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Kanazawa K, Miyamoto N, Hira K, Kijima C, Hattori N. Relative score of early neurological deterioration in perforator artery infarction: a retrospective study. BMC Neurol 2024; 24:298. [PMID: 39198817 PMCID: PMC11350949 DOI: 10.1186/s12883-024-03807-9] [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] [Received: 07/18/2023] [Accepted: 08/14/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND AND AIMS Compared to small vessel occlusion (SVO) patients, branch atheromatous disease (BAD) patients are more likely to develop early neurological deterioration (END). Stroke patients with END have a poor prognosis. Initial clinical features/radiological findings are often insufficient to distinguish between BAD and SVO; therefore, they may not detect END. In this retrospective study, we investigated relative factors for END in perforator artery infarction and created a scoring system for END in these patients. METHODS We extracted data from stroke patients with perforator artery infarction admitted to the Department of Neurology at Juntendo University between January 2016 and December 2022. We examined factors, such as the presence of SVO and BAD, leading to END. Variables with a P-value < 0.1 on univariate analysis were entered into binominal logistic regression analysis. RESULTS Of the 1,420 stroke patients admitted over a 7-year period, 201 with perforator infarction were included in this study. END was found in 27 of 201 patients (13.4%). Binominal logistic regression analysis of background factors less than p < 0.1 revealed that age > 69 (P = 0.032; odds ratio [OR], 3.941; 95% confidence interval [CI], 1.126-13.769), body mass index < 23.8 (P = 0.041; OR, 3.183; 95%CI, 1.049-9.654), and pretreatment with anti-platelets (P = 0.003; OR, 5.183; 95%CI, 1.783-15.071) were significant factors. Regarding anti-platelet therapy, END was observed in 34.4% of patients administered aspirin and 35.0% administered clopidogrel. Initial infarct lesion size over 15 mm on initial MRI had a P value of 0.076 in univariate analysis and an odds ratio of 1.330 (95% CI 0.471-3.755; P = 0.590) in binomial logistic regression analysis. The length of stay and modified Rankin Scale at discharge were significantly exacerbated in the END group. Creating a scoring system with 1 point for each relevant factor (pEND score), significant correlations were obtained with ROC curves, and over 2 points produced the highest sensitivity and specificity for detecting END. CONCLUSION Patients with high pEND scores may require intensive care from early hospitalization. In addition, the occurrence of stroke during anti-platelet therapy suggests the need for alternative treatment.
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Affiliation(s)
- Kazo Kanazawa
- Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113- 0033, Japan
| | - Nobukazu Miyamoto
- Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113- 0033, Japan.
| | - Kenichiro Hira
- Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113- 0033, Japan
| | - Chikage Kijima
- Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113- 0033, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113- 0033, Japan
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Zhang J, Luo Z, Zeng Y. Predictive Modeling of Early Neurological Deterioration in Patients with Acute Ischemic Stroke. World Neurosurg 2024; 191:58-67. [PMID: 39127376 DOI: 10.1016/j.wneu.2024.08.017] [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: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Ischaemic stroke is the leading cause of death worldwide, and early neurological deterioration(END) occurs in 20%-40% of patients, which is the main cause of severe neurological deficits and disability, and even increased mortality. The occurrence of END is closely related to the poor prognosis of the patients, so it is important to identify the risk factors for the occurrence of END in patients with AIS and target intervention at an early stage factors and targeted intervention is of great significance. METHODS Up to December 20, 2023, a comprehensive search was conducted across PubMed, Embase, Web of Science, MedLine, and The Cochrane Library for studies focusing on predictive models for END in acute stroke patients. Included studies either developed or validated predictive models. The Prediction Model Risk of Bias Assessment tool was utilized to assess bias in these prediction models. Pooled area under the curve values were calculated using DerSimonian and Laird random-effects model. RESULTS Nineteen studies, each presenting an original model, were identified. Predominantly constructed through logistic multiple regression, these models demonstrated robust predictive performance (area under the curve ≥0.80). Key predictors of END in acute ischemic stroke patients included blood glucose levels, baseline National Institute of Health Stroke Scale scores, extent of cerebral infarction, and stenosis in the carotid and middle cerebral arteries. DISCUSSION Clinical practitioners should closely monitor high-frequency predictors of END in patients. However, the varying quality of current models necessitates the selection of models that balance performance with operational simplicity in clinical practice.
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Affiliation(s)
- Jing Zhang
- Operating Room, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Zhifang Luo
- Operating Room, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
| | - Ying Zeng
- Operating Room, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
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Heitkamp C, Winkelmeier L, Heit JJ, Albers GW, Lansberg MG, Kniep H, Broocks G, Stracke CP, Schell M, Guenego A, Paech D, Wintermark M, Fiehler J, Faizy TD. Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow. Eur Stroke J 2024; 9:162-171. [PMID: 38069665 PMCID: PMC10916832 DOI: 10.1177/23969873231208277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/29/2023] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION Early neurological deterioration (END) is associated with poor outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Causes of END after mechanical thrombectomy (MT) include unsuccessful recanalization and reperfusion hemorrhages. However, little is known about END excluding the aforementioned causes. We aimed to investigate factors associated with unexplained END (ENDunexplained) with regard to the cerebral collateral status. PATIENTS AND METHODS Multicenter retrospective study of AIS-LVO patients with successful MT (mTICI 2b-3). On admission CT angiography (CTA), pial arterial collaterals and venous outflow (VO) were assessed using the modified Tan-Scale and the Cortical Vein Opacification Score (COVES), respectively. ENDunexplained was defined as an increase in NIHSS score of ⩾ 4 within the first 24 hours after MT without parenchymal hemorrhage on follow-up imaging. Multivariable regression analyses were performed to examine factors of ENDunexplained and unfavorable functional outcome (modified Rankin Scale score 3-6). RESULTS A total of 620 patients met the inclusion criteria. ENDunexplained occurred in 10% of patients. While there was no significant difference in pial arterial collaterals, patients with ENDunexplained exhibited more often unfavorable VO (81% vs. 53%; P < 0.001). Unfavorable VO (aOR [95% CI]; 2.56 [1.02-6.40]; P = 0.045) was an independent predictor of ENDunexplained. ENDunexplained was independently associated with unfavorable functional outcomes at 90 days (aOR [95% CI]; 6.25 [2.06-18.94]; P = 0.001). DISCUSSION AND CONCLUSION Unfavorable VO on admission CTA was associated with ENDunexplained. ENDunexplained was independently linked to unfavorable functional outcomes at 90 days. Identifying AIS-LVO patients at risk of ENDunexplained may help to select patients for intensified monitoring and guide to optimal treatment regimes.
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Affiliation(s)
- Christian Heitkamp
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory W Albers
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten G Lansberg
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Paul Stracke
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
- Department of Neuroradiology, University Hospital Muenster, Muenster, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Adrien Guenego
- Department of Neuroradiology, Erasme Medical Center, Brussels, Belgium
| | - Daniel Paech
- Clinic for Neuroradiology, University Hospital Bonn, Germany
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, TX, USA
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
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Jin M, Peng Q, Wang Y. Post-thrombolysis early neurological deterioration occurs with or without hemorrhagic transformation in acute cerebral infarction: risk factors, prediction model and prognosis. Heliyon 2023; 9:e15620. [PMID: 37144189 PMCID: PMC10151352 DOI: 10.1016/j.heliyon.2023.e15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/25/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives Early neurological deterioration (END) after ischemic stroke is a severe clinical event and can be caused by hemorrhagic and ischemic injury. We studied the difference between the risk factors of END occurs with or without hemorrhagic transformation after intravenous thrombolysis. Materials and methods Consecutive cerebral infarction patients who underwent intravenous thrombolysis from 2017 to 2020 in our hospital were retrospectively recruited. END was defined as a ≥2 points increase on 24-h National Institutes of Health Stroke Scale (NIHSS) score after therapy compared with the best neurological status after thrombolysis and divided into two types based on the computed tomography (CT): symptomatic intracranial hemorrhage (ENDh) and non-hemorrhagic factors (ENDn). Potential risk factors of ENDh and ENDn were assessed by multiple logistic regression and applied to establish the prediction model. Results A total of 195 patients were included. In multivariate analysis, the previous history of cerebral infarction (odds ratio [OR],15.19; 95% confidence interval [CI],1.43-161.17; P = 0.025), previous history of atrial fibrillation (OR,8.43; 95%CI,1.09-65.44; P = 0.043), higher baseline NIHSS score (OR,1.19; 95%CI,1.03-1.39; P = 0.022) and higher alanine transferase level (OR,1.05; 95%CI, 1.01-1.10; P = 0.016) were independently associated with ENDh. While higher systolic blood pressure (OR,1.03; 95%CI,1.01-1.05; P = 0.004), higher baseline NIHSS score (OR,1.13; 95%CI,2.86-27.43; P < 0.000) and large artery occlusion (OR,8.85, 95%CI,2.86-27.43; P < 0.000) were independent risk factors of ENDn. The prediction model showed good specificity and sensitivity in predicting the risk of ENDn. Conclusions There are differences between the major contributors to ENDh and ENDn, while a severe stroke can increase the occurrence of both sides.
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Affiliation(s)
- Mengzhi Jin
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang University
| | - Qingxia Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yidong Wang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat‑Sen Memorial Hospital, Sun Yat-Sen University
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University
- Corresponding author. No. 107 Yan Jiang Road West, Guangzhou 510120, Guangdong Province, China.
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Lee HJ, Kim T, Koo J, Kim YD, Na S, Choi YH, Song IU, Chung SW. Multiple chronic lacunes predicting early neurological deterioration and long-term functional outcomes according to TOAST classification in acute ischemic stroke. Neurol Sci 2023; 44:611-619. [PMID: 36255539 DOI: 10.1007/s10072-022-06446-5] [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] [Received: 09/06/2022] [Accepted: 10/06/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Studies regarding multiple chronic lacunes (MCLs) and clinical outcome according to stroke etiology are scarce. We sought to evaluate the association between MCL and short-term/long-term clinical outcomes according to stroke etiology. PATIENTS AND METHODS We analyzed a prospectively collected stroke registry of acute ischemic stroke patients over 4 years. The enrolled patients were classified as having large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic (CE) stroke, and other etiology. The early neurological deterioration (END) and favorable outcome at 3 months were assessed. RESULTS A total of 1070 patients were enrolled. Patients with MCL had significantly more END compared to those without MCL both in total population (adjusted odds ratio (OR), 1.7; 95% confidence interval [CI], 1.1-2.5; p = 0.013*) and in the LAA group (adjusted OR, 2.3; 95% CI, 1.3-4.2, p < 0.006). Patients with MCL had a significantly lower OR for favorable outcome at 3 months compared to those without MCL both in total population (adjusted OR, 0.7; 95% CI, 0.5-1.0, p = 0.035) and in the LAA group (adjusted OR, 0.6; 95% CI, 0.3-1.0, p = 0.043). However, MCL was not associated with END or long-term functional outcome in patients with SVO, CE, or other etiology. CONCLUSIONS The presence of MCL was an independent predictive factor for END as well as long-term poor functional outcome in acute ischemic stroke patients. These associations were only observed in patients with LAA, not in those with SVO, CE, or other etiology.
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Affiliation(s)
- Hyuk-Je Lee
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Taewon Kim
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea.
| | - Jaseong Koo
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young-Do Kim
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Seunghee Na
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Yun Ho Choi
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - In-Uk Song
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
| | - Sung-Woo Chung
- Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea
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Relationship between Neurological Deterioration and Blood Pressure/Heart Rate Variability in Patients with Acute Cerebral Infarction. J Stroke Cerebrovasc Dis 2022; 31:106504. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
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Xie X, Xiao J, Wang Y, Pan L, Ma J, Deng L, Yang J, Ren L. Predictive Model of Early Neurological Deterioration in Patients with Acute Ischemic Stroke: A Retrospective Cohort Study. J Stroke Cerebrovasc Dis 2021; 30:105459. [PMID: 33387889 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to develop a predictive model of early neurological deterioration (END) in patients with acute ischemic stroke (AIS). METHODS The present retrospective cohort study considered patients with AIS who were admitted to a tertiary hospital in Shenzhen, China between January 2014 and December 2018. An increase of 2 points or more on the National Institute of Health Stroke Scale (NIHSS) within 7 days indicated END. We selected baseline clinical, laboratory, and neuroimaging variables to construct predictive models through multivariate logistic regression. The receiver operating characteristic curve and calibration plots were calculated. RESULTS A total of 391 patients with AIS were enrolled in the study. END was observed in 64 (16.4%) cases. A prediction model developed from the initial NIHSS score, middle cerebral artery stenosis, and carotid stenosis of≥ 50% showed good discriminative ability: area under the receiver operating characteristic curve, 0.870 (95%CI, 0.813-0.911); threshold, -1.570; specificity, 84.40%; sensitivity, 75.00%; positive predictive value, 48.48%; and a negative predictive value, 94.52%. CONCLUSION Our predictive model developed from the initial NIHSS score, middle cerebral artery stenosis, and carotid stenosis of ≥ 50% could identify patients with AIS who were at risk of developing END. The model requires validation by larger studies performed at other institutions.
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Affiliation(s)
- Xiaohua Xie
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 518035 Shenzhen, China.
| | - Jingyi Xiao
- School of Nursing, Guangzhou Medical University, Guangzhou 510030, China.
| | - Yunyun Wang
- Department of Nursing, Children's Hospital of Anhui Medical University, Heifei, 230000, China.
| | - Lu Pan
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 518035 Shenzhen, China.
| | - Jiahui Ma
- Clinical College of The Second Shenzhen Hospital, Anhui Medical University, Shenzhen, 518035, China.
| | - Liping Deng
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 518035 Shenzhen, China.
| | - Jie Yang
- Clinical College of The Second Shenzhen Hospital, Anhui Medical University, Shenzhen, 518035, China.
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen, Guangdong 518035, China.
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Huang ZX, Gu HQ, Yang X, Wang CJ, Wang YJ, Li ZX. Risk factors for in-hospital mortality among acute ischemic stroke patients in China: a nationwide prospective study. Neurol Res 2020; 43:387-395. [PMID: 33357098 DOI: 10.1080/01616412.2020.1866356] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: We aimed to investigate factors related to in-hospital mortality (IHM) in acute ischemic stroke (AIS) patients.Methods: We prospectively investigated 827,314 patients who were admitted within 7 days of AIS between August 2015 and July 2019. Demographic characteristics, risk factors, and clinical and laboratory characteristics of patients were assessed. Univariate and multivariate logistic regression analyses were performed to identify predictors associated with IHM.Results: The IHM rate in this study was 0.5% in women and 0.3% in men. Factors associated with IHM in AIS included diabetes (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.03-1.43), female (OR 0.84, 95%CI 0.74-0.96), hypertension (OR 1.16, 95%CI 1.01-1.34), atrial fib/flutter (OR 1.51, 95%CI 1.29-1.77), other heart disease (OR1.43, 95%CI 1.23-1.67), prior myocardial infarction (OR 2.00, 95%CI 1.54-2.60), antiplatelet therapies (OR 0.71, 95%CI 0.60-0.84), gastrointestinal bleeding (OR 3.54, 95%CI 2.83-4.44), pulmonary embolism (OR 2.53, 95%CI1.41-4.53), dysphagia(OR7.32, 95%CI6.23-8.61), glycosylated hemoglobin (OR1.05, 95%CI 1.02-1.09), serum creatinine (OR 1.001, 95%CI 1.001-1.002), urea nitrogen (OR 1.10, 95%CI 1.08-1.12), National Institutes of Health Stroke Scale (NIHSS) score (4-5 vs. 0-4: OR 3.58; ≥15 vs. 0-4: OR 8.78), stroke rehabilitation (OR 0.27, 95%CI 0.23-0.30), age (third IQR vs. first IQR: OR 1.57; fourth IQR vs. first IQR: OR 2.23), and in-hospital stroke/TIArecurrence (OR 2.38, 95%CI 2.03-2.78).Conclusions: The findings from this study may help clinicians control the risk of IHM better for patients with AIS.
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Affiliation(s)
- Zhi-Xin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.,Department of Neurology, The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Hong-Qiu Gu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chun-Juan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zi-Xiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Xu Y, Chen Y, Chen R, Zhao F, Wang P, Yu S. External Validation of the WORSEN Score for Prediction the Deterioration of Acute Ischemic Stroke in a Chinese Population. Front Neurol 2020; 11:482. [PMID: 32547483 PMCID: PMC7272667 DOI: 10.3389/fneur.2020.00482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/04/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Early neurological deterioration (END) has been recognized as a serious neurological complication after acute ischemic stroke. However, to date, the WORSEN score was the only one scoring system specifically developed to detect END events in acute ischemic stroke patients. The purpose of this study was to investigate the WORSEN score's utility in China, and to determine the potential predictors of END in acute stroke patients. Methods: Consecutive patients with acute ischemic stroke admitted to the Department of Neurology, Aerospace Center Hospital between March 2015 to February 2017 were recruited into the study's cohort and divided into two groups: patients with and without END. END was defined as either an increase in two or more NIHSS points, an increment of at least one point in motor power or a description of fluctuating of clinical symptoms in medical reports during the first 7 days after admission. Severe END was defined as an increase of NIHSS ≥ 4 points from baseline during the first 7 days after admission. Results: Three hundred fifty four patients with acute ischemic stroke were enrolled in the present study and 67.5% were male. END occurred in 90 of these patients and severe END occurred in 55 of these patients. Logistic regression analysis showed that an initial NIHSS score ≥8, diameter of infarction, striatocapsular infarction, and TOAST type of large arterial atherosclerosis were independent predictors for END. The area under the ROC curve (AUC) of the WORSEN score for the prediction of END was 0.80 (95%CI 0.75-0.84), with a sensitivity of 62.22%, a specificity of 88.26%, positive predictive values of 64.37% and negative predictive values of 87.27%. Meanwhile, the AUC of the WORSEN score for the prediction of severe END was 0.82 (95%CI 0.78-0.86), with a sensitivity of 70.91%, specificity of 83.95%, positive predictive values of 44.83% and negative predictive values of 94.01%. Conclusion: END is a relatively common neurological complication in patients with acute ischemic stroke. Our findings showed that the WORSEN score had a good predictive value for identifying patients with END in a Chinese population. Moving forward, multi-center studies are required for further validations.
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Affiliation(s)
- Yicheng Xu
- Medical School of Chinese People's Liberation Army, Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Chen
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Ruiwei Chen
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Fei Zhao
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Peifu Wang
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Shengyuan Yu
- Medical School of Chinese People's Liberation Army, Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing, China
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Liu B, Zhang H, Wang R, Qu H, Sun Y, Zhang W, Zhang S. Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease. J Int Med Res 2020; 48:300060520926298. [PMID: 32459110 PMCID: PMC7273788 DOI: 10.1177/0300060520926298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To investigate the effects of early administration of tirofiban after
intravenous thrombolysis on early neurological deterioration in patients
with branch atheromatous disease. Methods We analyzed clinical data from patients with branch atheromatous disease. We
enrolled seven cases into the urokinase-only (UO) control group and 10 cases
into the urokinase + tirofiban (UT) treatment group. National Institutes of
Health Stroke Scale (NIHSS) scores were obtained at admission and on days 3
and 5 after admission. Modified Rankin Scale (mRS) scores were obtained 3
months after admission. Results Significant differences between the UO and UT groups were evident on days 3
and 5 after admission. In the UT group, there was a significant difference
between NIHSS scores at admission and on day 5, while there were no
significant differences in scores in the UO group. The early neurological
deterioration rates were not significantly different between the two groups.
However, there were significant differences in these rates at 72 and 120
hours. Both the mRS scores and the prognoses at 3 months differed between
the two groups. Conclusion Early administration of tirofiban after urokinase-mediated intravenous
thrombolysis reduces early neurological deterioration and improves the
long-term prognosis of patients with branch atheromatous disease.
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Affiliation(s)
- Bin Liu
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Hong Zhang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Rong Wang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Hongdang Qu
- Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Yifei Sun
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Wanlong Zhang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Shuye Zhang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
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Shaafi S, Sharifi-Bonab M, Ghaemian N, Mokhtarkhani M, Akbari H. Early Motor-Behavioral Outcome of Ischemic Stroke with Ketogenic Diet Preconditioning: Interventional Animal Study. J Stroke Cerebrovasc Dis 2019; 28:1032-1039. [PMID: 30658953 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/25/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cerebral stroke, with ischemic stroke being its most common type, is the leading cause of chronic disability. The ketogenic diet has been used for treating seizures for centuries and has been considered to be a treatment for other neurologic diseases in recent years. The goal of this study is to evaluate the effects of ketogenic diet preconditioning on the early motor-behavior outcome of rats with induced cerebral ischemic stroke. METHODS Twenty-four rats were surveyed in 3 groups of Main, Control, and Sham. The Main group received a ketogenic diet plus medium chain triglyceride oil starting 3 days prior to stroke induction, while the other 2 groups took a normal diet. Subsequently, Endothelin-1 was injected stereotactically near the middle cerebral artery to induce an ischemic stroke in the Main and Control group. Normal saline was injected to the members of the Sham group with the same technique. The motor-behavior functions of the rats were compared between 3 groups using adjusting step, beam, and cylinder tests. RESULTS After stroke induction, rats on ketogenic diet were able to adjust their steps more efficiently, moved faster on the beam, and used their hands more symmetrically in the transparent cylinder in relation to the rats in the Control group. CONCLUSION It seems that ketogenic diet preconditioning improves the early motor-behavioral outcome of ischemic stroke.
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Affiliation(s)
- Sheida Shaafi
- Department of Neurology, Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
| | - Mirmohsen Sharifi-Bonab
- Department of Neurology, Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran.
| | - Neda Ghaemian
- Department of Neurology, Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
| | - Mohaddeseh Mokhtarkhani
- Iranian Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossen Akbari
- Department of Neurology, Tabriz University of Medical Sciences, Razi Hospital, Tabriz, Iran
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Widhi Nugroho A, Arima H, Takashima N, Fujii T, Shitara S, Miyamatsu N, Sugimoto Y, Nagata S, Komori M, Kita Y, Miura K, Nozaki K. The JAGUAR Score Predicts 1-Month Disability/Death in Ischemic Stroke Patient Ineligible for Recanalization Therapy. J Stroke Cerebrovasc Dis 2018; 27:2579-2586. [PMID: 29941394 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/08/2018] [Accepted: 05/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Most available scoring system to predict outcome after acute ischemic stroke (AIS) were established in Western countries. We aimed to develop a simple prediction score of 1-month severe disability/death after onset in AIS patients ineligible for recanalization therapy based on readily and widely obtainable on-admission clinical, laboratory and radiological examinations in Asian developing countries. METHODS Using the Shiga Stroke Registry, a large population-based registry in Japan, multivariable logistic regression analysis was conducted in 1617 AIS patients ineligible for recanalization therapy to yield ß-coefficients of significant predictors of 1-month modified Rankin Scale score of 5-6, which were then multiplied by a specific constant and rounded to nearest integer to develop 0-10 points system. Model discrimination and calibration were evaluated in the original and bootstrapped population. RESULTS Japan Coma Scale score (J), age (A), random glucose (G), untimely onset-to-arrival time (U), atrial fibrillation (A), and preadmission dependency status according to the modified Rankin Scale score (R), were recognized as independent predictors of outcome. Each of their β-coefficients was multiplied by 1.3 creating the JAGUAR score. Its area under the curve (95% confidence interval) was .901 (.880- .922) and .901 (.900- .901) in the original and bootstrapped population, respectively. It was found to have good calibration in both study population (P = .27). CONCLUSIONS The JAGUAR score can be an important prediction tool of severe disability/death in AIS patients ineligible for recanalization therapy that can be applied on admission with no complicated calculation and multimodal neuroimaging necessary, thus suitable for Asian developing countries.
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Affiliation(s)
- Aryandhito Widhi Nugroho
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan; Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan; Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Takako Fujii
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Satoshi Shitara
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Yoshihisa Sugimoto
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan; Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science, Otsu, Japan
| | - Satoru Nagata
- Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science, Otsu, Japan
| | - Masaru Komori
- Department of Fundamental Biosciences, Shiga University of Medical Science, Otsu, Japan
| | - Yoshikuni Kita
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan; Department of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
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13
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Ayubi E, Safiri S. Comments on Analysis of the Usefulness of the WORSEN Score for Predicting the Deterioration of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:3032. [PMID: 28967589 DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Erfan Ayubi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran..
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