Poor Short-term Functional Outcomes Research Articles

Association between Vitamin D and Short-Term Functional Outcomes in Acute Ischemic Stroke

Vitamin D (Vit D) affects musculoskeletal performance and central nervous system neuroprotection. We aimed to investigate the association between serum Vit D levels and short-term functional outcomes in patients with acute ischemic stroke. This study involved patients with acute ischemic stroke confirmed on brain MRI. The National Institutes of Health Stroke Scale (NIHSS) was used to assess initial stroke severity upon admission. We evaluated the functional outcomes using the Berg Balance Scale (BBS), Manual Function Test (MFT), Korean Mini-Mental State Examination (K-MMSE), Korean version of the modified Barthel Index (K-MBI) within three weeks from the onset of stroke, and modified Rankin Scale (mRS) score at discharge. Overall, 192 patients were finally included and divided into three groups: Vit D sufficient (n = 28), insufficient (n = 49), and deficient (n = 115). Multivariate analysis showed that the Vit D deficient group presented with a higher risk of initially severe stroke (p = 0.025) and poor functional outcomes on the BBS (p = 0.048), MFT (p = 0.017), K-MMSE (p = 0.001), K-MBI (p = 0.003), and mRS (p = 0.032) compared to the Vit D sufficient group. Vit D deficiency may be associated with severe initial stroke and poor short-term post-stroke functional outcomes.

Multimodal ultrasound-based carotid plaque risk biomarkers predict poor functional outcome in patients with ischemic stroke or TIA

BackgroundCarotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.MethodsThis study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.ResultsSMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59, P = 0.041) and 0.51 (95% CI 0.31–0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95).ConclusionIntraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

Lower serum cystatin C level predicts poor functional outcome in patients with hypertensive intracerebral hemorrhage independent of renal function

We explored the association between the serum level of cystatin C (CysC) at admission and short-term functional outcome in patients with hypertensive intracerebral hemorrhage (HICH) without chronic kidney disease (CKD). A total of 555 patients with HICH were consecutively recruited after admission and were followed-up for 3 months after admission. The primary outcome was poor functional outcome (modified Rankin Scale [mRS] score ≥ 3). The median serum CysC level in our cohort was 1.03 mg/L (interquartile range, .89-1.20). Patients were categorized into four groups according to the serum CysC quartiles. Multivariate logistic regression analysis revealed a negative association between serum CysC and poor functional outcome at 3-month follow-up (quartile [Q]1 vs. Q4: adjusted odds ratio [OR] = .260, 95% confidence interval [CI] = .098, .691, p < .001). The negative association between serum CysC and poor functional outcome at 3 months was more pronounced in subgroups with smaller hematoma volume (≤ 30 mL), and absence of secondary intraventricular hemorrhage (IVH). Addition of serum CysC to a model containing conventional risk factors improved the model performance with net reclassification index (NRI) of .426% (p < .001) and integrated discrimination improvement (IDI) of .043% (p < .001) for poor functional outcome. Serum CysC was found to be a negative predictor of poor short-term functional outcome in HICH patients independent of renal function.

The Role of Intraventricular Hemorrhage in Traumatic Brain Injury: A Novel Scoring System.

Traumatic intraventricular hemorrhage (tIVH) is associated with increased mortality and disability in traumatic brain injury (TBI). However, the significance of tIVH itself remains unclear. Our goal is to assess whether tIVH affects in-hospital mortality and short-term functional outcomes. We retrospectively reviewed the records of 5048 patients with TBI during a 5-year period, and 149 tIVH patients were analyzed. Confounding was reduced using the inverse probability of treatment weighting (IPTW) based on propensity score. The association between IVH and outcomes was investigated using logistic regression in the IPTW-adjusted cohort. In our study, after adjustment for analysis, the in-hospital mortality rate (11.4% vs. 9.2%) and the poor functional outcome rate (37.9% vs.10.6%) were significantly higher in the tIVH group than in the non-tIVH group. Factors independently associated with outcomes were age ≥ 65 years, Glasgow Coma Scale (GCS) severity score, and the Graeb score. The Traumatic Graeb Score, a novel scoring system for predicting functional outcomes associated with tIVH, comprised the sum of the following components: GCS scores of 3 to 4 (=2 points), 5 to 12 (=1 point), 13 to 15 (=0 points); age ≥ 65 years, yes (=1 point), no (=0 points); Graeb score (0–12 points). A Traumatic Graeb Score ≥ 4 is an optimal cutoff value for poor short-term functional outcomes.

ASPECT scores of patients with focal intracerebral hemorrhage were correlated with their short- and medium-term functional outcomes

ABSTRACT Purpose The Alberta Stroke Program Early CT Score (ASPECTS) is widely used to guide thrombolytic therapy and predict the functional outcome of patients with acute ischemic stroke (AIS). Whether ASPECTS can predict the functional outcome of patients with intracerebral hemorrhage (ASPECTS-H) remains unclear. Methods Patients with primary intracerebral hemorrhage (ICH) were collected and retrospectively analyzed. ASPECTS-H was assessed at admission. Patients were followed up at 30 days and 90 days after the onset of ICH. Occurrence of death within 90 days after ICH was the primary endpoint. Modified Rankin Scale (mRS) ≥ 3 was considered a poor functional outcome. Results A total of 149 patients met eligibility criteria; 61 (40.9%) had poor functional outcome at 30 days, and 37 (24.8%) had poor functional outcome at 90 days. Using binary logistic regression modeling, we found that a low ASPECTS-H was associated with a poor functional outcome. The risk ratio of a low ASPECTS-H was 2.31 at 30 days (P = 0.000; 95% CI, 1.560–3.421) and 2.711 at 90 days (P = 0.000; 95% CI, 1.677–4.381). The optimal cutoff value of ASPECTS-H to discriminate good and poor 30-day and 90-day outcomes was 7.5 (Sensitivity30-day = 0.636, 1-Specificity30 – day = 0.311; Sensitivity90-day = 0.580, 1-Specificity90-day = 0.270). Conclusions A low ASPECTS-H was an indicator of poor short-term and long-term functional outcomes of ICH.

Does Deviation of Femoral and Tibial Tunnel Placement Leads to Poor Short Term Functional Outcomes in Arthroscopic Anterior Cruciate Ligament Reconstruction?

Does Deviation of Femoral and Tibial Tunnel Placement Leads to Poor Short Term Functional Outcomes in Arthroscopic Anterior Cruciate Ligament Reconstruction?

Personalized Consideration of Admission-Glucose Gap between Estimated Average and Initial Glucose Levels on Short-Term Stroke Outcome.

Background: Poststroke hyperglycemia is associated with poor outcomes. Most prior studies used initial glucose as an indicator of poststroke hyperglycemia without considering glycemic control status at the time of stroke occurrence. We aimed to investigate the effect of an admission-glucose gap on short-term functional outcomes in acute ischemic stroke (AIS). Methods: We enrolled patients with AIS or transient ischemic attack who had been admitted within 7 days of symptom onset to three stroke centers from May 2016 to December 2019. The admission-glucose gap between estimated average glucose levels (eAG) and initial glucose level (eAG–initial glucose) was categorized into four groups. The short-term functional outcome was evaluated using the modified Rankin Scale (mRS) score at 3 months after stroke onset and was dichotomized. Results: Among 1332 included subjects, 548 (41.1%) had poor short-term functional outcomes. After adjusting for multiple variables, a severe negative glucose gap (eAG–initial glucose ≤ −50 mg/dL) was significantly associated with poor short-term functional outcome (OR, 1.573; 95% CI, 1.101–2.248). After dichotomizing glycemic control status, its significance was only maintained in the good glycemic control group (HbA1c < 6.5%) (OR, 1.914; 95% CI, 1.155–3.169). Conclusions: An elevated admission-glucose gap, in which the initial glucose level was much higher than the estimated glucose level was based on HbA1c, was associated with poor stroke prognosis. In addition to admission-glucose levels, glycemic control status at the time of stroke onset should be considered when predicting short-term stroke outcomes.

Hypodensities within Hematoma is Time-Dependent and Predicts Outcome after Spontaneous Intracerebral Hemorrhage.

Non-contrast CT (NCCT) brain imaging biomarkers of hematoma expansion in intracerebral hemorrhage (ICH) has gained relevance in recent times. Though intra-hematoma hypodensities (IHH) can predict hematoma expansion and outcome, it is postulated to be time-dependent. To assess the differential prevalence of IHH in spontaneous ICH over time and assess its predictive valve in early hematoma expansion and functional outcome at 3 months. Patients with ICH within 48 h of stroke onset were included. Baseline clinical and demographic data were collected. Baseline NCCT brain was analyzed for hematoma volume, characterization of IHH, with 24-hours follow-up NCCT hematoma volume calculated for identification of hematoma expansion. Poor functional outcome was defined as mRS ≥3. Around 92 subjects were included in the study. IHH was found in 40%. Prevalence of IHH was higher in those with baseline NCCT performed within 3 h of symptom onset compared to those beyond 3 h (71% vs 29%, P = 0.002). The hematoma expansion was more common in patients with IHH compared to those without (54% vs 29%; P = 0.02). Multivariate analysis revealed the presence of IHH (rather than pattern or number) to be strongly associated with poor functional outcome at 3 months (OR 3.86; 95% CI: 1.11-13.42, P = 0.03). There is a decreasing prevalence of IHH as the time from symptom onset to NCCT increases. Nevertheless, its presence is significantly associated with hematoma expansion and predicted poor short-term functional outcomes in spontaneous ICH.

Lower uric acid level may be associated with hemorrhagic transformation but not functional outcomes in patients with anterior circulation acute ischemic stroke undergoing endovascular thrombectomy

To determine the correlation of uric acid (UA) with hemorrhagic transformation (HT) and poor short-term functional outcomes in anterior circulation acute ischemic stroke (AIS) patients after endovascular thrombectomy (EVT). A retrospective analysis was conducted for anterior circulation AIS patients who underwent EVT at our hospital from 2015 to 2019. HT within 72h was documented according to the European Cooperative Acute Stroke Study II Classification. Baseline demographic, clinical and laboratory data were compared between the HT and non-HT groups, and between patients with favorable and unfavorable outcomes on 90-day. A total of 247 AIS patients were enrolled, of which 92 (37.2%) and 85 (34.4%) experienced HT and had favorable functional outcomes at 3months respectively. Patients with HT had significantly lower UA levels compared to those without HT (322.60 ± 94.49 vs. 350.25 ± 99.28μmol /L, P = 0.032). In contrast, UA levels were similar in patients with good or poor outcomes (345.67 ± 103.55 vs. 336.95 ± 95.5μmol /L, P = 0.509). Compared to the patients with UA levels in the first quartile, those in the fourth quartile were at a higher risk of HT in univariate logistic regression analysis (OR = 0.383, 95% CI = 0.173-0.848, P = 0.018). The association remained significant after multivariable adjustment for potential confounders. A lower UA level is an independent risk factor of HT post-EVT in anterior circulation AIS patients, but is not associated with the short-term functional outcomes.

Hypodensities within hematoma is time dependent and predicts outcome after spontaneous intracerebral hemorrhage

NCCT brain imaging biomarkers of hematoma expansion in ICH has gained relevance in recent times. Though the intra-hematoma hypodensities can predict hematoma expansion and outcome, it is postulated to be time dependent. To assess the differential prevalence of intra-hematoma hypodensity in spontaneous ICH over time from performance of NCCT from symptom onset and assess its predictive valve in early hematoma expansion and functional outcome at 3 months. Patients with ICH within 48 hours of stroke onset were included. Baseline clinical and demographic data was collected. Baseline NCCT Brain was analysed for hematoma volume, characterisation of intra-hematoma hypodensity, with 24 hour follow up NCCT hematoma volume calculated for identification of hematoma expansion. Poor functional outcome was defined as mRS> 3. 92 subjects were included in the study. Intra-hematoma hypodensity was found in 40%. Prevalence of intra-hematoma hypodensity was higher in those with baseline NCCT performed within 3 hours of symptom onset compared to those beyond 3 hours. 54% of patients with intra-hematoma hypodensity had hematoma expansion compared to 29% without (P = 0.02). Multivariate analysis revealed presence of intra-hematoma hypodensity (rather than pattern or number) to be strongly associated with poor functional outcome at 3 months (OR 3.86; 95% CI: 1.11 -13.42, P = 0.03). There is a decreasing prevalence of intra-hematoma hypodensity as time from symptom onset to NCCT increases. Nevertheless the presence of intra-hematoma hypodensity is significantly associated with hematoma expansion and predicted poor short term functional outcomes in spontaneous ICH.

Interarm Blood Pressure Difference is Associated with Early Neurological Deterioration, Poor Short-Term Functional Outcome, and Mortality in Noncardioembolic Stroke Patients.

Background and PurposeInterarm differences in the systolic and diastolic blood pressures (IASBD and IADBD, respectively) are found in various populations, including stroke patients, but their significance for stroke outcomes has rarely been reported. We aimed to determine the associations of IASBD and IADBD with early neurological deterioration (END), functional outcome, and mortality.MethodsThis study included 1,008 consecutive noncardioembolic cerebral infarction patients who were admitted within 24 hours of onset and had automatic measurements of blood pressures in the bilateral arms. END was assessed within 72 hours of stroke onset according to predefined criteria. A poor functional outcome was defined as a score on the modified Rankin Scale ≥3 at 3 months after the index stroke. All-cause mortality was also investigated during a median follow-up of 24 months. The absolute difference of blood pressure measurements in both arms were used to define IASBD and IADBD.ResultsEND occurred in 15.3% (155/1,008) of the patients. A multivariate analysis including sex, age, and variables for which the p value was <0.1 in a univariate analysis revealed that IASBD ≥10 mm Hg was significantly associated with END [odds ratio (OR)=1.75, 95% CI=1.02–3.01]. IADBD ≥10 mm Hg was also related to END (OR=3.11, 95% CI=1.61–5.99). Moreover, having both IASBD ≥10 mm Hg and IADBD ≥10 mm Hg was related to a poor functional outcome (OR=2.67, 95% CI=1.36–5.35) and mortality (hazard ratio=7.67, 95% CI=3.76–12.83) even after adjusting for END.ConclusionsThis study suggests that an interarm blood pressure difference of ≥10 mm Hg could be a useful indicator for the risks of END, poor functional outcome, and mortality.

High Dietary Glycemic Load is Associated with Poor Functional Outcome in Patients with Acute Cerebral Infarction.

Background and PurposeElevated postprandial blood glucose is a critical risk factor for stroke. The dietary glycemic load (GL) and glycemic index (GI) are frequently used as markers of the postprandial blood glucose response to estimate the overall glycemic effect of diets. We hypothesized that high dietary GL, GI, or total carbohydrate intake is associated with a poor functional outcome in patients with acute ischemic stroke.MethodsWe prospectively included 263 first-ever ischemic stroke patients who completed a semiquantitative food-frequency questionnaire. The dietary GL, GI, and total carbohydrate intake were investigated by examining the average frequency of intake during the previous year based on reference amounts for various food items. Poor functional outcome was defined as a score on the modified Rankin Scale (mRS) of ≥3 at 3 months after stroke.ResultsThe patients were aged 65.4±11.7 years (mean±standard deviation), and 58.2% of them were male. A multivariate analysis adjusted for age, sex, marital status, prestroke mRS score, diabetes mellitus, hyperlipidemia, body mass index, triglycerides, low-density lipoprotein, hemoglobin A1c, stroke classification, and National Institutes of Health Stroke Scale score, early neurological deterioration, and high-grade white-matter hyperintensities revealed that the dietary GL and total carbohydrate intake were associated with a poor functional outcome, with odds ratios for the top quartile relative to the bottom quartile of 28.93 (95% confidence interval=2.82–296.04) and 36.84 (95% confidence interval=2.99–453.42), respectively (p for trend=0.002 and 0.002, respectively). In contrast, high dietary GI was not associated with a poor functional outcome (p for trend=0.481).ConclusionsIncreased dietary GL and carbohydrate intake were associated with a poor short-term functional outcome after an acute ischemic stroke.

Diagnostic and prognostic role of resistin and copeptin in acute ischemic stroke

Objectives: Our aim was to evaluate (i) whether there is a difference in the concentration of resistin and copeptin between acute ischemic stroke patients and stroke-free controls; and (ii) if there is any prognostic value of resistin and copeptin in predicting stroke infarct volume, stroke severity, and outcome.Methods: Our case-control study has recruited 112 acute ischemic stroke patients admitted within 24 h after the stroke onset. We have also included 63 age and gender matched stroke-free controls. Resistin and copeptin levels were measured by a commercial ELISA kits. Stroke severity was assessed according to the modified National Institute of Health Stroke Scale (mNIHSS) and the degree of disability was assessed using Barthel index (BI). Stroke infarct volume was determined by the volumetric estimation.Results: Resistin concentrations were significantly higher in patients (3.2 mg/L; IQR: 1.9–6.4) than in stroke-free controls (2.5 mg/L; IQR: 1.4–5.2; p = 0.024) whereas the concentration of copeptin did not differ between patients and controls. Copeptin concentrations were significantly higher in patients with poor functional outcome (Barthel index <60) (p = 0.021). There was a significant negative correlation between copeptin and BI score (ρ = −0.309, p = 0.020).Discussion: Resistin, but not copeptin levels are higher in acute ischemic stroke patients early after the stroke onset, than in age and gender matched stroke-free controls. Moreover, higher copeptin concentrations are predictive of poor short term functional outcome after ischemic stroke. If confirmed in larger prospective studies, resistin and copeptin could improve clinical diagnosis of stroke and effective management of patient recovery.

Intra-Articular Knee Injections Before Total Knee Arthroplasty: Outcomes and Complication Rates

BackgroundThe relationship between intra-articular injections and complication rates after total knee arthroplasty (TKA) remains controversial. This study's purpose was to determine the relationship between the number and timing of intra-articular injections with complications and outcomes after TKA from a single surgeon's database. MethodsWe retrospectively reviewed a series of 442 patients who underwent primary TKA from 2008-2015. Patient demographics, comorbidities, number and timing of ipsilateral intra-articular injections, and preoperative and postoperative functional outcome scores were recorded. Complications and infection rates at a minimum of 12-month follow-up were compared between patients who received 3 or less preoperative injections and those who received 4 or greater before TKA. Multivariate logistic regression analysis was performed to identify independent risk factors for complications and poor short-term outcomes after TKA. ResultsOf the 442 patients enrolled in the study, 390 patients (90%) received an ipsilateral injection before TKA. Patients receiving 4 or more injections (175 patients, 40%) did not have a difference in complication rate (14% vs 17%, P = .346), poor functional outcomes (6% vs 9%, P = .299), or infection rate (2% vs 4%, P = .286). When controlling for confounding variables, intra-articular corticosteroid, viscosupplementation, and any injection within 90 days were not associated with an increase in complications, infection, or poor functional outcomes after TKA (all P > .05). ConclusionOur data suggest that there is no relationship between timing and number of intra-articular injections with complication rate, infection, or poor short-term functional outcomes. Further larger studies are needed to confirm these findings.

Abstract TP332: Intracerebral Hemorrhage Volume to Edema Volume Ratio Predicts Poor Functional Outcome in Young Patients with Non-Lobar Primary Intracerebral Hemorrhage

Background and Purpose: Cerebral edema is known to contribute to clinical decline in patients with spontaneous ICH. We sought to evaluate the significance of cerebral edema on outcome in young patients with primary ICH. Methods: We performed a retrospective review of patients presenting to our CSC center from 2014-2015 with primary ICH, excluding patients with lobar ICH and age 55 and above. Patients were grouped according to functional outcome at discharge (mRS 0-3 vs. 4-6). Imaging characteristics of those with poor short-term functional outcome (mRS 4-6) were compared to those with mRS 0-3. Receiver Operating Characteristics curves were used to evaluate the discriminatory ability of imaging characteristics with regards to poor functional outcome. Results: A total of 38 patients met inclusion criteria (mean age 47, 42% black, 55% male). On presentation, patients with poor functional outcome had larger mean ICH volume (26 vs 9cc; p=0.020), higher ICH volume to edema volume ratios (2.0 vs. 0.7, p=0.010), more evidence of midline shift (38% vs. 6%, p=0.026), and IVH (52% vs. 17%, p=0.043). Groups did not differ in terms of edema volume, amount of midline shift, evidence of hydrocephalus, or herniation. ICH volume to edema volume ratio was a better discriminator of poor outcome (AUC=0.813, p=0.006) than ICH volume (AUC=0.802, p=0.008, Figure 1a). Further, ICH volume to edema volume ratio was a better discriminator of poor outcome (AUC=0.801, p=0.009) than ICH score (AUC=0.724, p=0.051, Figure 1b). Discussion: Among young patients with non-lobar primary ICH we observed that the ICH to edema ratio was a better predictor of poor functional status at discharge than ICH volume or ICH score.

Low Serum Levels of Brain-Derived Neurotrophic Factor Were Associated with Poor Short-Term Functional Outcome and Mortality in Acute Ischemic Stroke.

Circulating brain-derived neurotrophic factor (BDNF) has been highlighted as being a key regulator of rehabilitation-induced recovery after stroke. The aim of this study was to evaluate the association between serum levels of BDNF and functional outcome and mortality events in a 3-month follow-up study in a cohort of patients with an acute ischemic stroke (AIS). From January 2015 to December 2015, consecutive first-ever AIS patients admitted to the Department of Emergency of our hospital were identified. Serum BDNF levels were measured at admission. Functional outcome was evaluated at 3months using the modified Rankin scale (m-Rankin). We used logistic regression models to assess the relationship between BDNF levels and functional outcome or mortality. In this study, 204 patients were included. Patients with poor outcomes and non-survivors had significantly lower BDNF levels on admission (P<0.0001 all). Multivariate logistic regression analysis adjusted for common risk factors showed that BDNF levels in the lowest interquartile (≤1st 9.2ng/ml) was an independent predictor of functional outcome (odds ratios [OR]=3.75; 95% confidence interval [CI], 2.43-8.12) and mortality (OR=4.04; 95% CI, 2.07-9.14). The area under the receiver operating characteristic curve of BDNF was 0.77 (95% CI, 0.70-0.84) for functional outcome and 0.79 (95% CI, 0.71-0.86) for mortality. The findings indicated that low serum levels of BDNF at admission were significantly associated with poor short-term functional outcome and mortality, suggesting that BDNF may serve as a biomarker of poor function outcome after stroke.

Abstract TP78: When Non-revascularized Transfer Patients Come A-Knocking at a Stroke Center

Background: Guidelines recommend acute ischemic stroke (AIS) patients be transported rapidly to the closest certified stroke center (SC). The impact of SC care on transfer patients who do not receive acute revascularization therapy is not well understood. We sought to compare patient characteristics, adverse events (AEs), and short term functional outcomes in patients directly presenting to and transferred into a comprehensive stroke center (CSC). Methods: We conducted a retrospective review of consecutive AIS patients transferred to our CSC from March 2014-April 2015. We excluded patients who received tPA or endovascular therapy. Demographic and clinical data were collected. We compared AEs (hemorrhagic transformation [HT], DVT, PE, urinary tract infection [UTI], pneumonia [PNA], bacteremia) and poor short term functional outcome, as defined by modified Rankin scale (mRS) score 3-6, among patients directly admitted to our CSC and patients transferred to our CSC. Results: Of 589 patients who did not receive revascularization therapy, 24.4% were transfers. Transfers were disproportionately white (76.4 vs 57.8%, p&lt;0.001), had higher median NIHSS (5 vs 4, p=0.028), were less often privately insured (40.1 vs 46.4%), and had less desirable ASPECTS scores on initial head CT (8-10; 22.9 vs 44.0, p&lt;0.001). Transfers had higher odds of having AEs (crude OR 2.134, 95% 1.353-3.365). This association remained after adjusting for age, stroke severity, and admission glucose (OR 2.103, 95% CI 1.276-3.466.004). Transfers more frequently developed HT on repeat imaging (17.5 vs 7.0%, p&lt;0.001), clinical seizure during inpatient stay (4.9 vs 1.6%, p=0.024), and PNA (7.6 vs 3.8%, p=0.061). However, transfer status was not associated with poor short-term functional outcome (crude OR 1.453, 95% CI 0.986-2.141; adjusted OR 1.200, 95% CI 0.703-2.046). Conclusion: Despite having more severe strokes and higher frequency of adverse events, patients transferred into our CSC for a higher level of care did not have worse short term functional outcomes. This highlights the importance of specialized inpatient care provided in NICUs and stroke units by experienced multidisciplinary teams.

Abstract W P324: The Influence Of Low Density Lipoprotein On Intracerebral Hemorrhage Volume

Background and Purpose: High dose statin use either before (pre-morbid) or after an acute ischemic stroke has been associated with an increased risk of ICH. Prior studies suggest that premorbid statin use has a beneficial effect whereas lower LDL levels have a detrimental effect on functional outcomes in primary ICH. We sought to evaluate if pre-morbid statin use and serum LDL levels impacted ICH volume and outcomes in ICH. Methods: Patients with ICH admitted to our center from 2008-2013 were included. Demographic and clinical data were collected. Primary outcomes of interest were a large volume ICH (defined as volume greater than or equal to 30cc), and poor functional outcome at discharge defined as mRS of 4-6. Crude and adjusted logistic regression models were used to assess the relationship between LDL, statins and outcomes. Results: Of 403 patients, 18.6% (n=75) were taking a statin prior to ICH onset. The odds of a large volume ICH decreased by 12% for each 10 point decrease in serum LDL (OR 0.888, 95%CI 0.81-0.97, p=0.0115). In statin-naïve patients, the odds of a large volume ICH decreased by 16% for each 10 point decrease in LDL value (OR 0.84, 95%CI 0.76-0.94, p=0.0019). Patients who were on a statin prior to their ICH had no association between large volume ICH and LDL (OR 1.07, 95%CI 0.88-1.32, p=0.49). Statin use prior to ICH had no significant association with volume and location of ICH, admission NIHSS and a discharge mRS of 4-6 compared to statin-naïve patients (see Table). Conclusions: Statin use prior to ICH onset had no significant association with ICH volume or location, admission NIHSS, or poor short-term functional outcomes in comparison to statin-naïve patients. Lower serum LDL values were significantly associated with a decreased odds of large volume ICH, with the effect being driven by statin-naïve patients.

Abstract T P325: The Role Of A History Of Coronary Artery Disease, The Need For Transfusion And Outcomes In Patients With Intracerebral Hemorrhage

Background and Purpose: In patients with primary ICH, RBC transfusion (RBCT) may be detrimental and platelet transfusion effects are controversial. Different transfusion thresholds have been suggested in patients with coronary artery disease (CAD). We examined the relationship between transfusion and outcomes in ICH patients with and without CAD. Methods: A retrospective review of consecutive patients with primary ICH admitted to two academic stroke centers from 2008-2013 was conducted. Patients age&lt;18 years, in-hospital strokes and outside hospital transfers were excluded. Primary outcome was discharge mRS of 5-6. Logistic regression was used to assess the association with outcomes. Results: Out of 456 patients identified, 50 (11.2%) had CAD on admission. CAD patients were older (68 vs. 61; p=0.001). There was no significant difference in frequency of RBCT between patients who had CAD compared to those without (6% vs. 9%; p=0.53). The frequency of platelet transfusion was higher in patients with CAD (26% vs. 7%; p&lt;0.0001). This association was significant after adjusting for ICH score (OR 3.83; 95% CI 1.13-12.9; p=0.031). Patients with RBCT were at greater odds of having a mRS of 5-6 (OR 5.60, 95% CI 2.42-12.9, p&lt;0.001) compared to those without. After adjusting for admission hematocrit, ICH score, and CAD the association between RBCT and mRS remained significant (OR 16.3, 95% CI 2.11-125.9, p=0.007). Patients with platelet transfusion were at greater odds of having a mRS of 5-6 on univariable analysis (OR 2.85; 95% CI 1.42-5.71; p=0.003). This association is no longer significant after adjusting for ICH score, CAD and admission hematocrit (OR 2.88; 95%CI 0.67-12.3; p=0.15). In patients with ICH score 0-2, platelet transfusion is significantly associated with a mRS of 5-6 after adjusting for CAD (OR 2.48; 95%CI 1.16-5.35; p=0.02). Conclusions: A history of CAD is not associated with increased frequency of RBCT in ICH compared to patients without CAD, but it is significantly associated with a higher frequency of platelet transfusion. RBCT was significantly associated with poor short-term functional outcomes regardless of CAD history. In patients with low ICH scores, platelet transfusion was significantly associated with poor functional outcomes.

Abstract T P326: The Utility of Charlson Comorbidity Index in Predicting Short-term Outcomes in Patients with Primary Intracerebral Hemorrhage

Background and Purpose: The Charlson Comorbidity Index (CCI) is used to evaluate a patient's risk of in-hospital, 1-year and 10-year mortality, and has been validated in acute ischemic stroke. Previous studies have shown that CCI influences functional outcomes. We sought to evaluate the association between CCI and outcomes in patients with primary ICH presenting to our center. Methods: Patients with primary ICH admitted to our center from 2008-2013 were included. Demographic and clinical data were collected. Primary outcomes were a discharge mRS (dmRS) of 4-6, death and poor discharge disposition (any disposition other than home or inpatient rehabilitation). Crude and adjusted logistic regressions were used to evaluate the association between CCI and outcomes. Results: A total of 383 patients were identified. There were 37 (9.7%) patients with a CCI of 0 or 1, 242 (63.2%) patients with a CCI of 2-5, and 104 (27.2%) with a CCI of 6 or greater (Figure). While the continuous CCI was not significantly associated with a dmRS of 4-6 (OR 1.08, 95% CI 0.99-1.19, p=0.09), it was associated with disposition. The odds of poor disposition increased 18% with each increase in CCI (OR 1.18, 95% CI 1.08-1.28, p=0.0003). The odds of death increased 12% with each point increase in CCI (OR 1.12, 95% CI 1.02-1.23, p=0.021). After adjusting for baseline ICH score, CCI remained significantly associated with poor disposition (OR 1.13, 95% CI 1.00-1.27, p=0.042), however the association between CCI and death was not statistically significant (OR 1.05, 95% CI 0.91-1.21, p=0.52). Conclusions: In contrast to previous studies, the CCI was not associated with poor short-term functional outcome or in-hospital mortality. However, it was significantly associated with poor discharge disposition. This suggests that cumulative comorbidities only predict disposition in ICH, because the ICH score strongly impacts poor functional outcome and in-hospital mortality.