hospital mortality in ischemic stroke patients with and without sickle cell disease. ResultsClassical risk factors for ischemic stroke onset, including ischemic heart disease, carotid artery disease, lipidemias, hypertension, obesity, tobacco use, atrial fibrillation, personal or family history of stroke, congenital heart defects, congestive heart failure, cardiac valve disorder, peripheral vascular disease, and diabetes mellitus are associated with in-hospital mortality in non-sickle cell patients (p < 0.05). However, no significant association was found between these stroke risk factors and in-hospital mortality in sickle cell disease patients presenting with ischemic stroke (p > 0.05). ConclusionsWhile the classical risk factors for stroke onset are associated with in-hospital mortality in non-sickle cell stroke patients, they are not associated with in-hospital mortality in sickle cell stroke patients.

Association of reperfusion success and emboli in new territories with long term mortality after mechanical thrombectomy

BackgroundThe degree of reperfusion is the most important modifiable predictor of 3 month functional outcome and mortality in ischemic stroke patients treated with mechanical thrombectomy. Whether the beneficial effect of...

Association between estimated glomerular filtration rate and clinical outcomes in ischemic stroke patients with high-grade carotid artery stenosis

BackgroundChronic kidney disease has been identified as a risk factor affecting stroke prognosis. High-grade carotid artery stenosis (CAS) is associated with distal hemodynamic compromise. The association between the estimated glomerular filtration rate (eGFR) and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between eGFR and outcomes of acute IS patients with high-grade CAS.MethodsFrom January 1, 2007 to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. The eGFR on admission was assessed using the Modification of Diet in Renal Disease Study equation. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between different eGFR levels.ResultsAmong 372 individuals, 76 (20.4%) had an eGFR < 45, 65 (17.5%) had an eGFR between 45 and 59, and 231 (62.1%) had an eGFR ≥60 mL/min/1.73 m2. Compared to other groups, in the eGFR < 45 mL/min/1.73 m2 group, the prevalence rates of hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, valvular heart disease, and gout were significantly higher (P = 0.013, P = 0.030, P = 0.001, P < 0.001, P = 0.043, and P < 0.001, respectively). Patients with eGFR < 45 mL/min/1.73 m2 demonstrated lower hemoglobin and total cholesterol levels compared with other groups (P < 0.001 and P = 0.048). The blood potassium and uric acid levels were significantly higher in patients with eGFR < 45 mL/min/1.73 m2 (P < 0.001 and P < 0.001). The multivariate Cox proportional hazards model indicated that eGFR < 45 mL/min/1.73 m2 was a significant risk factor for 5-year all-cause mortality in IS patients with high-grade CAS after adjusting for these variables (hazard ratio = 2.05; 95% CI = 1.31–3.21; P = 0.002).ConclusionseGFR < 45 mL/min/1.73 m2 was associated with an increased risk of 5-year all-cause mortality in acute IS patients with high-grade CAS. Whether aggressive treatment of chronic kidney disease in IS patients with high-grade CAS can improve stroke outcomes should be confirmed in future studies.