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Cao F, Wan Y, Lei C, Zhong L, Lei H, Sun H, Zhong X, Xiao Y. Monocyte-to-lymphocyte ratio as a predictor of stroke-associated pneumonia: A retrospective study-based investigation. Brain Behav 2021; 11:e02141. [PMID: 33942561 PMCID: PMC8213641 DOI: 10.1002/brb3.2141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Early prediction of stroke-associated pneumonia (SAP) is significant in clinical practice, as it is frequently challenging due to delays in typical clinical manifestations and radiological changes. The monocyte-to-lymphocyte ratio (MLR) has been proposed as an indicator of systemic inflammation and infection. However, none of these studies have focused on the predictive value of the MLR for SAP. We investigated the predictive value of MLR for SAP and investigated its relationship with disease severity. METHODS In this retrospective study, we assessed 399 consecutive patients with acute stroke. SAP was defined according to the modified Centers for Disease Control and Prevention criteria. The severity of pneumonia was rated using the pneumonia severity index (PSI). MLR was calculated by dividing absolute monocyte counts by absolute lymphocyte counts. RESULTS Among all the patients, SAP occurred in 116 patients (29.1%). White blood cell (WBC), neutrophil, monocyte, and MLR levels in the SAP group were higher than those in the non-SAP group, while lymphocyte levels were lower (p < .05). Multivariable regression analysis revealed that the MLR (OR = 7.177; 95% CI = 1.190-43.292, p = .032) remained significant after adjusting for confounders. The ROC curve showed that the AUC value of MLR for SAP was 0.779, the optimal cutoff value of MLR for SAP was 0.388, with a specificity of 64.7% and sensitivity of 81.3%. The MLR levels were significantly higher in the severe pneumonia group when assessed by PSI (p = .024) than in the mild group. The AUC value of MLR was 0.622 (95% CI = 0.520-0.724, p = .024) in the severe pneumonia group. The optimal cutoff value of MLR was 0.750, with a specificity of 91.0% and a sensitivity of 33.0%. CONCLUSIONS Our study shows that a high MLR is an independent risk factor for SAP and has a predictive value for severe pneumonia in patients with SAP.
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Affiliation(s)
- Feng Cao
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu Wan
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chunyan Lei
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - LianMei Zhong
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - HongTao Lei
- School of Public Health, Kunming Medical University, Kunming, China
| | - Haimei Sun
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xing Zhong
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - YaDan Xiao
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Zhou H, Zhang M, Sun L, Li W, Liu Q. A simple LC-MS/MS method for simultaneous determination of cilostazol and ambroxol in Sprague-Dawley rat plasma and its application to drug-drug pharmacokinetic interaction study following oral delivery in rats. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1179:122766. [PMID: 34247102 DOI: 10.1016/j.jchromb.2021.122766] [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: 11/09/2020] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Recently, a combination of cilostazol and ambroxol has been used in the clinical treatment of stroke-associated pneumonia (SAP). However, the pharmacokinetic drug-drug interaction (DDI) of cilostazol and ambroxol has not been reported. In this paper, a rapid, reproducible and sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method for simultaneous determination of cilostazol and ambroxol in Sprague-Dawley (SD) rat plasma was established and validated for the first time. Domperidone was used as the internal standard (IS) and one-step liquid-liquid extraction (LLE) method was used to extract analytes and IS from plasma samples with methyl tert-butyl ether as extractant. A rapid chromatographic separation within 4.8 min was carried on an Ultimate ® XB-C18 column with a mobile phase consisting of methanol-acetonitrile-formic acid (0.1%) aqueous solution (90:2:8, v/v/v) at a flow rate of 500 μL/min. The quantitative detection of the analytes and IS were performed on a positive electrospray ionization mode (ESI), and scanned by multi-reaction monitoring (MRM) with the ion transitions m/z 370.3 → m/z 288.2 for cilostazol, m/z 378.8 → m/z 263.8 for ambroxol and m/z 426.2 → m/z 175.1 for domperidone (IS), respectively. It had good linearity in the range of 5.0-1000 ng/mL for cilostazol and 1.0-200 ng/mL for ambroxol in rat plasma. The methodology was fully validated with selectivity, linearity, lower limits of quantification, precision, accuracy, extraction recovery, matrix effect, stability and carry-over effect. The validated data have met the determination requirements of biological samples in FDA guideline. The method was successfully applied to the pharmacokinetics and DDI study of cilostazol and ambroxol in male SD rats. The current study found that the interaction between cilostazol and ambroxol may be caused by CYP3A4 and the pharmacological properties of cilostazol, which may be helpful for therapeutic drug monitoring, clinical dose reference and provide a valuable tool for drug-drug interactions.
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Affiliation(s)
- Hao Zhou
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenhe District, Shenyang 110016, PR China
| | - Min Zhang
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenhe District, Shenyang 110016, PR China
| | - Ling Sun
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenhe District, Shenyang 110016, PR China
| | - Wenfang Li
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenhe District, Shenyang 110016, PR China
| | - Qian Liu
- Department of Pharmaceutical Analysis, School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenhe District, Shenyang 110016, PR China.
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Percutaneous Endoscopic Gastrostomy versus Nasogastric Tube Feeding: Oropharyngeal Dysphagia Increases Risk for Pneumonia Requiring Hospital Admission. Nutrients 2019; 11:nu11122969. [PMID: 31817381 PMCID: PMC6950210 DOI: 10.3390/nu11122969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Aspiration pneumonia is the most common cause of death in patients with percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding. This study aimed to compare PEG versus NGT feeding regarding the risk of pneumonia, according to the severity of pooling secretions in the pharyngolaryngeal region. Methods: Patients were stratified by endoscopic observation of the pooling secretions in the pharyngolaryngeal region: control group (<25% pooling secretions filling the pyriform sinus), pharyngeal group (25–100% pooling secretions filling the pyriform sinus), and laryngeal group (pooling secretions entering the laryngeal vestibule). Demographic data, swallowing level scale score, and pneumonia requiring hospital admission were recorded. Results: Patients with NGT (n = 97) had a significantly higher incidence of pneumonia (episodes/person-years) than those patients with PEG (n = 130) in the pharyngeal group (3.6 ± 1.0 vs. 2.3 ± 2.1, P < 0.001) and the laryngeal group (3.8 ± 0.5 vs. 2.3 ± 2.2 vs, P < 0.001). The risk of pneumonia was significantly higher in patients with NGT than in patients with PEG (adjusted hazard ratio = 2.85, 95% CI: 1.46–4.98, P < 0.001). Cumulative proportion of pneumonia was significantly higher in patients with NGT than with PEG for patients when combining the two groups (pharyngeal + laryngeal groups) (P = 0.035). Conclusion: PEG is a better choice than NGT feeding due to the decrease in risk of pneumonia requiring hospital admission, particularly in patients with abnormal amounts of pooling secretions accumulation in the pyriform sinus or leak into the laryngeal vestibule.
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Pacheco-Castilho AC, Vanin GDM, Dantas RO, Pontes-Neto OM, Martino R. Dysphagia and Associated Pneumonia in Stroke Patients from Brazil: A Systematic Review. Dysphagia 2019; 34:499-520. [PMID: 31111249 DOI: 10.1007/s00455-019-10021-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/15/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
Dysphagia and its associated complications are expected to be relatively more frequent in stroke patients in Brazil than in similar patients treated in developed countries due to the suboptimal stroke care in many Brazilians medical services. However, there is no estimate of dysphagia and pneumonia incidence for the overall stroke population in Brazil. We conducted a systematic review of the recent literature to address this knowledge gap, first screening citations for relevance and then rating full articles of accepted citations. At both levels, judgements were made by two independent raters according to a priori criteria. Fourteen accepted articles underwent critical appraisal and data extraction. The frequency of dysphagia in stroke patients was high (59% to 76%). Few studies assessed pneumonia and only one study stratified patients by both dysphagia and pneumonia, with an increased Relative Risk for pneumonia in patients with stroke and dysphagia of 8.4 (95% CI 2.1, 34.4). Across all articles, we identified bias related to: heterogeneity in number and type of stroke; no rater blinding; and, assessments that were not reproducible, reliable or validated. Despite the high frequency of dysphagia and associated pneumonia in stroke patients in Brazil, the quality of the available literature is low and that there is little research focused on these epidemiologic data. Future rigorously designed studies are in dire need to accurately determine dysphagia incidence and its impact on stroke patients in Brazil. These data will be critical to properly allocate limited national resources that maximize the quality of stroke care.
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Affiliation(s)
- Aline Cristina Pacheco-Castilho
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil.
| | - Gabriela de Martini Vanin
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil
| | - Rosemary Martino
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Nageeb RS, Abozaid MMN, Nageeb GS, Omran AA. Mean platelet volume to platelet count ratio as a laboratory indicator of mortality in pneumonia following ischemic stroke. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:27. [PMID: 30363799 PMCID: PMC6182329 DOI: 10.1186/s41983-018-0028-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 09/17/2018] [Indexed: 02/05/2023] Open
Abstract
Background Platelets have a vital role in antimicrobial host defenses. The objective of this study was to evaluate if increased mean platelet volume to platelet count (MPV/PC) ratio in acute ischemic stroke patients complicated with pneumonia was associated with increased mortality risk. Methods The current study was conducted at Zagazig University Hospitals. It included 500 acute ischemic stroke patients classified as group 1 that included 51 patients complicated with pneumonia after admission and group 2 that included the remaining 449 patients. Clinical assessment was carried out to exclude comorbid medical illnesses likely to interfere with platelet function or morphology. Laboratory investigations including MPV/PC ratio and brain imaging were carried out for all patients. Results There was a significant difference between both groups regarding age, National Institutes of Health Stroke Scale (NIHSS) score, and mortality within 30 days (p = 0.02, 0.03, 0.01). There was a significant difference between survivors and non-survivors of group 1 regarding to pneumonia severity index (PSI) classes IV and V (p = 0.01 and 0.02, respectively). Also, there was a significant difference regarding confusion, urea ≥ 7 mmol/L, respiratory rater ≥ 30 breaths/min, systolic blood pressure ≤ 90 mmHg or diastolic blood pressure ≤ 60 mmHg, and age ≥ 65 years at pneumonia occurrence (CURB-65) scores 3, 4, and 5 (p = 0.03, 0.02, and 0.01, respectively). Moreover, there was a significant difference regarding decreased GCS score at pneumonia occurrence, higher NIHSS scores, PSI, and higher MPV/PC ratio (p = 0.01, 0.01, 0.028, and 0.01, respectively). Age > 65 years, need for mechanical ventilation, GCS score of > 9, PSI class ≥ IV, CURB-65 scores ≥ 3, and increased MPV/PC ratio were all significantly associated with 30-day mortality in group 1 (p = 0.03, 0.01, 0.001, 0.04, 0.01, and 0.03, respectively). The predictors of 30-day mortality risk factors were GCS less than 9, increased MPV/PC ratio, and CURB-65 scores ≥ 3 (p = 0.001, 0.05, and 0.01, respectively). Conclusions Once pneumonia develops, MPV/PC ratio could be considered a significant laboratory indicator of 30-day mortality.
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Affiliation(s)
- Rania S Nageeb
- 1Department of Neurology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | | | - Ghada S Nageeb
- 3Department of Rheumatology & Rehabilitation, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Alaa A Omran
- 4Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
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Güngen BD, Tunç A, Aras YG, Gündoğdu AA, Güngen AC, Bal S. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program. BMC Neurol 2017; 17:132. [PMID: 28693521 PMCID: PMC5504678 DOI: 10.1186/s12883-017-0912-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 07/05/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. METHODS This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. RESULTS Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (p<0.001; r=0.440, r=0.432, r=0.339 and r=0.410, respectively). One and three months mortality- ICU admission had a statistically significant relationship with parenteral nutrition (p<0.001; r=0.346, r=0.300, respectively; r=0.294 and r=0.294, respectively). Similarly, there was also a statistically significant relationship between pneumonia onset and one- and three-month mortality- ICU admission (p<0.05; r=0.217, r=0.127, r=0.185 and r=0.185, respectively). A regression analysis showed that parenteral nutrition (odds ratio [OR] =13.434, 95% confidence interval [CI] =1.148-157.265, p=0.038) was a significant predictor of ICU admission. The relationship between pulmonary physiotherapy (PPT) and ICU admission- pneumonia onset at the end of three months was statistically significant (p=0.04 and p=0.043, respectively). CONCLUSION This study showed that PPT improved the prognosis of ischemic stroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes. TRIAL REGISTRATION NCT03195907 . Trial registration date: 21.06.2017 'Retrospectively registered'.
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Affiliation(s)
| | - Abdulkadir Tunç
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey.
| | - Yeşim Güzey Aras
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey
| | | | - Adil Can Güngen
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey
| | - Serdar Bal
- Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey
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