Outcome In Ischemic Stroke Patients Research Articles

Factors Affecting Ischemic Stroke Short-Term Outcome According to Hemoglobin Level

Background and aims There seems to be a U-shaped relation between hemoglobin level and ischemic stroke severity. We aimed to explore possible causes of this relation. Methods All patients with ischemic stroke between 2006 and 2016 admitted within 3 hours of onset were included. Hemoglobin and NIHSS score were obtained on admission. Modified Rankin Scale (mRS) score was obtained day 7. Locally weighted scatterplot smoothing (lowess smoother) curves displaying the frequencies of M1 occlusion and complications according hemoglobin level on admission and lowess smoother curves displaying mRS day 7 in patients with and without middle cerebral artery (M1) occlusion according to hemoglobin level on admission were obtained. Results This study includes 905 ischemic stroke patients. Low hemoglobin was associated with pneumonia and urinary tract infection. Neurological worsening was not associated with hemoglobin level. Increasing mRS day 7 was strongly associated with increasing high hemoglobin in patients with M1 occlusion (correlation factor=.61, P=.02). Conclusions Poor outcome in ischemic stroke patients with low hemoglobin is associated with complications during the hospital stay whereas poor outcome in ischemic stroke patients with increasing high hemoglobin levels is associated with occlusion of the middle cerebral artery.

Perbandingan Luaran Klinis Pasien Stroke Iskemik dengan Hipertensi dan Non Hipertensi di UPT RSUD Undata Provinsi Sulawesi Tengah Periode Maret 20202 – Maret 2022

Stroke is the main cause of disability at high risk for cognitive impairment. Hypertension is the main trigger for the occurrence of stroke. The Barthel Index is one of the measuring tools used to assess patients with neurological disorders and undergoing rehabilitation. This study aims to compare the clinical outcomes of ischemic stroke patients with hypertension and non-hypertension at Undata Hospital of Central Sulawesi Province from March 2020 to March 2022. This study uses an analytical observational research method with a cross-sectional design. The samples consist of 68 patients. The data were collected through secondary data, namely medical records of ischemic stroke patients with hypertension and non-hypertensive. The data were tested for normality using the Kolmogorov-Smirnov test and processed using the Mann-Whitney and the unpaired T-tests. The results show no comparison of clinical outcomes of ischemic stroke patients with hypertension and non-hypertension. The results of statistical tests of the Barthel index before going to the hospital obtained a p-value of 0.106. and the results of statistical tests of the Barthel index after hospitalization is a p-value of 0.881. There is no difference in clinical outcomes in ischemic stroke patients with hypertension and non-hypertension at Undata Hospital of Central Sulawesi Province from March 2020 to March 2022.

The impact of funding on the quality and interpretation of systematic reviews of mechanical thrombectomy in stroke patients.

Funding may impact the quality and findings of systematic reviews (SRs). We aimed to compare the methodological quality of funded and non-funded SRs that investigated the outcomes in ischemic stroke patients undergoing mechanical thrombectomy. We conducted a comprehensive search strategy in different databases, including Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline (including epub ahead of print, in-process & other non-indexed citations), PubMed, Scopus and Web of Science Core Collection to retrieve all relevant SRs. Random sequence generation matched each funded SR with a non-funded one. A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool was used to assess the bias and quality of the included SRs. We also used uni- and multivariate analysis to perform our analysis, and results were expressed in odds ratio (OR) and 95% confidence interval (CI). We retrieved 150 articles, which were randomized and matched into 100 SRs, including 50 funded and 50 non-funded studies. By multivariate analysis, we found that including randomized clinical trials (RCTs) (OR: 5.7; 95% CI: 1.8-17.8; p = 0.003) and reporting conflict of interests (OR: 5.2; 95 CI: 1.1-24; p = 0.036) were the only significant differences between funded and non-funded SRs. No significant differences were found regarding the overall confidence for low-quality (OR: 0.54; 95% CI: 0.09-3.2; p = 0.49) and moderate/high-quality SRs (OR: 0.17; 95% CI: 0.02-1.87; p = 0.14). Funded studies tend to include RCTs more often and report conflict of interests with no significant impact on overall confidence.

The Combination of Whole-Brain Features and Local-Lesion Features in DSC-PWI May Improve Ischemic Stroke Outcome Prediction.

Accurate and reliable outcome predictions can help evaluate the functional recovery of ischemic stroke patients and assist in making treatment plans. Given that recovery factors may be hidden in the whole-brain features, this study aims to validate the role of dynamic radiomics features (DRFs) in the whole brain, DRFs in local ischemic lesions, and their combination in predicting functional outcomes of ischemic stroke patients. First, the DRFs in the whole brain and the DRFs in local lesions of dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) images are calculated. Second, the least absolute shrinkage and selection operator (Lasso) is used to generate four groups of DRFs, including the outstanding DRFs in the whole brain (Lasso (WB)), the outstanding DRFs in local lesions (Lasso (LL)), the combination of them (combined DRFs), and the outstanding DRFs in the combined DRFs (Lasso (combined)). Then, the performance of the four groups of DRFs is evaluated to predict the functional recovery in three months. As a result, Lasso (combined) in the four groups achieves the best AUC score of 0.971, which improves the score by 8.9% compared with Lasso (WB), and by 3.5% compared with Lasso (WB) and combined DRFs. In conclusion, the outstanding combined DRFs generated from the outstanding DRFs in the whole brain and local lesions can predict functional outcomes in ischemic stroke patients better than the single DRFs in the whole brain or local lesions.

Effect of Immediate Antihypertensive Treatment on Clinical Outcomes in Acute Ischemic Stroke Patients With Different Renal Function Status.

It remains unclear whether different blood pressure management strategies should be administered for acute stroke patients with or without impaired renal function. We conducted a secondary analysis of the CATIS trial (China Antihypertensive Trial in Acute Ischemic Stroke) to investigate the effect of early antihypertensive treatment among patients with acute ischemic stroke according to the baseline renal function assessed by estimated glomerular filtration rates (eGFR). The CATIS trial randomly assigned 4071 acute ischemic stroke patients with systolic blood pressure between 140 and 220 mm Hg to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. A primary outcome (composite outcome of death and major disability) and secondary outcomes were compared between antihypertensive treatment and control groups by baseline renal function levels of eGFR values of <60, 60 to 89, and ≥90 mL/min per 1.73 m2. At day 14 or hospital discharge, the primary outcome was not significantly different between the antihypertensive treatment and control groups in each subgroup stratified by renal function status (P=0.98 for homogeneity), and the odds ratios (95% CIs) were 1.23 (0.76-2.02) in patients with eGFR <60 mL/min per 1.73 m2, 0.94 (0.75-1.19) in patients with eGFR values of 60-89 mL/min per 1.73 m2, and 1.04 (0.88-1.24) in patients with eGFR ≥90 mL/min per 1.73 m2, respectively. In addition, early antihypertensive treatment was not associated with secondary clinical outcomes by baseline renal function (P>0.05 for all homogeneity). Early antihypertensive treatment had a neutral effect on clinical outcomes in ischemic stroke patients with different renal function status. URL: https://www. gov; Unique Identifier: NCT01840072.

Associations of Neutrophil-Lymphocyte Ratios with Reperfusion and Functional Outcomes in Ischemic Stroke after Endovascular Therapy

ObjectivesTreatment of ischemic stroke with endovascular thrombectomy (EVT) leads to improved outcomes compared to IV tPA. The neutrophil-lymphocyte ratio (NLR), a marker of inflammation, has been proposed to predict outcomes in ischemic stroke patients and may be used to identify patients at risk for poor outcomes after EVT. Materials and MethodsThis was a retrospective study of adult ischemic stroke patients undergoing EVT between 1/1/2018 and 12/31/2020. Outcomes were successful reperfusion (TICI score ≥2B), favorable discharge NIHSS (≤4), favorable discharge and 3-month mRS (≤2), and symptomatic intracranial hemorrhage (sICH). The primary exposure was NLR, measured pre- and post-EVT. Other variables collected included demographics and timing of stroke onset, arrival, groin puncture, tPA, and recanalization. ResultsA total of 592 patients were included. The most common vessel involved was the middle cerebral artery (73%). Lower admission NLR was associated with favorable discharge NIHSS and favorable discharge and 3-month mRS (all P < 0.01). NLRs measured after EVT were associated with all the primary outcomes. Improvements in NLR after EVT were associated with favorable discharge (P = 0.02) and 3-month mRS (P = 0.02) and lower incidence of sICH (P = 0.01). ConclusionsBecause of the long-term functional deficits that can persist after ischemic stroke, it is vital to identify patients with higher probability for these outcomes. The results from this study showed that favorable NLR measures, as well as favorable trends in NLR over time, are associated with improved outcomes, indicating that NLR is a useful marker to identify patients at risk for poor functional outcomes.

Prognostic nomogram for the outcomes in acute stroke patients with intravenous thrombolysis.

The prediction of neurological outcomes in ischemic stroke patients is very useful in treatment choices, as well as in post-stroke management. This study is to develop a convenient nomogram for the bedside evaluation of stroke patients with intravenous thrombolysis. We reviewed all enrolled stroke patients with intravenous thrombolysis retrospectively. Favorable outcome was defined as modified Rankin Score (mRs) less than 2 at 90 days post thrombolysis. We compared the clinical characteristics between patients with favorable outcome and poor outcome. Then, we applied logistic regression models and compared their predictability. A total of 918 patients were enrolled in this study, 448 patients from one hospital were included to develop a nomogram, whereas 470 patients from the other hospital were used for the external validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with baseline NIHSS, blood sugar, blood cholesterol level, part-and full anterior circulation infarction (OCSP type). The AUC was 0.767 (95% CI 0.653-0.772) and 0.836 (95% CI 0.697-0.847) in the derivation and external validation cohorts, respectively. The calibration plot for the probability of severe neurological outcome showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts. A convenient outcome evaluation nomogram for patients with intravenous thrombolysis was developed, which could be used by physicians in making clinical decisions and predicting patients' prognosis.

Venous Outflow Profiles Are Linked to Clinical Outcomes in Ischemic Stroke Patients with Extensive Baseline Infarct.

Background and Purpose The benefit of endovascular thrombectomy (EVT) treatment is still unclear in stroke patients presenting with extensive baseline infarct. The use of additional imaging biomarkers could improve clinical outcome prediction and individualized EVT selection in this vulnerable cohort. We hypothesized that cerebral venous outflow (VO) may be associated with functional outcomes in patients with low Alberta Stroke Program Early CT Score (ASPECTS). Methods We conducted a retrospective multicenter cohort study of patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Extensive baseline infarct was defined by an ASPECTS of ≤5 on admission computed tomography (CT). VO profiles were assessed on admission CT angiography using the Cortical Vein Opacification Score (COVES). Favorable VO was defined as COVES ≥3. Multivariable logistic regression was used to determine the association between cerebral VO and good clinical outcomes (90-day modified Rankin Scale score of ≤3). Results A total of 98 patients met the inclusion criteria. Patients with extensive baseline infarct and favorable VO achieved significantly more often good clinical outcomes compared to patients with unfavorable VO (45.5% vs. 10.5%, P<0.001). Higher COVES were strongly associated with good clinical outcomes (odds ratio, 2.17; 95% confidence interval, 1.15 to 4.57; P=0.024), independent of ASPECTS, National Institutes of Health Stroke Scale, and success of EVT. Conclusions Cerebral VO profiles are associated with good clinical outcomes in AIS-LVO patients with extensive baseline infarct. VO profiles could serve as a useful additional imaging biomarker for treatment selection and outcome prediction in low ASPECTS patients.

Metric-Based Simulation Training to Proficiency for Endovascular Thrombectomy in Ischemic Stroke.

Ischemic stroke is one of the leading causes of death and long-term disability in the West. Mechanical revascularization techniques are considered the standard of care for large vessel occlusive stroke. Traditional apprenticeship models involve doctors training their skills on patients. Simulation platforms have long been recognized as an alternative to this. There has however been very little robust assessment of the training outcomes achieved on some of these platforms. At best, these simulations increase understanding of the procedural process and may help improve some technical skills; at worst they may instill bad habits and poor technique. The prerequisite of any simulation process must be to teach what to do, with which devices, in the correct sequence as well as what not to do. It should provide valid metric-based feedback to the trainee that is objective, transparent, and fair for formative and summative performance feedback. It should deliver a training program that measures the performance progress of trainees against expert benchmarks—benchmarks that represent an evidence-based peer-reviewed standard. In this paper, we present a perspective for PBP training for thrombectomy based on our experience with the process of procedure characterization, metric validation, and early experience of using this approach for proficiency training. Patient outcomes are not only determined by optimal performance in the Angio Suite but also by an efficient patient procedure pathway. There will be value in utilizing the PBP training standard not only for the procedure itself but also for the constituent elements of the stroke pathway to further improve treatment outcomes for ischemic stroke patients.

Fatty Acids and Lipid Paradox-Neuroprotective Biomarkers in Ischemic Stroke.

Stroke is the primary cause of death and disability worldwide, with ischemic stroke up to 80% of the total cases. Lipid profile was established as a major risk factor for stroke, but recent studies show a paradoxical relationship between serum values and the outcome of stroke patients. Our study aims to analyze the impact of the classic extended lipid profile, including fatty acids as potential neuroprotective biomarkers for the outcome of ischemic stroke patients. We included 298 patients and collected clinical, paraclinical, and outcome parameters. We used a method consisting of high-performance liquid chromatography coupled with mass spectrometry to quantify serum fatty acids. We observed a negative correlation between National Institutes of Health Stroke Scale (NIHSS) at admission and total cholesterol (p = 0.040; r = −0.120), respectively triglycerides (p = 0.041; r = −0.122). The eicosapentaenoic to arachidonic acid ratio has a negative correlation, while the docosahexaenoic to eicosapentaenoic acid ratio positively correlates with all the prognostic parameters, showing a potential neuroprotective role for eicosapentaenoic acid in preventing severe ischemic stroke. The impact of the lipid profile paradox and the dependency relationship with the fatty acids represent a significant predictive factor for the functional and disability prognostic of ischemic stroke patients.

In-hospital clinical outcomes in diffusion weighted imaging-negative stroke treated with intravenous thrombolysis

ObjectiveWe aimed to investigate whether negative diffusion weighted imaging (DWI) is related to the in-hospital clinical outcomes for ischemic stroke patients with intravenous tissues plasminogen activator (IV tPA).MethodsWe retrospectively enrolled patients who received IV tPA therapy within 4.5 hours from symptoms onset. The classification of DWI-positive or negative was based on post-IV tPA MR scan. Demographic factors, stroke characteristics, imaging information, and the in-hospital clinical outcomes including early neurological improvement (ENI) and favourable functional outcome were collected. Multivariable logistic regression and sensitivity analyses were conducted to test whether negative DWI imaging was an independent predictor of the in-hospital clinical outcomes.ResultsIn the final study population, 437 patients treated with IV tPA were included and 12.36% of them had negative DWI imaging at the first MR scan post IV tPA. In the DWI-negative group, 51.9% (28/54) of the patients achieved ENI at 24 hours and 74.1% (40/54) of the patients achieved favourable clinical outcome at discharge. DWI-negative was not related to ENI (adjusted odds ratio 0.93, 95% confidence interval 0.17–4.91) or favourable clinical outcome (adjusted odds ratio 2.40, 95% confidence interval 0.48–11.95). Additional sensitivity analyses yielded similar results.ConclusionDWI-negative is not associated with ENI or favourable functional outcome at discharge.

Unraveling the potential of endothelial progenitor cells as a treatment following ischemic stroke.

Ischemic stroke is becoming one of the most common causes of death and disability in developed countries. Since current therapeutic options are quite limited, focused on acute reperfusion therapies that are hampered by a very narrow therapeutic time window, it is essential to discover novel treatments that not only stop the progression of the ischemic cascade during the acute phase, but also improve the recovery of stroke patients during the sub-acute or chronic phase. In this regard, several studies have shown that endothelial progenitor cells (EPCs) can repair damaged vessels as well as generate new ones following cerebrovascular damage. EPCs are circulating cells with characteristics of both endothelial cells and adult stem cells presenting the ability to differentiate into mature endothelial cells and self-renew, respectively. Moreover, EPCs have the advantage of being already present in healthy conditions as circulating cells that participate in the maintenance of the endothelium in a direct and paracrine way. In this scenario, EPCs appear as a promising target to tackle stroke by self-promoting re-endothelization, angiogenesis and vasculogenesis. Based on clinical data showing a better neurological and functional outcome in ischemic stroke patients with higher levels of circulating EPCs, novel and promising therapeutic approaches would be pharmacological treatment promoting EPCs-generation as well as EPCs-based therapies. Here, we will review the latest advances in preclinical as well as clinical research on EPCs application following stroke, not only as a single treatment but also in combination with new therapeutic approaches.

Sympathovagal imbalance in early ischemic stroke is linked to impaired cerebral autoregulation and increased infarct volumes.

Autonomic dysfunction is associated with worse outcome of ischemic stroke patients by mechanisms that are not fully understood. There is evidence of autonomic influence in cerebrovascular control but this has not been studied in acute stroke. Therefore, we examined the relationship between heart rate variability (HRV) and baroreflex sensitivity (BRS) in dynamic cerebral autoregulation in the early hours post ischemia, and its impact in clinical and radiological outcome. We prospectively enrolled 26 patients with acute ischemic stroke in middle cerebral artery. Arterial blood pressure (Finometer), cerebral blood flow velocity (transcranial Doppler), and electrocardiogram were recorded within 6h. HRV was assessed by the standard side deviations of normal inter-beat intervals, spectral analysis and non-linear entropy indexes. Spontaneous BRS was assessed by spectral and sequence methods. Dynamic cerebral autoregulation was assessed by transfer function analysis (coherence, phase and gain). Infarct volume was calculated from computed tomography at 24h. Clinical outcome was assessed by the modified Rankin scale. Increased BRS and HRV high frequencies power, both reflecting increased vagal modulation, were correlated with higher gain values of cerebral autoregulation (p<0.05). The higher vagal modulation was also associated with later large infarct volumes (p<0.05) but not with clinical outcome. Increased vagal modulation in early hours of acute ischemic stroke, may interfere with cerebrovascular control and is associated with larger infarcts. Understanding the mechanisms that govern this complex interplay can be useful as novel therapeutic targets to improvement of outcome.

Assessment of risks with acute ischemic stroke in association with CRP levels

Background: There is growing evidence of the prognostic importance of C-reactive protein (CRP) in ischemic stroke. However, the independent value of CRP at different stages after stroke has not been established. Therefore, we assessed the prognostic values of CRP in ischemic stroke. C- reactive protein (CRP), an acute phase reactant and a marker for underlying systemic inflammation has been reported to be elevated in acute coronary syndromes. It has been reported that concentrations of C-reactive protein is directly correlated with the presence and severity of atherosclerosis and are predictors of coronary events and mortality in patients with acute coronary syndromes. Aims and Objectives: The primary aim of this study was to systematically and critically review the relationship between CRP and long-term functional outcome in ischemic stroke patients to evaluate the current state of the literature and also risks involved in it. Materials and methods: This is a prospective study carried out in the Department of Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chengalpet, Tamilnadu. Personal history regarding dietary habits, smoking, alcohol consumption and tobacco chewing were noted. NIH Stroke Scale was assessed in all patients to assess the neurological disability and its prognosis.

Clinical characteristics and outcomes of ischemic stroke patients during Ramadan vs. non-Ramadan months: Is there a difference?

ObjectivesTo study the clinical characteristics and outcomes of patients experiencing an ischemic stroke during Ramadan vs. non-Ramadan months in a tertiary academic center in an Islamic country.MethodsWe retrospectively reviewed all patients with ischemic stroke (IS) in Ramadan and non-Ramadan months for four consecutive years (February 2016–June 2019). All demographics, vascular risk factors, laboratory results, modified Rankin Scale (mRS) at admission and discharge, National Institute Stroke Scale (NIHSS), and in-hospital complication data were collected for all patients.ResultsOne thousand and 58 patients were included (non-Ramadan, n = 960; during Ramadan, n = 98). The mean age during Ramadan was 59 ± 13 years. Most non-Ramadan IS patients during Ramadan were male (68.5%; 57.1%, respectively). There was no statistical difference in vascular risk factors and medical history between the two groups. However, Ramadan patients had higher median NIHSS scores at discharge (p = 0.0045). In addition, more ICU admissions were noted among Ramadan patients (p = 0.009). In the gender-specific analysis for Ramadan patients, we found a statistically significant difference in smoking and urinary tract infection (p = 0.006, p = 0.005, respectively).ConclusionBased on our results, there was no difference, in general, between patients with IS during Ramadan and non-Ramadan months. However, IS patients had higher NIHSS scores at discharge and more ICU admissions during Ramadan. Last, we suggest future studies with larger sample sizes, longer duration, and including all types of strokes.

Hyponatremia Is Associated With Post-thrombolysis Hemorrhagic Transformation and Poor Clinical Outcome in Ischemic Stroke Patients.

ObjectiveHyponatremia is the most common electrolyte disorder encountered in patients with neurological conditions, such as stroke. Studies have shown that it is associated with worse clinical outcomes and increased mortality in acute ischemic stroke (AIS). However, the role of hyponatremia has not been elucidated in patients with AIS who received intravenous thrombolysis (IVT) therapy. Therefore, this study aimed to investigate the effect of serum sodium levels on the clinical outcome and hemorrhagic transformation (HT) in patients with AIS who received thrombolytic therapy.MethodsPatients diagnosed with AIS who received IVT therapy between May 2015 and December 2020 were included in this study. All patients were screened for serum sodium levels immediately after hospital admission, before IVT therapy. The occurrence of HT was evaluated using computed tomography (CT) 24 ± 2 h after thrombolysis. Then, 3-month clinical outcomes were obtained by telephone calls or outpatient visits, and poor 3-month clinical outcomes were defined as modified Rankin Scale scores ≥3. The effects of serum sodium levels on the clinical outcome and HT were assessed using the multivariate logistic regression analysis.ResultsOf the 963 included patients, 82 (8.5%) had hyponatremia, 157 (16.3%) developed HT, and 333 (34.6%) had poor 3-month outcomes. Of the 82 patients with hyponatremia, 21 (25.6%) developed HT, and 39 (47.6%) had poor 3-month outcomes. Patients with hyponatremia had a higher incidence of post-thrombolysis HT (25.6 vs. 15.4%, p = 0.017) and worse clinical outcome (47.6 vs. 33.4%, p = 0.01) than those with normal serum sodium levels. Patients had significantly lower serum sodium levels in those with HT [138.4 (136.4–140.3, IQR) vs. 139.0 (137.2–140.7, IQR) mmol/L, p = 0.019] and poor 3 month outcome [139.0 (137.2–140.7) vs. 138.4 (136.7–140.3) mmol/L, p = 0.005] than those without. After adjusting for major covariates, the multivariate logistic regression analysis revealed that lower serum sodium levels were independently associated with an increased risk of HT [odds ratio (OR) = 1.804; 95% CI: 1.048–3.105] and poor 3-month outcome (OR = 1.647; 95% CI: 1.012–2.679).ConclusionLower serum sodium level was an independent risk factor for post-thrombolysis HT and poor clinical outcome in patients with AIS who received thrombolytic therapy.

Sinus rhythm restoration and improved outcomes in patients with acute ischemic stroke and in-hospital paroxysmal atrial fibrillation.

It is unclear whether early cardiac rhythm control is beneficial in patients with acute ischemic stroke and paroxysmal atrial fibrillation (PAF). We sought to investigate whether PAF self-termination and in-hospital sinus rhythm (SR) restoration is associated with improved outcome in ischemic stroke patients with PAF, compared to those with sustained atrial fibrillation (AF). Consecutive patients with first-ever acute stroke and confirmed PAF during hospitalization were followed for up to 10 years after the index stroke or until death. We investigated the association of in-hospital self-terminated PAF and PAF conversion to SR compared to sustained AF with 10-year all-cause mortality, stroke recurrence, and major adverse cardiovascular events (MACE). Cox regression analysis was performed to identify independent predictors of each outcome. Among 297 ischemic stroke patients with in-hospital PAF detection, PAF was self-terminated in 87 (29.3%) patients, while 143 (48.1%) patients received antiarrhythmic medication in order to achieve PAF conversion to SR. During a median (Interquartile range, IQR) period of 28 (4-68) months, among patients with self-terminated PAF there were 13.5 deaths, 3.6 stroke recurrences, and 5.3 MACE per 100 patient-year while in patients who underwent medical PAF conversion there were 11.7 deaths, 4.6 stroke recurrences, and 5.8 MACE per 100 patient-year. Patients with sustained AF experienced 23.8 deaths, 8.7 stroke recurrences, and 13.9 MACE per 100 patient-years. In multivariable analysis, compared to patients with sustained AF, PAF self-termination was associated with significantly lower 10 years-risk of death (adjusted hazards ratio (adjHR): HR: 0.63, 95% Confidence interval: 0.40-0.96), stroke recurrence (adjHR: HR: 0.41, 95% CI: 0.19-0.91), and MACE (adjHR: 0.43, 95% CI: 0.23-0.81), while PAF medical conversion to SR was associated with lower 10 years-risk of death (adjHR: 0.65, 95% CI: 0.44-0.97) and MACE (adjHR: 0.56, 95% CI: 0.33-0.95). This study showed that in-hospital PAF self-termination was associated with lower risk of 10-year mortality, stroke recurrence, and MACE, potentially attributed to the lower burden of AF, whereas in-hospital PAF conversion to SR was associated with lower risk of 10-year mortality and MACE. Early restoration of sinus rhythm is associated with improved survival and MACE in patients with acute ischemic stroke and PAF.

Novel Survival Features Generated by Clinical Text Information and Radiomics Features May Improve the Prediction of Ischemic Stroke Outcome.

Background: Accurate outcome prediction is of great clinical significance in customizing personalized treatment plans, reducing the situation of poor recovery, and objectively and accurately evaluating the treatment effect. This study intended to evaluate the performance of clinical text information (CTI), radiomics features, and survival features (SurvF) for predicting functional outcomes of patients with ischemic stroke. Methods: SurvF was constructed based on CTI and mRS radiomics features (mRSRF) to improve the prediction of the functional outcome in 3 months (90-day mRS). Ten machine learning models predicted functional outcomes in three situations (2-category, 4-category, and 7-category) using seven feature groups constructed by CTI, mRSRF, and SurvF. Results: For 2-category, ALL (CTI + mRSRF+ SurvF) performed best, with an mAUC of 0.884, mAcc of 0.864, mPre of 0.877, mF1 of 0.86, and mRecall of 0.864. For 4-category, ALL also achieved the best mAuc of 0.787, while CTI + SurvF achieved the best score with mAcc = 0.611, mPre = 0.622, mF1 = 0.595, and mRe-call = 0.611. For 7-category, CTI + SurvF performed best, with an mAuc of 0.788, mPre of 0.519, mAcc of 0.529, mF1 of 0.495, and mRecall of 0.47. Conclusions: The above results indicate that mRSRF + CTI can accurately predict functional outcomes in ischemic stroke patients with proper machine learning models. Moreover, combining SurvF will improve the prediction effect compared with the original features. However, limited by the small sample size, further validation on larger and more varied datasets is necessary.

The Relationship between Drug-Related Problems and Clinical Outcomes in Ischemic Stroke Patients in the Hospitalized Neurology Ward of RSUP Dr. M. Djamil Padang

The Relationship between Drug-Related Problems and Clinical Outcomes in Ischemic Stroke Patients in the Hospitalized Neurology Ward of RSUP Dr. M. Djamil Padang

Characteristic of Red Blood Cell Profile as a Predictor of 30-Day Clinical Outcome in Ischemic Stroke Patients

Ischemic stroke is the most common type of stroke in Indonesia. Measuring inflammatory biomarkers (IL-6) is a way to predict clinical outcomes in ischemic stroke patients. However, the laboratory test is very expensive, so it requires another test that can represent the inflammation, for instance, by measuring RDW and MCV value when hospitalized. Hence, this study aims to measure RDW and MCV value of ischemic stroke patients at admission with a 30-day clinical outcome (disability). This study is a retrospective cohort that used secondary data from medical records of ischemic stroke patients in Bethesda Hospital Yogyakarta and was conducted on 105 subjects. They are divided into two groups by their mRS score in 30-day after onset, (1) the independent group (mRS score of 0- 2), (2) the dependent group (mRS score of 3-6). After that, these two groups are analyzed by an independent t-test. High RDW and low MCV value at admission increased 30-day disability risk. There was a statistically significant RDW value and 30-day clinical outcome (p=0,008), but there was no statistically significant MCV value and 30-day clinical outcome (p=0,277). 30-day clinical outcome in ischemic stroke patients can be predicted by their characteristic of red blood cell profile at admission.