Mortality In Acute Stroke Patients Research Articles

Effect of sarcopenia on mortality in acute stroke patients receiving endovascular treatment.

To investigate the effect of sarcopenia on mortality in patients with acute ischemic stroke caused by anterior circulation large artery occlusion who underwent endovascular treatment. Acute ischemic stroke patients (n = 194) treated with mechanical thrombectomy who underwent chest computed tomography between 2019 and 2022 (median age, 69 [interquartile range: 61-77], 95 females, 99 males) were evaluated retrospectively. The cross-sectional area and density of the pectoralis muscle [pectoralis muscle area (PMA) and pectoralis muscle density (PMD)] at the level of the aortic arch and the erector spinae muscle at the T12 level [erector spinae muscle area (ESMA) and erector spinae muscle density (ESMD)] were measured. The association between skeletal muscle parameters and mortality outcomes was investigated using the receiver operating characteristic (ROC) curve and multivariable logistic regression analyses. The 90-day mortality rate was 32% in the study population (n = 62). The ROC analysis revealed that ESMD [area under the curve (AUC): 0.765] and PMD (AUC: 0.759) performed best in the prediction of 90-day mortality. In the multivariable logistic regression analysis, PMD [odds ratio (OR): 0.896; 95% confidence interval (CI): 0.846-0.948; p < 0.001], ESMA (OR: 0.929; 95% CI: 0.878-0.983; p = 0.011), and ESMD (OR: 0.947; 95% CI: 0.913-0.983; p = 0.004), but not PMA, were independent risk factors for 90-day mortality. PMD, ESMA, and ESMD may be risk factors for 90-day mortality after mechanical thrombectomy for acute ischemic stroke.

Short-term of mortality in acute stroke patients

Background: Stroke is a major cause of disability and death. A significant number of patients with acute stroke dies within 30 days of developing stroke. The aim of the study was to determine the short-termmortality (within 30 days) in acute stroke patients. Methods: This was a cross-sectional study, carried out in the Department of Medicine of Rangpur Medical College Hospital. Date was collected for 6 months (from January to June). Results: During the study period, we studied of 248 acute stroke patients, among them 110 were hemorrhagic and 138 were ischemic. Mean age of the patients were 56.02 years in hemorrhagic stroke and 61.26 years in ischemic stroke. In case of hemorrhagic stroke, short term mortality was 45.5% (50), among them in hospital death was 88% (44) and majority of the deaths occurred with in the first 7 days. Mortality was significantly higher among patients with larger hematomas (&gt;60 cm3) compared to subjects with smaller hematomas (&lt;30 cm3). Short term mortality was 18.1% in ischemic stroke. Infarction size more than 10 mm2, total anterior circulation syndrome (TACS) and GCS less than 10 at presentation were significantly associated with short term mortality. Conclusion: Short-term mortality was high in acute hemorrhagic stroke than acute ischemic stroke. In hemorrhagic stroke larger hematoma, GCS at presentation, ventricular extension and in case of ischemic stroke size of the infarction, arterial territory involvement and GCS were predictor of mortality. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 205

Association between Mean Arterial Pressure during the First 24 Hours and Clinical Outcome in Critically Ill Stroke Patients: An Analysis of the MIMIC-III Database

Abnormal blood pressure is common in critically ill stroke patients. However, the association between mean arterial pressure (MAP) and mortality of critically ill stroke patients remains unclear. We extracted eligible acute stroke patients from the MIMIC-III database. The patients were divided into three groups: a low MAP group (MAP ≤ 70 mmHg), a normal MAP group (70 mmHg < MAP ≤ 90 mmHg), and a high MAP group (MAP > 90 mmHg). The Cox proportional hazards model and restricted cubic splines were used to assess the association between MAP and mortality. Sensitivity analyses were conducted to investigate whether MAP had different effects on mortality in different subpopulations. A total of 2885 stroke patients were included in this study. The crude 7-day and 28-day mortality was significantly higher in the low MAP group than that in the normal MAP group. By contrast, patients in the high MAP group did not have higher crude 7-day and 28-day mortality than those in the normal MAP group. After multiple adjustments using the Cox regression model, patients with low MAP were consistently associated with higher 7-day and 28-day mortality than those with normal MAP in the following subgroups: age > 60 years, male, those with or without hypertension, those without diabetes, and those without CHD (p < 0.05), but patients with high MAP were not necessarily associated with higher 7-day and 28-day mortality after adjustments (most p > 0.05). Using the restricted cubic splines, an approximately L-shaped relationship was established between MAP and the 7-day and 28-day mortality in acute stroke patients. The findings were robust to multiple sensitivity analyses in stroke patients. In critically ill stroke patients, a low MAP significantly increased the 7-day and 28-day mortality, while a high MAP did not, suggesting that a low MAP is more harmful than a high MAP in critically ill stroke patients.

Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis

BackgroundPost-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke.MethodsOur search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD.ResultsThe pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13–7.79) and mortality 4.07 (95% CI, 2.17–7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13–2.07), previous stroke 1.40 (95% CI, 1.18–1.67), severe stroke 1.38 (95% CI, 1.17–1.61), females 1.25 (95% CI, 1.09–1.43), and diabetes mellitus 1.24 (95% CI, 1.02–1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70–0.95) and ischaemic stroke 0.54 (95% CI, 0.46–0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis.ConclusionsAssessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate.Trial registrationhttps://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb.

An mNUTRIC-based nomogram for predicting the in-hospital death risk in patients with acute stroke.

To establish a risk prediction model for in-hospital death in acute stroke patients based on nutritional risk scores. A retrospective analysis was performed including 268 acute stroke patients. The Nutritional Risk Screening 2002 (NRS2002) and modified Nutritional Risk in the Critically Ill (mNUTRIC) score were used to evaluate the nutritional status of patients with acute stroke after admission to the neurological intensive care unit (NICU), and laboratory parameters and clinical characteristics were collected. Multivariate logistic regression analysis was performed to screen the risk factors for in-hospital death in acute stroke patients, and a nomogram for predicting death based on the nutritional risk score was established. The mortality of acute stroke in the NICU was 25.8%. Multivariate logistic regression analysis showed that the mNUTRIC score, female sex, lymphocyte count, pulmonary infection and mechanical ventilation were independent risk factors for in-hospital mortality in acute stroke patients (P &lt; 0.001 or 0.05). The above indexes were used to establish a prediction model of the in-hospital death risk for acute stroke patients. The area under the ROC curve, sensitivity, and specificity of the prediction model were 0.891 (95% CI = 0.853-0.928), 82.5%, and 81.7%, respectively. The nomogram was established and then internally validated using bootstrap repeat sampling 2000 times, the C-index was 0.880, and the predicted values of the calibration curve were in agreement with the measured values. The mNUTRIC-based nomogram model can be used as a reliable tool to predict the in-hospital mortality risk of acute stroke patients.

Prognostic significance of thyroid dysfunction in acute stroke

Background: Cerebrovascular accidents (CVAs) are the leading cause of morbidity and mortality. Several comorbidities have been associated with increased mortality in acute stroke patients. Conditions such as hypertension, dyslipidemia, diabetes mellitus, and thyroid dysfunction are identified as risk factors in the etiology of stroke. Methods: This is a prospective study involving 40 patients admitted with acute stroke between October 2010 and July 2012 in Kasturba Hospital, Manipal, under the Departments of Medicine and Neurology. Results: Thyroid dysfunction has been associated with CVAs and is an area of active research in the present times. Conclusion: Low T3 level was associated with unfavorable outcome and with posterior circulation stroke as accessed using the National Institutes of Health Stroke Scale.

Clinical Features, Risk Factors and Hospital Mortality of Acute Stroke Patients

Background: Stroke is a leading cause of mortality and disability worldwide. To prevent complications and permanent defects, early diagnosis, distinguishing the type and risk factor of stroke is crucial. Methodology: It was a hospital based cross sectional study, purposive sampling method was used, and a total of 469 stroke patients admitted into Department of Medicine, Rangpur medical college hospital, Bangladesh were included in this study. Results: In this study we have studied of 469 acute stroke patients. Among them 81% (380) were ischemic stroke patients and 19% (89) were hemorrhagic stroke. Overall male were more than female 308 (65.7%) vs 161(34.4%). The mean age for the ischemic stroke group was 64.1 ± 10.9 years, which was significantly higher than that of the hemorrhagic group (59.8 ± 9.60years) (P&lt;0.05). Acute hemorrhagic stroke patients presented with acute onset of focal neurological deficit 61.8%, headache 64%, vomiting 59.6%, alteration of consciousness 48.3% and convulsion 27%. On the other hand, acute ischemic stroke patient presented with alteration of consciousness 65.5%, acute onset of focal neurological deficit 39.5%, paralysis 41%, deficit after awakening 32.4% and aphasia 34.7%. Among the risk factors of stroke in acute ischemic stroke patients hypertension was 59.2%, diabetes mellitus 20%, history of previous stroke 16.1%, ischemic heart disease 14.5% and atrial fibrillation 10.3% were present, on the other hand in acute hemorrhagic stroke patients hypertension 76.4%, smoking 70.8% and diabetes mellitus 6.7% were present. 26.97% of the acute hemorrhagic stroke and 13.9% of the acute ischemic stroke patients died in hospital. Conclusion: Common presentation of stroke was acute onset of focal neurological deficit; headache and vomiting were more in hemorrhagic stroke patient; alteration of consciousness, paralysis was predominant in ischemic stroke patient.

Abstract WP240: Urinary Biomarker of Kidney Tubular Function, Risk of Acute Kidney Injury, and Mortality in Acute Stroke Patients

Background and Purpose: Urinary liver-type fatty-acid binding protein (L-FABP), which is a biomarker of kidney tubule injury, has been studied extensively and established as a risk marker of acute kidney injury (AKI) and cardiovascular disease outcomes. However, no evidence to date has indicated whether kidney tubule injury has any potential for predictor of AKI and mortality in acute stroke patients. The aim of the present study was to accurately determine the prevalence of AKI and effect on clinical outcome of acute stroke patients assessed by urinary L-FABP. Methods: Acute ischemic stroke and intracerebral hemorrhage patients hospitalized in the stroke care unit (SCU) within 24 h after symptom onset were prospectively investigated. AKI was defined on the basis of Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We evaluated the association among urinary L-FABP, AKI, and 3-months mortality using multivariate logistic analysis adjusted for baseline estimated glomerular filtration rate (eGFR), albuminuria, stroke risk factors, and neurological severity. Results: In total, 601 acute stroke patients (390 males; median age 72 years, ischemic stroke 476 cases and intracranial hemorrhage 125 cases) were enrolled to the study. AKI occurred in 32 acute stroke patients (5.3%). In the univariate analysis, high urinary L-FABP level had positive associations with AKI (25.4 μg/g Cr vs. 3.6 μg/g Cr, P&lt;0.001) and 3 months mortality (13.4 μg/g Cr vs. 3.8 μg/g Cr, P&lt;0.001). In the multivariate analysis, elevated urinary L-FABP level was independently associated with AKI (OR 1.015; 95% CI, 1.008-1.023, P&lt;0.001) and 3-months mortality (OR 1.012; 95% CI, 1.001-1.023, P=0.032). Moreover, AKI also increased the risk of 3-months mortality after stroke (OR 7.053, 95% CI, 1.771-28.087, P=0.006). Conclusion: Biomarker of tubular dysfunction is independent predictor of AKI and mortality in acute stroke patients.

Incidence and Risk Factors of Acute Kidney Injury in Acute Stroke - in a Tertiary Care Hospital

Acute kidney injury (AKI) is a common complication after acute stroke. Multiple additional risk factors are also responsible for development of AKI during acute stroke. This cross sectional observational study was conducted with a total of 240 newly detected computed tomography (CT) confirmed acute stroke patients in Mymensingh Medical College Hospital with an aim to find out the incidence and risk factors of AKI in acute stroke. In this study, AKI developed in 15.42% of all types of acute stroke and more commonly in haemorrhagic stroke than in ischaemic stroke (23.44% vs. 12.50%, P&lt;0.05). AKI was found more frequently (54.05%) in old &gt;60 years age group and in male patients(17.93% vs. 11.58% &amp; P&gt;0.05). Again, AKI developed most commonly in chronic kidney disease (CKD) (33.33%, P&lt;0.05) and then in diabetes mellitus (DM) (31.03%, P&lt;0.05), in ischaemic heart disease (IHD) (28.11%, P&lt;0.05), in hypertension (21.14%, P&lt;0.05), in previous stroke (15.22%, P&gt;0.05), in dyslipidaemia (13.33%, P&gt;0.05), and in smoker (9.89%, P&gt;0.05). Family history of (H/O) DM was present in 30.00% (P&gt;0.05) and that of hypertension and kidney disease was present in 24.44% (P&gt;0.05) and 25.00% (P&gt;0.05) of stroke patients, respectively. Among the AKI patients, majority (70.27%) had hypertension and 37.84% had CKD, 29.73% had IHD. DM and smoker were 24.32%of each. Family H/O of hypertension, DM and kidney disease was present in 29.73%, 16.22% &amp; 13.51 % of AKI patients, respectively. So, this study had identified several important risk factors of AKI, in particular age, sex, smoking, hypertension, DM, IHD, CKD and types of stroke. So, the risk score could be easily calculated to predict the risk of AKI in stroke patients. And thus to prevent the development of AKI is of utmost importance to reduce the related morbidity and mortality of acute stroke patients. A multicenter nationwide intensive research is needed to identify the precise mechanism, risk factors, their relation and actual outcome of AKI that develop in patients with acute stroke.&#x0D; CBMJ 2019 January: vol. 08 no. 01 P: 12-18

Impact of delay in early swallow screening on pneumonia, length of stay in hospital, disability and mortality in acute stroke patients.

Early swallow screening, within 4 h of admission, is required for all acute stroke patients to commence nutritional support, as recommended. We evaluated the impact of delay in early swallow screening on outcomes in patients admitted with acute stroke. Prospective cohort study of 1656 men (mean ± SD age = 73.1y ± 13.2) and 1653 women (79.3y ± 13.0) admitted with stroke to hyperacute stroke units (HASUs) in Surrey. Logistic regression was used to assess the risk (adjusted for age, stroke severity and co-morbidities) of delay in swallow screening on pneumonia, length of stay (LOS) > 3 weeks in HASU or hospital, moderately severe to severe disability on discharge (modified Rankin scale score = 4-5) and mortality during admission. Compared with those who received swallow screening within 4 h of admission, a delay between 4 and 72 h was associated with greater risks of pneumonia: OR = 1.4 (95%CI:1.1-1.9, P = 0.022), moderately severe to severe disability on discharge: OR = 1.4 (1.1-1.7, P = 0.007) and a delay beyond 72 h was associated with even greater risks of pneumonia: OR = 2.3 (1.4-3.6, P < 0.001), prolonged LOS in HASU: OR = 1.7 (1.0-3.0, P = 0.047, median LOS = 6.2 vs. 14.7 days) and hospital: OR = 2.1-fold (1.3-3.4, P = 0.007, median LOS = 6.8 vs. 14.9 days), moderately severe to severe disability on discharge: OR = 2.5 (1.7-3.7, P < 0.001) and mortality: OR = 3.8 (2.5-5.6, P < 0.001). These risks persisted after excluding 103 patients who died within 72 h. Delay in early screening for swallow capacity in acute stroke patients is detrimental to outcomes, possibly due to delaying nutritional provision or through inappropriate feeding leading to aspiration. Routine early screening needs greater attention in HASUs.

Association between acute kidney injury and increased hospital mortality in acute stroke patients

Background: Acute kidney injury (AKI) has been associated with increased mortality in a variety of clinical settings. Acute kidney injury (AKI) is common and associates with poor clinical outcomes. Information about the incidence of AKI and effect on stroke outcomes is limited.

Noninfectious complications of acute stroke and their impact on hospital mortality in patients admitted to a stroke unit in Warsaw from 1995 to 2015

BackgroundMedical complications often worsen the prognosis after stroke. Our aim was to investigate the association between particular noninfectious complications and hospital mortality of acute stroke patients admitted to an urban Polish stroke center, and changes in their occurrence from 1995 to 2015. MethodsThis is a retrospective analysis of 5174 consecutive patients admitted for acute ischemic stroke or cerebral hemorrhage to a Polish urban stroke center between 1995 and 2015. The occurrence of complications was reported for years 1995–2000 (n=883), 2001–2006 (n=1567), 2006–2010 (n=1539) and 2011–2015 (n=1183). Odds ratios (OR) with 95% confidence interval (95% CI) for stroke unit death were calculated after adjustment for age, congestive heart failure (CHF), pre-existing disability, stroke type and baseline neurological deficit in three different time periods. ResultsOver time there was a significant decrease in the occurrence of myocardial infarction (MI) (2.2%, 1.4%, 1.0% and 0.3%, respectively), exacerbated CHF (4.6%, 5.1%, 2.6% and 2.0%) and deep vein thrombosis (DVT) (4.6%, 2.7%, 1.2% and 1.1%). Adjusted odds for stroke unit death were increased by myocardial infarction (MI) (OR 17.5, 95% CI: 8.5–35.7), exacerbated CHF (OR 15.0, 95% CI: 9.8–23.0), pulmonary embolism (PE) (OR 11.5, 95% CI: 6.1–21.6), gastrointestinal bleeding (OR 9.2, 95% CI: 4.4–18.9) and recurrent stroke (OR 5.4, 95% CI: 3.1–9.3). ConclusionsOver the last two decades Polish urban stroke units may have achieved a significant reduction of the occurrence of some noninfectious complications (i.e. MI, exacerbated CHF and DVT). However, the list of conditions associated with stroke unit mortality includes not only MI and exacerbated CHF but also PE, gastrointestinal bleeding and recurrent stroke.

Factors Influencing In-hospital Mortality in Acute Stroke Patients in a Tertiary Care Hospital in Kolkata, India

Factors Influencing In-hospital Mortality in Acute Stroke Patients in a Tertiary Care Hospital in Kolkata, India

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Background: Knowledge on the risk factors of developing pneumonia, one of the top causes of mortality in acute stroke patients admitted to a tertiary government hospital, is lacking. Aim and Objective: This study aimed to determine the factors associated with the risk of developing pneumonia in acute stroke patients admitted to the emergency department of a tertiary government hospital. Materials and Methods: A retrospective matched case–control study involving acute stroke patients admitted to the emergency department of a tertiary government hospital with 168 pneumonia patients matched with 168 controls by sex was employed. Age, sex, vascular risk factors, previous hospitalization within the past 3 months, type and location of stroke, need for intubation, length of hospital emergency room stay, National Institute of Health Stroke Scale (NIHSS) score on admission, pre-morbid Modified Rankin Scale (mRS) score, and outcome (mortality, NIHSS score and mRS score at discharge) were obtained from the medical charts. Odds ratios were calculated using a multivariate logistic regression analysis. Among stroke patients developing pneumonia, the type of pneumonia and microorganisms were identified. Results: Smoking, alcohol intake, dysphagia, hemorrhagic stroke, need for intubation, and age were associated with pneumonia. Pneumonia increases the odds of mortality and disability by 14 and 7 times, respectively. Hospital-acquired pneumonia is the most common type with Acinetobacter baumanii and Klebsiella pneumonia as the most common microorganisms identified. Conclusion: Age, alcohol intake, dysphagia, hemorrhagic stroke, and need for intubation increase the risk for post-stroke pneumonia with organisms isolated consistent with nosocomial pneumonia.

Admission troponin-I predicts subsequent cardiac complications and mortality in acute stroke patients.

The importance of troponin elevation at stroke presentation remains uncertain. We aimed to assess whether baseline ultrasensitive Troponin I (hs-TnI) predicts cardiac complications and outcome in acute stroke patients. Stroke patients admitted within 6 h were consecutively enrolled from May 2013 to March 2014. Blood samples were taken at admission to determine hs-TnI by chemiluminescent microparticle immunoassay. hs-TnI > 34.2 pg/ml (male) and >15.6 pg/ml (female) were considered elevated. Complications during in-hospital stay and outcome at 90 days were prospectively recorded. Independent predictors of cardiac complications (heart failure and acute coronary syndrome) and mortality were determined by logistic regression. The additional predictive value of hs-TnI was evaluated by integrated discrimination improvement index. A subanalysis was performed after excluding patients with previous cardiac diseases. From 174 patients, 39(22%) had elevated hs-TnI, having these patients higher incidence of cardiac complications (57% versus 19%, p = 0.004). hs-TnI was an independent predictor of cardiac complications (OR = 16.1 (1.7-150.3)) together with diastolic blood pressure (OR = 0.92 (0.86-0.99)). Addition of hs-TnI to clinical variables significantly improved discrimination (IDI = 15.2% (7.8-22.7)). Subanalysis in patients without previous cardiac diseases showed similar results. Elevated hs-TnI was independently associated with 90 days mortality (OR = 3.6 (1.3-9.4)), but addition of hs-TnI to clinical data did not result in an increased discrimination. The present study confers hs-TnI a 2b level of evidence as a diagnostic tool to predict cardiac complications in stroke. Absence of serial hs-TnI measurements and limited sample size are the main weaknesses of the study. Patients with elevated baseline hs-TnI showed a higher frequency of cardiac complications and a higher mortality. Measurement of hs-TnI in acute stroke might be useful to identify patients at a high risk of cardiac complications and death.

Abstract TP19: Charlson Comorbidity Index Predicts Mortality and Functional Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy. Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was &lt;2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days. Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p &lt;0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3). Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.

National Institutes of Health Stroke Scale Item Profiles as Predictor of Patient Outcome: External Validation on Safe Implementation of Thrombolysis in Stroke-Monitoring Study Data.

National Institutes of Health Stroke Scale (NIHSS) item profiles that were recently proposed and validated may prove useful for clinical prognostication and research studies. We aimed to validate the NIHSS item profiles in hyper-acute stroke patients who received thrombolysis treatment (tissue-type plasminogen activator). We applied the latent class analysis probabilities of the profile membership generated from the derivation study onto NIHSS data from the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST). We separately considered NIHSS data collected within 3 hours and at ≈24 hours after stroke onset to obtain 2 sets of symptom groupings. The discrimination and calibration of both sets of symptom profiles were assessed from their association with outcomes. The outcome measures included modified Rankin Scale (mRS; using full distribution and dichotomized, mRS 0-1 or back to baseline) at day 90 and mortality by 90 days. We obtained data for 6843 patients. Ordinal analysis of mRS showed odds of better outcome across the profiles, for each set of symptom profiles, adjusted for age, sex, and prestroke mRS. Dichotomized outcomes mirrored the ordinal findings. There were significant differences in prognostic discrimination ability for the dichotomized outcome measures between the 2 sets of symptom profiles, with the latter set (ie, 24-hour symptom profiles) performing better. The NIHSS item profiles are individually associated with functional outcome and mortality in acute stroke patients treated with tissue-type plasminogen activator. Considering profiles of NIHSS subscores rather than only the total score is informative for prognostication, particularly for assessments collected 24 hours after stroke onset.

Inpatient Statin Use Is Associated with Decreased Mortality of Acute Stroke Patients with Very Low Low-Density Lipoprotein Cholesterol

To investigate the potential benefits of inpatient statin therapy on mortality of acute stroke patients with very low admission low-density lipoprotein cholesterol (LDL-C) level (<1.81 mmol/L). The acute stroke patients with admission LDL-C level less than 1.81 mmol/L were enrolled from the China National Stroke Registry. The patients were divided into statin group and non-statin group during hospitalization. The association between statin therapy and mortality of participants in 1 year was analyzed by multivariable binary logistic regression models. A total of 1018 patients were enrolled, and the cumulative mortality rate was 10.1% at 3 months, 13.1% at 6 months, and 15.9 % at 1 year. The all-cause mortality rate in statin group was significantly lower than that in non-statin group (3.6% versus 13.7% at 3 months, P < .001; 6.2% versus 16.9% at 6 months, P < .001; 8.4% versus 20% at 1 year, P < .001). The logistic analyses showed that statin therapy during hospitalization was independently associated with decreased mortality at 3 months (odds ratio [OR], .35; 95% confidence interval [CI], .18-.67), at 6 months (OR, .42; 95% CI, .25-.73) and at 1 year (OR, .47; 95% CI, .29-.76). Statin use during hospitalization could decrease mortality of acute ischemic stroke patients with very low admission LDL-C.

Mortality in acute stroke: predictive value of lipid profile and routine investigations

Background: The prognostic value of routine blood investigations in acute stroke has not been adequately studied. Most studies do not use accumulative measurement of these parameters and numbers of subjects taken were less. In this study we assess the impact of these simple parameters on the mortality in acute stroke patients as well as their correlation with clinical findings . Methods: Total 205 consecutive patients of acute stroke presented within 72 hours of symptom onset were studied. After clinical evaluation and neuroimaging, routine blood investigations along with lipid profile estimations were performed. The patients were followed up for a maximum period of 30 days from onset of stroke . Results: After analysis it was demonstrated that out of all clinical parameters low Glasgow Coma Scale (GCS), higher systolic and diastolic blood pressure can strongly predict fatality significantly. Among blood investigations raised leukocyte counts(TLC) , erythrocyte sedimentation rate, blood urea, serum creatinine, serum bilirubin along with decreased level of total cholesterol (p=0.0001) and low density lipoprotein (LDL) (p=0.02) signifies their accumulative importance in predicting fatality in expired patients. But after logistic regression analysis only GCS, TLC, blood urea, serum creatinine and total cholesterol independently correlate with mortality . Conclusions: Our study shows that it is useful to take necessary interventions, accordingly in early hours focusing on correctable parameters in acute stroke to prevent mortality in acute stroke.

Hospital mortality from atrial fibrillation associated with ischemic stroke: a national data report

Purpose: To study factors associated with poor outcomes in acute ischemic stroke patients with atrial fibrillation (AF) by using a national database. Materials and Methods: This study was a retrospective analytical study by retrieving data from the Thailand national database system for universal coverage (UC) health insurance system. All adult patients aged over 18 years who were admitted with acute ischemic stroke during the fiscal years 2004–2012 by the appropriate ICD codes were searched. Eligible patients with AF were categorized as alive or dead during hospital stay. The mortality rate and factors associated with in-hospital mortality were studied. Results: There were 522,699 patients diagnosed as acute stroke; 277,291 patients (53.1%) had acute ischemic stroke. Of those with ischemic stroke, 25,319 patients (9.1%) had AF. The mortality rates of acute ischemic stroke with AF were 14.1% and without AF were 6.2%, (p < 0.001). Significant factors associated with mortality in acute stroke patients with AF by multivariate logistic regression were female gender (adjusted odds ratio; AOR 1.28), co-morbid diseases such as diabetes (AOR 1.28), hypertension (AOR 1.26), rt-PA treatment (AOR 0.55), and stroke complications, such as pneumonia (AOR 2.60), septicemia (AOR 6.50), or gastrointestinal bleeding (AOR 2.16). Conclusions: At the national level, AF caused a higher mortality rate in acute ischemic stroke than in non-AF patients. Gender, co-morbid diseases, rt-PA treatment, and stroke complications were associated with mortality in acute ischemic stroke with AF.