Risk In Stroke Patients Research Articles

Efficacy of Acupuncture in Reducing Accidental Injury Risk in Stroke Patients: A National-Scale Cohort Study

BackgroundFalls among stroke patients pose a significant health concern, leading to injuries, reduced mobility, and functional limitations. Recent research has suggested the potential benefits of acupuncture in enhancing balance and motor function in stroke patients. However, large-scale, long-term studies on acupuncture's role in reducing the risk of accidental injuries are scarce. This study aimed to evaluate acupuncture's effectiveness in decreasing the risk of accidental injuries in stroke patients. Materials and methodsThis study employed a large-scale cohort design, utilizing data from the 2000 Longitudinal Generation Tracking Database (LGTD 2000) in Taiwan, covering two million individuals. The cohort comprised stroke patients hospitalized between 2001 and 2012, with follow-up periods of at least six years to estimate accidental injury incidence and risk. Acupuncture treatments during both inpatient and outpatient phases after stroke diagnosis were included. Accidental injury data, including vehicular accidents and falls, were extracted from specialized hospitalization records. Hazard ratios were calculated, adjusting for variables like comorbidities, hypnotic medication usage, and demographic factors. ResultA total of 108,196 newly diagnosed stroke patients were included in the final cohort, with 42,083 receiving acupuncture treatment and 66,113 not receiving acupuncture. The acupuncture group exhibited a significantly lower incidence rate of accidental injuries (10.2 per 1,000 person-years) compared to the non-acupuncture group (15.8 per 1,000 person-years). After adjusting for various covariates, the acupuncture group had a reduced risk of accidental injuries with an adjusted hazard ratio (aHR) of 0.74 (95% CI: 0.51-0.92). Subgroup analyses revealed consistent protective effects of acupuncture across different patient profiles and treatment characteristics, including age, sex, comorbidities, and hypnotic medication usage. ConclusionThis study provides evidence supporting the potential of acupuncture as an adjunctive therapy to reduce the risk of accidental injuries among stroke patients. Regardless of stroke subtype, age, or comorbidity burden, acupuncture was associated with a lower risk of accidental injuries.

Development, validation, and visualization of a novel nomogram to predict depression risk in patients with stroke

BackgroundThis study aimed to develop and validate a predictive nomogram model applicable to depression risk in stroke patients. MethodsParticipants from the NHANES database (n = 1097) were enrolled from 2005 to 2018; 767 subjects were randomly assigned to the training cohort, and the remaining subjects composed the testing cohort. A nomogram containing the optimal predictors identified by the least absolute shrinkage and selection operator (LASSO) and logistic regression methods was constructed to estimate the probability of depression in stroke patients. To evaluate the performance of the nomogram, the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA) and internal validation were utilized. ResultsAge, family income, trouble sleeping, coronary heart disease, and total cholesterol were included in the nomogram after filtering predictive variables. The AUCs of the nomogram for the training and testing cohorts were 0.782 (95 % CI = 0.742–0.821) and 0.755 (95 % CI = 0.675–0.834), respectively. The calibration plot revealed that the predicted probability was extremely close to the actual probability of depression occurrence in both the training and testing cohorts. DCA revealed that the nomogram model in the training and testing cohorts had a net benefit when the risk thresholds were 0–0.59 and 0–0.375, respectively. LimitationsThis study was limited by the absence of clinical external validation, which hindered the estimation of the nomogram's external applicability. In addition, this study has a cross-sectional design. ConclusionsA novel nomogram was successfully constructed and proven to be beneficial for identifying individuals at high risk for depression among stroke patients.

Detecting Aspiration Risk in Stroke Patients Using the Water Swallow Test (WST)

Abstract Background The 3-ounce water swallow test (WST) is a widely used method during clinical (bed side) examination for screening of individuals who are at risk for oropharyngeal dysphagia and aspiration. Stroke represents the most frequent cause of neurological dysphagia. Aim of the Work The aim of this study is to detect the risk of aspiration in stroke patients using the 3-ounce water swallow test. Patients and Method This study included 40 stroke patients recruited from the Phoniatrics unit of Ain Shams University Hospitals. They were subjected to history taking, clinical assessment and the 3-ounce WST. Results The results of the 3-ounce Water Swallow Test showed that 18 (45%) patients had a positive test. Conclusion Almost half of participants are at risk of aspiration.

A novel higher performance nomogram based on explainable machine learning for predicting mortality risk in stroke patients within 30 days based on clinical features on the first day ICU admission

BackgroundThis study aimed to develop a higher performance nomogram based on explainable machine learning methods, and to predict the risk of death of stroke patients within 30 days based on clinical characteristics on the first day of intensive care units (ICU) admission.MethodsData relating to stroke patients were extracted from the Medical Information Marketplace of the Intensive Care (MIMIC) IV and III database. The LightGBM machine learning approach together with Shapely additive explanations (termed as explain machine learning, EML) was used to select clinical features and define cut-off points for the selected features. These selected features and cut-off points were then evaluated using the Cox proportional hazards regression model and Kaplan-Meier survival curves. Finally, logistic regression-based nomograms for predicting 30-day mortality of stroke patients were constructed using original variables and variables dichotomized by cut-off points, respectively. The performance of two nomograms were evaluated in overall and individual dimension.ResultsA total of 2982 stroke patients and 64 clinical features were included, and the 30-day mortality rate was 23.6% in the MIMIC-IV datasets. 10 variables (“sofa (sepsis-related organ failure assessment)”, “minimum glucose”, “maximum sodium”, “age”, “mean spo2 (blood oxygen saturation)”, “maximum temperature”, “maximum heart rate”, “minimum bun (blood urea nitrogen)”, “minimum wbc (white blood cells)” and “charlson comorbidity index”) and respective cut-off points were defined from the EML. In the Cox proportional hazards regression model (Cox regression) and Kaplan-Meier survival curves, after grouping stroke patients according to the cut-off point of each variable, patients belonging to the high-risk subgroup were associated with higher 30-day mortality than those in the low-risk subgroup. The evaluation of nomograms found that the EML-based nomogram not only outperformed the conventional nomogram in NIR (net reclassification index), brier score and clinical net benefits in overall dimension, but also significant improved in individual dimension especially for low “maximum temperature” patients.ConclusionsThe 10 selected first-day ICU admission clinical features require greater attention for stroke patients. And the nomogram based on explainable machine learning will have greater clinical application.

Radiomics using non-contrast CT to predict hemorrhagic transformation risk in stroke patients undergoing revascularization.

This study explores whether textural features from initial non-contrast CT scans of infarcted brain tissue are linked to hemorrhagic transformation susceptibility. Stroke patients undergoing thrombolysis or thrombectomy from Jan 2012 to Jan 2022 were analyzed retrospectively. Hemorrhagic transformation was defined using follow-up magnetic resonance imaging. A total of 94 radiomic features were extracted from the infarcted tissue on initial NCCT scans. Patients were divided into training and test sets (7:3 ratio). Two models were developed with fivefold cross-validation: one incorporating first-order and textural radiomic features, and another using only textural radiomic features. A clinical model was also constructed using logistic regression with clinical variables, and test set validation was performed. Among 362 patients, 218 had hemorrhagic transformations. The LightGBM model with all radiomics features had the best performance, with an area under the receiver operating characteristic curve (AUROC) of 0.986 (95% confidence interval [CI], 0.971-1.000) on the test dataset. The ExtraTrees model performed best when textural features were employed, with an AUROC of 0.845 (95% CI, 0.774-0.916). Minimum, maximum, and ten percentile values were significant predictors of hemorrhagic transformation. The clinical model showed an AUROC of 0.544 (95% CI, 0.431-0.658). The performance of the radiomics models was significantly better than that of the clinical model on the test dataset (p < 0.001). The radiomics model can predict hemorrhagic transformation using NCCT in stroke patients. Low Hounsfield unit was a strong predictor of hemorrhagic transformation, while textural features alone can predict hemorrhagic transformation. Using radiomic features extracted from initial non-contrast computed tomography, early prediction of hemorrhagic transformation has the potential to improve patient care and outcomes by aiding in personalized treatment decision-making and early identification of at-risk patients. • Predicting hemorrhagic transformation following thrombolysis in stroke is challenging since multiple factors are associated. • Radiomics features of infarcted tissue on initial non-contrast CT are associated with hemorrhagic transformation. • Textural features on non-contrast CT are associated with the frailty of the infarcted tissue.

Non-linear relationship between red blood cell distribution width and gastrointestinal bleeding risk in stroke patients: results from multi-center ICUs.

The red blood cell distribution width (RDW) is closely linked to the prognosis of multiple diseases. However, the connection between RDW and gastrointestinal bleeding (GIB) in stroke patients is not well understood. This study aimed to clarify this association. This retrospective study involved 11,107 hospitalized patients from 208 hospitals in the United States, admitted between January 1, 2014, and December 31, 2015. We examined clinical data from 7,512 stroke patients in the intensive care unit (ICU). Multivariate logistic regression assessed the link between RDW and in-hospital GIB in stroke patients. Generalized additive model (GAM) and smooth curve fitting (penalty spline method) were utilized to explore the non-linear relationship between RDW and GIB in stroke patients. The inflection point was calculated using a recursive algorithm, and interactions between different variables were assessed through subgroup analyses. Among the 11,107 screened stroke patients, 7,512 were included in the primary analysis, with 190 identified as having GIB. The participants had a mean age of (61.67 ± 12.42) years, and a median RDW of 13.9%. Multiple logistic analysis revealed RDW as a risk factor for in-hospital GIB in stroke patients (OR = 1.28, 95% CI 1.21, 1.36, p < 0.05). The relationship between RDW and in-hospital GIB in stroke patients was found to be non-linear. Additionally, the inflection point of RDW was 14.0%. When RDW was ≥14.0%, there was a positive association with the risk of GIB (OR: 1.24, 95% CI: 1.16, 1.33, p < 0.0001). Conversely, when RDW was <14.0%, this association was not significant (OR: 1.02, 95% CI: 0.97-1.07, p = 0.4040). This study showed a substantial non-linear link between RDW and the risk of GIB in stroke patients. Maintaining the patient's RDW value below 14.0% could lower the risk of in-hospital GIB.

Hyperhomocysteinemia Increases Vascular Risk in Stroke Patients with Chronic Kidney Disease.

We aimed to assess the prognostic impact of hyperhomocysteinemia (HHcy) on the recurrent vascular event risk in stroke patients with or without chronic kidney disease (CKD). In this prospective observational study, 621 patients (mean age, 69.5 years; male, 62.2%) with ischemic stroke or transient ischemic attack were consecutively enrolled within 1 week of onset and followed-up for 1 year. HHcy was defined as elevated levels of fasting total homocysteine ＞15 µmol/L. CKD was defined as an estimated glomerular filtration rate of ＜60 mL/min/1.73 m2 or a history of renal replacement therapy. The primary outcome was a composite of major adverse cardiovascular events (MACEs), including nonfatal stroke, nonfatal acute coronary syndrome, major peripheral artery disease, and vascular death. The prevalence of HHcy was 18.5%. Patients with HHcy were more likely to have intracranial (37.4% versus 24.8%; p=0.008) and extracranial (20.9% versus 13.0%; p=0.037) artery stenosis than were those without HHcy. At 1 year, patients with HHcy were at a greater risk of MACE than were those without HHcy (annual rate, 17.8% versus 10.4%; log-rank p=0.033). In the Cox proportional hazard regression models, HHcy was independently associated with an increased risk of MACE in patients with CKD (adjusted hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.02-4.20), whereas HHcy was not predictive of MACE in those without CKD (adjusted HR, 1.00; 95% CI, 0.30-3.32). Elevated levels of serum homocysteine can be an important modifiable risk factor in stroke patients with CKD, but not in those without CKD.

STROKE RISK FACTOR ANALYSIS USING STROKE RISK SCORECARDAT RSUD DR. HARJONO S. PONOROGO

Objective: Stroke is a condition that occurs when the blood supplay to a part of the brain is suddenly interrupted, because some brain cells die due to disruption of blood flow due to blockage or rupture of brain blood vessels. Death of brain tissue can lead to loss of fungtions controlled by that tissue. Stroke is the main cause of fungtional disorders, where 20% of patients who survive still require treatment at a health institution after 3 months and 15-30% of sufferers experience permanent disability. The introduction of risk factors for stroke is very important, beacause many patients have more than one risk factor and are sometomes ignored, so that the incidence of stroke cannot be avoided. Practical strategies in dealing with the burden of stroke should focus on prevention and treatment based on risk factors. This study is an observational analytic study with a cross-sectional design to determine the relationship between risk factors and the level of risk of stroke patients hospitalized at RSUD dr. Harjono S Ponorogo. This type of research is non-experimental research. This study was conducted in the stroke patient inpatient room.Methods:. The research design used (crosssectional), this sampling technique used consecutive sampling and tabulated data. The sample is 60 respondents. The research instrument uses medical records to view the respondents basic data and medical diagnosis, and the stroke risk scorecard to obtain the results of the assessment of stroke risk factors and the risk level of stroke patients.Results: The results of the study from 60 medical records of stroke patients, risk factors that were proven to have a significant relationship with the level of stroke risk were blood pressure, smoking history, cholesterol levels, history of diabetes. Meanwhile, based on the stroke risk scorecard, the risk level for stroke is mostly high risk.Conclusion: The risk factors that were shown to have a significant relationship with the level of stroke risk based on the results of the distribution table were blood pressure, smoking history, cholesterol levels, history of diabetes. Meanwhile, based on the Stroke Risk Scorecard, the level of stroke risk in stroke patients at Dr. Harjono S Ponorogo Hospital is mostly high risk.

349 THE IMPACT OF INTER-HOSPITAL TRANSFER TO ENDOVASCULAR THROMBECTOMY (EVT) CENTRES ON THE INCIDENCE OF TENOUS THROMBOEMBOLISM (VTE) IN STROKE PATIENTS

Abstract Background The risk of VTE is increased following an ischaemic stroke with pulmonary emboli accounting for up to 25% of early deaths after stroke. Patients suitable for EVT have a higher NIHSS (average 16 in Ireland, 2020) and are more likely to have hemiplegia, potentiating the risk of VTE. Many VTE prophylaxis interventions that are provided to in-hospital stroke patients are not provided to those during the journey to thrombectomy centres. Our objective was to assess the incidence of VTE in acute ischaemic stroke patients transferred from a peripheral hospital to an EVT centre and estimate the potential national impact. Methods We reviewed the files of patients (n=35) transferred from a peripheral hospital to an EVT centre from January 1st 2019 until December 31st 2021 and included those who had a VTE confirmed on imaging during their admission. We calculated the incidence of VTE in these patients and the potential national figure. The sample size in this review is small, however 458 patents were transported to EVT centres from other hospitals in Ireland in 2020. Results VTE was confirmed in 8.57%(n=3/35) ; 1 out of 15, in 2019, 2 out of 10 in 2020, 0 out of 10 in 2021. The potential national rate using figures from 2020 equates to 39 VTEs. Conclusion We report a substantial risk of VTE risk in stroke patients during transit to EVT centres. Agreed national thrombectomy guidelines do not address the prevention of VTE in transit. A national audit of VTE in patients transferred from peripheral hospitals is needed with special focus on the role of mechanical preventative devices(pneumatic compression) in this preventable complication of stroke.

Effect of Antigravity Treadmill Gait Training on Gait Function and Fall Risk in Stroke Patients.

Objective To investigate the effect of antigravity treadmill gait training (AGT) on gait function, balance, and fall risk in stroke patients.MethodsThis study included 30 patients with stroke (mean age, 73 years). All subjects were randomly divided into two groups. The intervention group (n=15) performed AGT for 20 minutes, five times per week for 4 weeks. The control group (n=15) received conventional gait training for the same duration. To assess fall risk, the Tinetti Performance-Oriented Mobility Assessment (POMA) was measured. The Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 10-m walk test (10mWT) were measured to assess dynamic balance. All scales were measured before intervention (T0) and at 4 weeks (T1) and 12 weeks (T2) after intervention.ResultsResults showed that the total POMA score, BBS, and 10mWT scores improved significantly (p<0.05) at T1 and T2 in both groups. The POMA gait score (4.20±1.37 at T1, 4.87±1.36 at T2) and TUG (4.52±4.30 at T1, 5.73±4.97 at T2) significantly improved (p<0.05) only in the intervention group. The changes in total POMA score and BBS of the intervention group (7.20±2.37, 7.47±3.07) improved more significantly (p<0.05) between T0 and T2 than the control group (2.53±2.10, 2.87±2.53).ConclusionOur study showed that AGT enhances dynamic balance and gait speed and effectively lowers fall risk in stroke patients. Compared to conventional gait therapy, AGT would improve gait function and balance in stroke patients more effectively.

Thrombolysis in stroke patients with elevated inflammatory markers

ObjectiveTo investigate the prognostic value of white blood cell count (WBC) on functional outcome, mortality and bleeding risk in stroke patients treated with intravenous thrombolysis (IVT).MethodsIn this prospective multicenter study from the TRISP registry, we assessed the association between WBC on admission and 3-month poor outcome (modified Rankin Scale 3–6), mortality and occurrence of symptomatic intracranial hemorrhage (sICH; ECASS-II-criteria) in IVT-treated stroke patients. WBC was used as continuous and categorical variable distinguishing leukocytosis (WBC > 10 × 109/l) and leukopenia (WBC < 4 × 109/l). We calculated unadjusted/ adjusted odds ratios with 95% confidence intervals (OR [95% CI]) with logistic regression models. In a subgroup, we analyzed the association of combined leukocytosis and elevated C-reactive protein (CRP > 10 mg/l) on outcomes.ResultsOf 10,813 IVT-treated patients, 2527 had leukocytosis, 112 leukopenia and 8174 normal WBC. Increasing WBC (by 1 × 109/l) predicted poor outcome (ORadjusted 1.04[1.02–1.06]) but not mortality and sICH. Leukocytosis was independently associated with poor outcome (ORadjusted 1.48[1.29–1.69]) and mortality (ORadjusted 1.60[1.35–1.89]) but not with sICH (ORadjusted 1.17[0.94–1.45]). Leukopenia did not predict any outcome. In a subgroup, combined leukocytosis and elevated CRP had the strongest association with poor outcome (ORadjusted 2.26[1.76–2.91]) and mortality (ORadjusted 2.43[1.86–3.16]) when compared to combined normal WBC and CRP.ConclusionIn IVT-treated patients, leukocytosis independently predicted poor functional outcome and death. Bleeding complications after IVT were not independently associated with leukocytosis.

Impaired left atrial reservoir strain in patients with ischaemic stroke is associated with atrial fibrillation development

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The investigation of patients with ischaemic stroke includes undoubtedly their evaluation for atrial fibrillation (AF). On the other hand, the role of left atrial (LA) function in cardiovascular disease is increasingly researched, while echocardiography strain analysis is a novel attractive technique. Purpose In this retrospective study, we investigated the association between LA function assessed with reservoir strain and the follow-up development of AF. Methods The study population consisted of consecutive ischaemic stroke patients with preserved left ventricular ejection fraction who were on sinus rhythm at the moment of enrollment and had no history of AF. Baseline LA reservoir strain was assessed with 2-dimensional transthoracic echocardiography (apical 4-chamber view) using longitudinal speckle-tracking technique. Afterwards, patients were investigated for AF with ambulatory electrocardiography during one-year follow-up. Differences in the distribution of LA reservoir strain values within the groups of patients with and without AF development were examined with Mann-Whitney U test (new procedure). The level of statistical significance was set to a p value of &amp;lt;0.05. Results Sixty-three patients (41 males, 22 females) of a mean age of 50.94 years [minimum = 20, maximum = 65, standard deviation (SD)=10,02] were enrolled in the study. Eight (12.7%) patients developed atrial fibrillation on follow-up. Overall, the mean LA reservoir strain was 32.75% (minimum = 5.62%, maximum = 71.88%, SD=%) and the median value was 32.91%. The values were shown to be lower in the group with later AF development (mean rank = 13.94, Mann-Whitney U = 75.5, p = 0.003) than in those without this finding (mean rank = 13.94). Neither the gender nor the age was associated with AF diagnosis. Conclusion Lower LA reservoir strain values were found to be associated with AF development in ischaemic stroke patients of our study. Pending more research data from large studies, this novel technique appears to be promising in identifying AF risk in stroke patients. Figure Non parametric assessment with Mann-Whitney U test (new procedure) of left atrial reservoir strain analysis with 2-dimensional transthoracic echocardiography in the groups of ischaemic stroke patients with and without atrial fibrillation development. Abstract Figure.

The Role of Vitamin D in the Relationship Between Gender and Deep Vein Thrombosis Among Stroke Patients.

Introduction: Accumulating evidence had demonstrated that females had a higher risk of deep vein thrombosis (DVT) than males, but the mechanism was still unknown. Vitamin D was found to play an essential role in DVT, and gender may influence the serum vitamin D levels. This study aimed to explore whether vitamin D played a role in the gender difference in DVT.Materials and Methods: A total of 444 patients with acute stroke were recruited, which were divided into the DVT group (n = 222) and the non-DVT group (n = 222). Serum vitamin D levels were measured after admission and were split into three categories, including deficiency (<50 nmol/L), insufficiency (52.5–72.5 nmol/L), and sufficiency (more than 75 nmol/L). Hierarchical regression analysis was adopted to analyze the relationship between gender and DVT, controlling the confounding factors.Results: Females showed a higher proportion of DVT than males (60.7 vs. 42.5%, p < 0.001), and lower serum vitamin D levels than males (53.44 ± 16.45 vs. 69.43 ± 23.14, p < 0.001). Moreover, serum vitamin D levels were lower in the DVT group than in the non-DVT group (59.44 ± 19.61 vs. 66.24 ± 23.86, p < 0.001). Besides, the DVT group showed a lower proportion of vitamin D sufficiency than the non-DVT group (21.2 vs. 32.9%, p < 0.05). Hierarchical regression analysis showed that females had 2.083-fold (p < 0.001, unadjusted model) and 1.413-fold (p = 0.155, adjusted model) risk to develop DVT. In addition, the sufficiency status of vitamin D showed an independent protective effect on DVT (unadjusted model OR, 0.504, p = 0.004; adjusted model OR, 0.686, p = 0.011).Conclusion: Females had a higher risk of DVT than males, and vitamin D may play an essential role in this relationship. Further studies are needed to explore whether vitamin D supplementation could reduce DVT risk in stroke patients, especially females.

Stroke Patients with Nearly Independent Transfer Ability are at High Risk of Falling

ObjectivesTo examine the relationship between patients’ transfer ability and fall risk in stroke patients during hospitalization. Materials and methodsWe retrospectively enrolled 237 stroke patients who were transferred to a convalescent rehabilitation ward from acute wards in the same hospital. Using incident reports, we investigated their fall rates and activity status at the falls according to their transfer abilities, which were assessed with Functional Independence Measure (FIM) transfer scores. The bi-weekly time trend of fall rates in all patients and in three subgroups based on FIM transfer scores of 1–3, 4–5, and 6–7, and activity status at the falls, were investigated. In addition, changes of patients’ transfer ability on admission, at the first fall, and at discharge were investigated among falling patients. ResultsThe fall rate was the greatest in patients with a FIM transfer score of 4 (14.3 times/1000 person-days). The majority of falls for patients with a FIM transfer score of 1 occurred at the activity status of “on the bed” and “sitting”, while three quarters of patients with a FIM score of 7 had falls during “standing” and “walking”. No longitudinal trend in fall rates was found overall; however, the fall rate trends differed depending on the FIM transfer score. The majority of the patients who fell required full assistance for transfers upon admission but required no assistance at discharge. ConclusionsFall risk differed among patients with various transfer abilities; the greatest risk was in those who needed minimal assistance for transfers.

Correction to: Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation.

Correction to: Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation.

Assessment for cardiovascular fitness in patients with stroke: which cardiopulmonary exercise testing method is better?

ABSTRACT Background: Assessment for cardiovascular disease (CVD) is important in stroke patients, both being one of the main factors limiting success in stroke rehabilitation and its increased risk in stroke patients. Reduced exercise capacity after stroke decreases patients’ functionality and further increases the risk of CVD. Carefully selected cardiopulmonary exercise testing (CPET) can be safely used to determine the risk of CVD and to prescribe exercise program in stroke rehabilitation. Objectives: The primary purpose of this study is to determine the most appropriate CPET in patients with stroke. The secondary aim is to determine the relationship between cardiorespiratory fitness and functional status of the patients. Methods: Two CPETs using treadmill and bicycle ergometer protocols determined with a preliminary study were performed on participants. The main outcome measure was VO2peak. Patients were also evaluated according to Brunnstrom motor staging, Modified Ashworth Scale, Berg Balance Scale, and Functional Independence Measure. Results: In total, 38 patients reached higher VO2peak values at treadmill test compared to bicycle test (p < 0.001). The mean VO2peak reached at treadmill CPET was 62% of the control group where mean VO2peak reached at bicycle was 76% of the control group. No significant correlation was found between Brunnstrom staging, spasticity, Berg Balance Scale, and VO2peak . Discussion: The results of this study indicate that CPET can be performed safely in stroke patients when appropriate protocol was selected and that treadmill was more appropriate to determine cardiorespiratory fitness in this study population.

May 2021 Stroke Highlights

May 2021 <i>Stroke</i> Highlights

Predictors of death within 6 months of stroke onset: A model with Barthel index, platelet/lymphocyte ratio and serum albumin.

AimsTo develop and internally validate a nomogram to predict the risk of death within 6 months of onset of stroke in Chinese. Identifying risk factors with potentially direct effects on the nomogram will improve the quality of risk assessment and help nurses implement preventive measures based on patient‐specific risk factors.DesignA retrospective study.MethodsWe performed a least absolute shrinkage and selection operator (LASSO) regression modelling and multivariate logistic regression analysis to establish a prediction model of death risk in stroke patients within 6 months of onset. LASSO and time‐dependent Cox regression models were further used to analyse the 6‐month survival of stroke patients. Data were collected from 21 October 2013–6 May 2019.ResultsThe independent predictors of the nomogram were Barthel index (odds ratio (OR) = 0.980, 95% confidence interval (CI) = 0.961–0.998, p = .03), platelet/lymphocyte ratio (OR = 1.005, 95% CI = 1.000–1.010, p = .04) and serum albumin (OR = 0.854, 95% CI = 0.774–0.931, p < .01). This model showed good discrimination and consistency, and its discrimination evaluation C‐statistic was 0.879 in the training set and 0.891 in the internal validation set. The DCA indicated that the nomogram had a higher overall net benefit over most of the threshold probability range. The time‐dependent Cox regression model established the impact of the time effect of the age variable on survival time.ConclusionsOur results identified three predictors of death within 6 months of stroke in Chinese. These predictors can be used as risk assessment indicators to help caregivers performing clinical nursing work, and in clinical practice, it is suggested that nurses should evaluate the self‐care ability of stroke patients in detail. The constructed nomogram can help identify patients at high risk of death within 6 months, so that intervention can be performed as early as possible.

Importance of lipid ratios for predicting intracranial atherosclerotic stenosis.

BackgroundThis study aims to investigate the association of lipid ratios with intracranial atherosclerotic stenosis (ICAS) in a Chinese population.MethodsThis cross-sectional study included 658 consecutive patients with ischemic stroke. Intracranial and extracranial arteries were evaluated for atherosclerotic stenosis using digital subtraction angiography or computed tomography angiography. Lipid ratios [total cholesterol (TC)/high-density lipoprotein-cholesterol (HDL-C), triglycerides (TG)/HDL-C, low-density lipoprotein-cholesterol (LDL-C)/HDL-C, non-high-density lipoprotein-cholesterol (non-HDL-C)/HDL-C, remnant cholesterol (RC)/HDL-C, apolipoprotein B (apo B)/apolipoprotein A-I (apo A-I), and apo B/HDL-C] were calculated.ResultsThe TC/HDL-C, LDL-C/HDL-C, RC/HDL-C, non-HDL-C/HDL-C, apo B/HDL-C and apo B/apo A-I ratios (all P < 0.05) were significantly associated with ICAS but not with extracranial atherosclerotic stenosis after adjustment for confounding factors. Receiver operating characteristic (ROC) curves analysis revealed that the apo B/apo A-I ratio had the largest area under the ROC curve (AUC) among lipid levels alone and for lipid ratios (AUC = 0.588). Lipid ratios had higher AUC values than those for lipid levels alone for the identification of ICAS.ConclusionThe TC/HDL-C, LDL-C/HDL-C, RC/HDL-C, non-HDL-C/HDL-C apo B/HDL-C, and apo B/apo A-I ratios were significantly related to ICAS risk. Compared with the other variables tested, the apo B/apo A-I ratio appeared to be a better discriminator for identifying ICAS risk in stroke patients.

Stratification of venous thromboembolism risk in stroke patients by Caprini score.

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolus (PE) is a serious complication in hospitalized stroke patients. This study is designed to examine the incidence of VTE and the effectiveness of chemo thromboprophylaxis in this population. From January 2015 to April 2018, we calculate the Caprini score for every admitted patient to evaluate VTE risk. For analysis Demographic information, Caprini score, national institutes of health stroke scale (NIHSS) score, prothrombin time (PT), thrombin time (TT), D-Dimer and medical co-morbidity are noted. Of 3,824 inpatients during the study period, 21 patients (0.55%) have VTE complications. Among patients (n=148) with a Caprini score between 0 and 2, 1 patient (0.68%) have VTE. VTE (52.38%) most commonly occurred in patients of Caprini score 7-8 group. In patients with VTE (n=21) age, Caprini score, NIHSS score, National Early Warning Score (NEWS) score, PT, TT, D-Dimer are significantly higher than those (n=3,803) without VTE (P<0.05). The Caprini score is highly recommended to assess the risk of venous thrombosis in stroke patients. Early mechanical and chemical prophylaxis are recommended for patients to reduce the incidence of venous thrombosis.