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Cimoli M, Gibney J, Lim M, Castles J, Dammert P. Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1410023. [PMID: 38957683 PMCID: PMC11217566 DOI: 10.3389/fresc.2024.1410023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.
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Affiliation(s)
- Michelle Cimoli
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Jennifer Gibney
- Speech Pathology Department, Nepean Hospital, Penrith, NSW, Australia
| | - Mathew Lim
- Dental Services, Alfred Health, Prahran, VIC, Australia
- Melbourne Dental School, University of Melbourne, Carlton, VIC, Australia
| | - Jo Castles
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Pedro Dammert
- Pulmonary and Critical Care Department, Scripps Mercy Hospital Chula Vista, Chula Vista, CA, United States
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Fry CH, Fluck A, Affley B, Kakar P, Sharma P, Fluck D, Han TS. Urinary incontinence indicates mortality, disability, and infections in hospitalised stroke patients. BJU Int 2024; 133:604-613. [PMID: 38419275 DOI: 10.1111/bju.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To assess the impact of urinary incontinence (UI) on health outcomes over the entire spectrum of acute stroke severity (National Institutes of Health Stroke Scale [NIHSS] scores: 0-42), due to a paucity of data on patients with milder strokes. PATIENTS AND METHODS Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme (1593 men, 1591 women; mean [SD] age 76.8 [13.3] years) admitted to four UK hyperacute stroke units (HASUs). Relationships between variables were assessed by multivariable logistic regression. Data were adjusted for age, sex, comorbidities, pre-stroke disability and intra-cranial haemorrhage, and presented as odds ratios with 95% confidence intervals. RESULTS Amongst patients with no symptoms or a minor stroke (NIHSS scores of 0-4), compared to patients without UI, patients with UI had significantly greater risks of poor outcomes including: in-hospital mortality; disability at discharge; in-hospital pneumonia; urinary tract infection within 7 days of admission; prolonged length of stay on the HASU; palliative care by discharge; activity of daily living (ADL) support, and new discharge to care home. In patients with more moderate stroke (NIHSS score of 5-15) the same outcomes were identified; being at greater risk for patients with UI, except for palliative care by discharge and ADL support. With the highest stroke severity group (NIHSS score of 16-48) all outcomes were identified except in-patient mortality, pneumonia, and ADL support. However, odds ratios diminished as NIHSS scores increased. CONCLUSIONS Urinary incontinence is a useful indicator of poor short-term outcomes in older patients with an acute stroke, but irrespective of stroke severity. This provides valuable information to healthcare professionals to identify at-risk individuals.
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Affiliation(s)
- Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Adam Fluck
- Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
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Nishimura T, Matsugaki R, Matsuda S. Physical Rehabilitation and Post-Stroke Pneumonia: A Retrospective Observational Study Using the Japanese Diagnosis Procedure Combination Database. Neurol Int 2023; 15:1459-1468. [PMID: 38132973 PMCID: PMC10745980 DOI: 10.3390/neurolint15040094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
In this study, the relationship between the duration of physical rehabilitation and occurrence of pneumonia after ischemic stroke was examined. We included 426,508 patients aged ≥75 years with acute ischemic stroke. A multilevel logistic regression analysis nested at the hospital level was conducted to examine the association between the duration of physical rehabilitation and occurrence of pneumonia. The duration of physical rehabilitation refers to the hours of physical rehabilitation performed daily until the 7th day of hospitalization. In the multivariable analysis, the intensity of rehabilitation for durations of 20-39 min/day (adjusted odds ratio [aOR]: 0.78, 95% Confidence Interval [CI]: 0.75-0.81, p < 0.001), 40-59 min/day (aOR: 0.68, 95% CI: 0.66-0.71, p < 0.001), 60-79 min/day (aOR:0.56, 95% CI: 0.53-0.58, p < 0.001), and ≥80 min/day (aOR: 0.46, 95% CI: 0.44-0.48, p < 0.001) were significantly associated with a reduced incidence of pneumonia. In addition, the trend identified for duration of rehabilitation was significant (p < 0.001). The results of this study suggest the usefulness of high-duration physical rehabilitation for preventing pneumonia in older patients with ischemic stroke.
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Affiliation(s)
- Takehiro Nishimura
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (T.N.); (S.M.)
| | - Ryutaro Matsugaki
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan; (T.N.); (S.M.)
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Zhao Y, Chen C, Huang Z, Wang H, Tie X, Yang J, Cui W, Xu J. Prediction of upcoming urinary tract infection after intracerebral hemorrhage: a machine learning approach based on statistics collected at multiple time points. Front Neurol 2023; 14:1223680. [PMID: 37780719 PMCID: PMC10538571 DOI: 10.3389/fneur.2023.1223680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/18/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose Accurate prediction of urinary tract infection (UTI) following intracerebral hemorrhage (ICH) can significantly facilitate both timely medical interventions and therapeutic decisions in neurocritical care. Our study aimed to propose a machine learning method to predict an upcoming UTI by using multi-time-point statistics. Methods A total of 110 patients were identified from a neuro-intensive care unit in this research. Laboratory test results at two time points were chosen: Lab 1 collected at the time of admission and Lab 2 collected at the time of 48 h after admission. Univariate analysis was performed to investigate if there were statistical differences between the UTI group and the non-UTI group. Machine learning models were built with various combinations of selected features and evaluated with accuracy (ACC), sensitivity, specificity, and area under the curve (AUC) values. Results Corticosteroid usage (p < 0.001) and daily urinary volume (p < 0.001) were statistically significant risk factors for UTI. Moreover, there were statistical differences in laboratory test results between the UTI group and the non-UTI group at the two time points, as suggested by the univariate analysis. Among the machine learning models, the one incorporating clinical information and the rate of change in laboratory parameters outperformed the others. This model achieved ACC = 0.773, sensitivity = 0.785, specificity = 0.762, and AUC = 0.868 during training and 0.682, 0.685, 0.673, and 0.751 in the model test, respectively. Conclusion The combination of clinical information and multi-time-point laboratory data can effectively predict upcoming UTIs after ICH in neurocritical care.
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Affiliation(s)
- Yanjie Zhao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhouyang Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haoxiang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tie
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jinhao Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenyao Cui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Bond VE, Doeltgen S, Kleinig T, Murray J. Dysphagia-related acute stroke complications: A retrospective observational cohort study. J Stroke Cerebrovasc Dis 2023; 32:107123. [PMID: 37058873 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107123] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVES Post-stroke dysphagia is associated with aspiration pneumonia, but strategies intended to mitigate this complication, such as oral intake modifications, may unintentionally lead to dehydration-related complications such as urinary tract infections (UTIs) and constipation. This study aimed to determine the rates of aspiration pneumonia, dehydration, UTI and constipation in a large cohort of acute stroke patients and the independent predictors of each complication. MATERIALS AND METHODS Data were extracted retrospectively for 31,953 acute stroke patients admitted to six hospitals in Adelaide, South Australia over a 20-year period. Tests of difference compared rates of complications between patients with and without dysphagia. Multiple logistic regression modelling explored variables that significantly predicted each complication. RESULTS In this consecutive cohort of acute stroke patients, with a mean (SD) age of 73.8 (13.8) years and 70.2% presenting with ischaemic stroke, rates of complications were: aspiration pneumonia (6.5%); dehydration (6.7%); UTI (10.1%); and constipation (4.4%). Each complication was significantly more prevalent for patients with dysphagia compared to those without. Controlling for demographic and other clinical variables, the presence of dysphagia independently predicted aspiration pneumonia (OR=2.61, 95% CI 2.21-3.07; p<.001), dehydration (OR=2.05, 95% CI 1.76-2.38; p<.001), UTI (OR=1.34, 95% CI 1.16-1.56; p<.001), and constipation (OR=1.30, 95% CI 1.07-1.59; p=.009). Additional predictive factors were increased age and prolonged hospitalisation. CONCLUSIONS Aspiration pneumonia, dehydration, UTI, and constipation are common acute sequelae of stroke and independently associated with dysphagia. Future dysphagia intervention initiatives may utilise these reported complication rates to evaluate their impact on all four adverse health complications.
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Affiliation(s)
- Verity E Bond
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Timothy Kleinig
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Joanne Murray
- Speech Pathology, College of Nursing and Health Sciences, Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia.
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Hospital-acquired pneumonia is more frequent and lethal in stroke patients: A nationwide 4-year study. Infect Control Hosp Epidemiol 2023; 44:122-124. [PMID: 34585657 DOI: 10.1017/ice.2021.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a higher incidence of hospital-acquired pneumonia (HAP) in patients admitted with stroke (odds ratio, 5.6; 95% CI, 5.4-5.8). Patients with HAP and stroke had an elevated risk of death (odds ratio, 1.2; 95% CI, 1.1-1.3). The incidence and mortality of HAP in stroke patients increased across all age groups.
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Yamauchi K, Kumagae K, Goto K, Harayama E, Tanaka S, Hagiwara R, Uchida Y, Kuroyama S, Koyanagi Y, Arakawa S. Ambulation status at an acute care hospital predicts pneumonia and mortality in stroke patients: A retrospective cohort study. Geriatr Gerontol Int 2022; 22:554-559. [PMID: 35706408 DOI: 10.1111/ggi.14411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
AIM Higher post-stroke functional performance is associated with lower mortality in patients with stroke. This study aimed to investigate the relationship between ambulation ability in the acute phase of stroke, and pneumonia and mortality 1 year after stroke onset. METHODS This retrospective cohort study included consecutive stroke patients between April 2008 and December 2018. Patients were divided into six groups according to their Functional Ambulation Category score at discharge (0 [unable to walk] to 5 [able to walk independently]). We observed pneumonia cases and all-cause mortality over 1 year, and investigated the association between Functional Ambulation Category score and pneumonia or mortality. Survival analysis was carried out using Kaplan-Meier curves, log-rank tests and Cox regression models. RESULTS We analyzed 1727 consecutive patients (median age 77 years; 54% men). During the observation period, 144 patients (8.3%) experienced pneumonia and 157 (9.1%) died. Increasing ambulatory impairment showed stepwise relationships with the risk of pneumonia and mortality. Compared with patients with a Functional Ambulation Category score of 5, those with scores of 4 and 3 showed no significant association with pneumonia risk; a score ≤2 was significantly different. There was a stepwise relationship between increased gait disturbance and risk of death compared with the Functional Ambulation Category 5 group. CONCLUSIONS Ambulation ability at discharge from an acute hospital is an important predictor of pneumonia incidence and survival in stroke patients at 1 year; these associations were observed even after controlling for clinical parameters, such as stroke severity and comorbidity. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Kenichi Kumagae
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Kei Goto
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Eisei Harayama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shota Tanaka
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Risa Hagiwara
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yoshiko Uchida
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Sota Kuroyama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yasuhiro Koyanagi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
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Lukasewicz Ferreira SA, Hubner Dalmora C, Anziliero F, de Souza Kuchenbecker R, Klarmann Ziegelmann P. Factors predicting non-ventilated hospital-acquired pneumonia: systematic review and meta-analysis. J Hosp Infect 2021; 119:64-76. [PMID: 34666117 DOI: 10.1016/j.jhin.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/29/2021] [Accepted: 09/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) results in approximately 15-20% of all infections in hospitals, with more than two-thirds being in patients not using mechanical ventilation. The incidence of non-ventilated hospital-acquired pneumonia (NVHAP) is increasing, and it is associated with a longer length of stay, the need for intensive care unit hospitalization and mechanical ventilation use, and higher mortality. AIM To identify, quantify, and summarize predictive factors for NVHAP in adult patients admitted to non-intensive care units as determined by previous observational studies. METHODS PubMed, Embase, Scopus, and LILACS were systematically searched. Case-control and cohort studies were included, and a meta-analysis was performed for all factors studied more than once. National Institute of Health assessment tools were applied to assess the quality of the studies. FINDINGS Thirty-eight articles showing 204 predictive factors were included. A meta-analysis was performed for 58 factors, 32 of which were significantly associated with NVHAP. When the sensitivity analysis was performed without poor-quality studies, 24 factors remained associated with NVHAP. CONCLUSION Although there is a lack of good-quality studies to establish predictive factors for NVHAP, the results of this study showed 24 factors associated with the development of this infectious complication. Knowledge of the significant predictive factors for NVHAP will enable the identification of patients most likely to develop it.
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Affiliation(s)
- S A Lukasewicz Ferreira
- Hospital Infection Control Service, Hospital de Clínicas de Porto Alegre and Qualis, Porto Alegre, Brazil.
| | - C Hubner Dalmora
- Hospital Infection Control Service, Hospital de Clínicas de Porto Alegre and Qualis, Porto Alegre, Brazil
| | - F Anziliero
- Military Police of Rio Grande do Sul, Brazil
| | - R de Souza Kuchenbecker
- Health Technology Assessment Institute (IATS/CNPq), Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - P Klarmann Ziegelmann
- Health Technology Assessment Institute (IATS/CNPq), Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
Supplemental Digital Content is available in the text. The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies.
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Affiliation(s)
- Jeroen C de Jonge
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (J.C.d.J., H.B.v.d.W.)
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Center, Amsterdam Neuroscience, the Netherlands (D.v.d.B.)
| | - Patrick Lyden
- Departments of Physiology and Neuroscience and Neurology, USC Keck School of Medicine, Los Angeles, CA (P.L.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (M.C.B.)
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom (P.M.B.)
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (J.C.d.J., H.B.v.d.W.)
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Crary MA. Adult Neurologic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pilato F, Silva S, Valente I, Distefano M, Broccolini A, Brunetti V, Caliandro P, Marca GD, Di Iorio R, Frisullo G, Monforte M, Morosetti R, Piano C, Calandrelli R, Capone F, Alexandre A, Pedicelli A, Colosimo C, Caricato A. Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit-A Prospective Cohort Study. Brain Sci 2020; 10:brainsci10120911. [PMID: 33256264 PMCID: PMC7761293 DOI: 10.3390/brainsci10120911] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20–11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04–10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61–0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92–0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11–0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65–37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.
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Affiliation(s)
- Fabio Pilato
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
- Correspondence: ; Tel.: +39-06-30151
| | - Serena Silva
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Iacopo Valente
- UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.V.); (R.C.); (A.A.); (A.P.); (C.C.)
| | - Marisa Distefano
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Aldobrando Broccolini
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Valerio Brunetti
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Pietro Caliandro
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Giacomo Della Marca
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Riccardo Di Iorio
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Giovanni Frisullo
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Mauro Monforte
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Roberta Morosetti
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Carla Piano
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Rosalinda Calandrelli
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Andrea Alexandre
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Alessandro Pedicelli
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Cesare Colosimo
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Anselmo Caricato
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
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12
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Tsai SCS, Lin FCF. Surgical treatments for post-intubation laryngotracheal stenosis in patients with central nervous system injuries. Medicine (Baltimore) 2020; 99:e18628. [PMID: 32011442 PMCID: PMC7220156 DOI: 10.1097/md.0000000000018628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.
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Affiliation(s)
- Stella Chin-Shaw Tsai
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital
- Department of Nutrition, Providence University
| | - Frank Cheau-Feng Lin
- School of Medicine, Chung Shan Medical University
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
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13
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Eltringham SA, Kilner K, Gee M, Sage K, Bray BD, Smith CJ, Pownall S. Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review. Dysphagia 2019; 35:735-744. [PMID: 31493069 PMCID: PMC7522065 DOI: 10.1007/s00455-019-10061-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
Abstract
Dysphagia is associated with increased risk of stroke-associated pneumonia (SAP). However, it is unclear what other factors contribute to that risk or which measures may reduce it. This systematic review aimed to provide evidence on interventions and care processes associated with SAP in patients with dysphagia. Studies were screened for inclusion if they included dysphagia only patients, dysphagia and non-dysphagia patients or unselected patients that included dysphagic patients and evaluated factors associated with a recorded frequency of SAP. Electronic databases were searched from inception to February 2017. Eligible studies were critically appraised. Heterogeneity was evaluated using I2. The primary outcome was SAP. Eleven studies were included. Sample sizes ranged from 60 to 1088 patients. There was heterogeneity in study design. Measures of immunodepression are associated with SAP in dysphagic patients. There is insufficient evidence to justify screening for aerobic Gram-negative bacteria. Prophylactic antibiotics did not prevent SAP and proton pump inhibitors may increase risk. Treatment with metoclopramide may reduce SAP risk. Evidence that nasogastric tube (NGT) placement increases risk of SAP is equivocal. A multidisciplinary team approach and instrumental assessment of swallowing may reduce risk of pneumonia. Patients with impaired mobility were associated with increased risk. Findings should be interpreted with caution given the number of studies, heterogeneity and descriptive analyses. Several medical interventions and care processes, which may reduce risk of SAP in patients with dysphagia, have been identified. Further research is needed to evaluate the role of these interventions and care processes in clinical practice.
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Affiliation(s)
- Sabrina A Eltringham
- Speech and Language Therapy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. .,Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
| | - Karen Kilner
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Melanie Gee
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Karen Sage
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | | | - Craig J Smith
- Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Sue Pownall
- Speech and Language Therapy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Tørnes M, McLernon DJ, Bachmann MO, Musgrave SD, Warburton EA, Potter JF, Myint PK. Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke. Front Neurol 2019; 10:827. [PMID: 31447761 PMCID: PMC6691802 DOI: 10.3389/fneur.2019.00827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals. Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service (NHS) acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics. Results: We included 2,241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3 to 11%. The hospital that had the lowest odds of UTI [odds ratio (OR) = 0.50 (95% confidence interval (CI) 0.22–.11)] in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate [OR=2.69 (1.56–4.64)] was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner. Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to be addressed to improve the ultimate stroke outcome.
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Affiliation(s)
- Michelle Tørnes
- Ageing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - David J McLernon
- Medical Statistics Team, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stanley D Musgrave
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | | | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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15
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Smith C, Almallouhi E, Feng W. Urinary tract infection after stroke: A narrative review. J Neurol Sci 2019; 403:146-152. [DOI: 10.1016/j.jns.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
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16
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Maeda K, Ishida Y, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Burden of Premorbid Consumption of Texture Modified Diets in Daily Life on Nutritional Status and Outcomes of Hospitalization. J Nutr Health Aging 2019; 23:973-978. [PMID: 31781727 DOI: 10.1007/s12603-019-1237-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Due to the water-rich cooking process required to soften texture modified diets (TMDs), TMDs may have poorer nutrition. The aim of this study was to investigate the associations between daily premorbid TMD consumption and nutritional status at the time of hospitalization, and its burden on hospitalization outcomes. DESIGN Retrospective observational study. SETTING An academic hospital. PARTICIPANTS The cohort comprised 3,594 older adult patients aged ≥65 years admitted to the hospital. MEASUREMENTS Patients were interviewed on admission using a premorbid daily consumption meal form to determine whether the patient ate a TMD. Nutritional status was examined using nutritional screening tools (Mini-Nutritional Assessment Short Form [MNA-SF], Malnutrition Universal Screening Tool [MUST], Geriatric Nutritional Risk Index [GNRI]) and the European Society of Clinical Nutrition and Metabolism (ESPEN)-defined criteria of malnutrition at admission. Length of hospital stay (LOS) and in-hospital mortality were considered outcomes of hospitalization. Multivariate analyses were performed to detect associations between premorbid TMD consumption and nutritional status and outcomes. RESULTS The mean age of the subjects was 75.9±7.0 years, including 58% males. Overall, 110 (3.1%) patients consuming a premorbid TMD were identified. They were older (p<0.001), had poor nutritional status (lower MNA-SF score [p<0.001] and GNRI value [p<0.001], higher MUST score [p<0.001], and more prevalent ESPEN-defined malnutrition [61.8% vs. 14.0%, p<0.001] than did patients without a TMD. The mortality rate and LOS of patients with TMD was higher (7.3% vs. 2.9%, p=0.017) and longer (19 days vs. 8 days, p<0.001) than those without TMD. Multivariate analyses showed that TMD consumption was independently associated with poor nutritional status and prolonged LOS after adjusting confounders. CONCLUSION Daily consumption of a TMD during the premorbid period affects nutritional status at the time of hospitalization and outcomes. Further studies are necessary to investigate whether nutritional intervention can improve outcomes for people on a TMD.
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Affiliation(s)
- K Maeda
- Keisuke Maeda, M.D., Ph.D., Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan, Phone: +81-561-62-3311; Fax: +81-561-78-6364, E-mail:
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17
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Predictors of post-stroke fever and infections: a systematic review and meta-analysis. BMC Neurol 2018; 18:49. [PMID: 29685118 PMCID: PMC5913801 DOI: 10.1186/s12883-018-1046-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/13/2018] [Indexed: 01/21/2023] Open
Abstract
Background Fever after stroke is common, and often caused by infections. In the current study, we aimed to test the hypothesis that pneumonia, urinary tract infection and all-cause fever (thought to include at least some proportion of endogenous fever) have different predicting factors, since they differ regarding etiology. Methods PubMed was searched systematically for articles describing predictors for post-stroke pneumonia, urinary tract infection and all-cause fever. A total of 5294 articles were manually assessed; first by title, then by abstract and finally by full text. Data was extracted from each study, and for variables reported in 3 or more articles, a meta-analysis was performed using a random effects model. Results Fifty-nine articles met the inclusion criteria. It was found that post-stroke pneumonia is predicted by age OR 1.07 (1.04–1.11), male sex OR 1.42 (1.17–1.74), National Institutes of Health Stroke Scale (NIHSS) OR 1.07 (1.05–1.09), dysphagia OR 3.53 (2.69–4.64), nasogastric tube OR 5.29 (3.01–9.32), diabetes OR 1.15 (1.08–1.23), mechanical ventilation OR 4.65 (2.50–8.65), smoking OR 1.16 (1.08–1.26), Chronic Obstructive Pulmonary Disease (COPD) OR 4.48 (1.82–11.00) and atrial fibrillation OR 1.37 (1.22–1.55). An opposite relation to sex may exist for UTI, which seems to be more common in women. Conclusions The lack of studies simultaneously studying a wide range of predictors for UTI or all-cause fever calls for future research in this area. The importance of new research would be to improve our understanding of fever complications to facilitate greater vigilance, monitoring, prevention, diagnosis and treatment.
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18
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Yan T, Liu C, Li Y, Xiao W, Li Y, Wang S. Prevalence and predictive factors of urinary tract infection among patients with stroke: A meta-analysis. Am J Infect Control 2018; 46:402-409. [PMID: 29153643 DOI: 10.1016/j.ajic.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is thought to be a common complication of stroke and is regarded as a potential risk factor for poor stroke outcomes. However, there is a controversy among predictive factors of stroke-associated UTIs. We aim to estimate the prevalence and predisposing factors of UTIs among patients with stroke. METHODS PubMed, EMBASE, and Elsevier Science Direct were searched by 2 independent researchers. Sixteen studies with a total of 13,513 patients were included to evaluate the prevalence and predictive factors of stroke-associated UTIs published from the earliest records to March 10, 2017. Pooled effect sizes were calculated using the fixed effect model or random effect model according to I2 and P values. RESULTS The pooled prevalence of UTI was 19.0% (95% confidence interval [CI], 15%-22%; P <.01). The predisposing factors for UTIs include female sex (odds ratio [OR], 1.93; 95% CI, 1.55-2.41), older age (OR, 1.28; 95% CI, 1.09-1.50), higher modified Rankin Scale score (OR, 1.90; 95% CI, 1.43-2.53), and postvoid residual volume >100 mL (OR, 3.69; 95% CI, 2.09-6.52). CONCLUSIONS Approximately one-fifth of patients with stroke contracted at least 1 UTI after cerebral apoplexy. Female sex, older age, higher modified Rankin Scale score, and postvoid residual volume >100 mL were associated with higher risk of UTI.
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Affiliation(s)
- Tianyuan Yan
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Chenxia Liu
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Yingxia Li
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Wei Xiao
- Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Yating Li
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Shuhui Wang
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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Infections Diagnosed after Admission to a Stroke Unit and Their Impact on Hospital Mortality in Poland from 1995 to 2015. J Stroke Cerebrovasc Dis 2018. [PMID: 29526387 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Implementation of modern stroke unit care might have attenuated the negative effect of infections on stroke outcome. Our aim was to investigate changes in the occurrence of pneumonia and urinary infections diagnosed after admission to experienced Polish stroke center between 1995 and 2015, and their association with hospital mortality. MATERIALS AND METHODS This is a retrospective registry-based analysis of consecutive patients with acute stroke from highly urbanized area (Warsaw, Poland) in years 1995-2015. A total of 5174 patients were divided to 4 time periods: 1995-2000 (n = 883), 2001-2006 (n = 1567), 2006-2010 (n = 1539), and 2011-2015 (n = 1183). Odds ratios (ORs) for hospital death were calculated after adjustment for age, congestive heart failure, preexisting disability, stroke type, and baseline neurological deficit, separately in years 1995-2015, 1995-2000, and 2011-2015. RESULTS Over time there was a significant decrease in the proportion of patients diagnosed with pneumonia (20%, 19%, 9%, and 15%, respectively) or urinary tract infection (29%, 21%, 24%, and 18%, respectively) and in the proportion of patients having body temperature of 38.0°C or higher at least once within first 7 days of hospital stay (20%, 20%, 13%, and 13%, respectively), without significant change in the use of antibiotics (range 35%-37%). Hospital mortality was strongly predicted by pneumonia (OR 3.6-4.2) and fever (OR 2.7-4.7) but not urinary infections. CONCLUSIONS Over the last 2 decades there was a decrease in the proportion of patients with acute stroke diagnosed with pneumonia or urinary tract infection during stroke unit stay. Hospital death was strongly predicted by pneumonia and fever but no by urinary infections.
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20
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Urinary Incontinence and Indwelling Urinary Catheters as Predictors of Death after New-Onset Stroke: A Report of the South London Stroke Register. J Stroke Cerebrovasc Dis 2018; 27:118-124. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/12/2017] [Indexed: 11/19/2022] Open
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21
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Ruborg R, Gunnarsson K, Ström JO. Predictors of post-stroke body temperature elevation. BMC Neurol 2017; 17:218. [PMID: 29237408 PMCID: PMC5729487 DOI: 10.1186/s12883-017-1002-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Growing evidence indicates that elevated body temperature after stroke is associated with unfavorable outcome. The aim of the current study was to investigate which factors predict temperature elevation within 48 h of stroke onset. Specifically, we hypothesized that temperature elevation would be associated with stroke symptom severity and that hemorrhagic stroke would cause a more pronounced temperature increase compared to ischemic stroke. Methods The medical records of 400 stroke patients were retrospectively reviewed. Multiple linear regression analysis was used to determine which factors were associated with elevated body temperature. Results Several factors were significantly associated with peak body temperature (the highest recorded body temperature) within 48 h of stroke onset: stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS) (regression coefficient; (RC) 0.022), female gender (RC 0.157), tympanic/non-rectal temperature reading (RC −0.265), swallowing difficulties (RC 0.335), intubation (RC 0.470), antipyretic treatment (RC 0.563), and C-reactive protein > 50 or signs of infection at admission (RC 0.298). Contrary to our expectations, patients with intracerebral hemorrhage did not have higher peak body temperatures than patients with ischemic stroke. Conclusions In conclusion, temperature elevation within the first 48 h of stroke onset is common, can be partially predicted using information at admission and is strongly associated with stroke severity. The strong association with stroke severity may, at least partly, explain the previously described association between post-stroke temperature elevation and unfavorable outcome.
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Affiliation(s)
- Rebecca Ruborg
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Gunnarsson
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jakob O Ström
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. .,Region Örebro Län, Neuro- och rehabmedicinska kliniken, Södra Grev Rosengatan, 701 85, Örebro, Sweden.
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Maeda K, Koga T, Akagi J. Tentative nil per os leads to poor outcomes in older adults with aspiration pneumonia. Clin Nutr 2016; 35:1147-52. [DOI: 10.1016/j.clnu.2015.09.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/23/2015] [Accepted: 09/26/2015] [Indexed: 11/24/2022]
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23
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Zhang H. Progress in Research on the Mechanism and Treatment of Post-stroke Infection. INFECTION INTERNATIONAL 2016. [DOI: 10.1515/ii-2017-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractPost-stroke infection hinders the recovery of stroke patients and can even cause death. The main mechanism of post-stroke infection is related with the post-stroke center, the activation of the peripheral immune system, and the release of inflammatory factors caused by the lesion area and pathophysiological changes in the body. Therefore, elucidating the body’s abnormal immune inflammatory responses after stroke is crucial for the prevention, treatment, and alleviation of post-stroke infection.
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Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0158992. [PMID: 27410965 PMCID: PMC4943733 DOI: 10.1371/journal.pone.0158992] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/25/2016] [Indexed: 12/16/2022] Open
Abstract
Background The association between urinary incontinence (UI) and increased mortality remains controversial. The objective of our study was to evaluate if this association exists. Methods We performed a systematic review and meta-analysis of observational studies comparing death rates among patients suffering from UI to those without incontinence. We searched in Medline, Embase and the Cochrane library using specific keywords. Studies exploring the post-stroke period were excluded. Hazard ratios (HR) were pooled using models with random effects. We stratified UI by gender and by UI severity and pooled all models with adjustment for confounding variables. Results Thirty-eight studies were retrieved. When compared to non-urinary incontinent participants, UI was associated with an increase in mortality with pooled non adjusted HR of 2.22 (95%CI 1.77–2.78). The risk increased with UI severity: 1.24 (95%CI: 0.79–1.97) for light, 1.71 (95%CI: 1.26–2.31) for moderate, and 2.72 (95%CI: 1.90–3.87) for severe UI respectively. When pooling adjusted measures of association, the resulting HR was 1.27 (95%CI: 1.13–1.42) and increased progressively for light, moderate and severe UI: 1.07 (95%CI: 0.79–1.44), 1.25 (95%CI: 0.99–1.58), and 1.47 (95%CI: 1.03–2.10) respectively. There was no difference between genders. Conclusion UI is a predictor of higher mortality in the general and particularly in the geriatric population. The association increases with the severity of UI and persists when pooling models adjusted for confounders. It is unclear if this association is causative or just reflects an impaired general health condition. As in most meta-analyses of observational studies, methodological issues should be considered when interpreting results.
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25
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Crary MA. Adult Neurologic Disorders. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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