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Robles R, Chen Z, Bains SS, Dubin JA, Mont MA, Delanois RE, Patel NK. Stroke History and Time Elapsed are Predictors of Complications in Total Knee Arthroplasty. J Arthroplasty 2024; 39:921-926. [PMID: 37852444 DOI: 10.1016/j.arth.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A consensus has not been reached regarding the optimal timing of elective total knee arthroplasty (TKA) following a stroke. The purpose of this study was to examine the optimal period between stroke and TKA to minimize complications. Specifically, we assessed: (1) medical and surgical complications; (2) timing of stroke and TKA; (3) associated risk factors. METHODS A national database identified 69,815 TKA patients that were separated into 6 exclusive cohorts using a stratum likelihood ratio: no stroke (n = 20,000), stroke within 6 (n = 17,764), 12 (n = 10,338), 18 (n = 8,370), 24 (n = 7,121), and 30 months (n = 6,222) prior to TKA. We analyzed 90-day, 1-year, and 2-year complications in each subgroup. Multivariate analyses were used to identify risk factors for periprosthetic joint infection (PJI). RESULTS The multivariate regression model identified that patients with a stroke within 6 months of TKA had increased risk of PJI at all time points (P < .001). Also, stroke 12 to 18 months before TKA elevated PJI risk at 1 and 2 years (all P < .021), while those over 18 months did not show a significant risk compared to controls (P > .067). CONCLUSIONS Stroke prior to TKA was associated with an increased risk of postoperative complications, specifically PJI. We recommend a minimum of 6 months between stroke and TKA, with 18 months offering the lowest risk.
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Affiliation(s)
- Rafael Robles
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nirav K Patel
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia
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2
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Kim HC, Lee HJ, Kim YT, Jang BC. Risk of Neurodegenerative Diseases in Elderly Koreans with an Initial Diagnosis of Type 2 Diabetes: A Nationwide Retrospective Cohort Study. J Diabetes Res 2023; 2023:7887792. [PMID: 38020200 PMCID: PMC10651337 DOI: 10.1155/2023/7887792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Type 2 diabetes (T2D) and neurodegenerative diseases (NDs) are common among elderly individuals. Growing evidence has indicated a strong link between T2D and NDs, such as Alzheimer's disease. However, previous studies have limitations in exploring the epidemiological relationship among these diseases as a group of NDs rather than as a specific type of ND. We aimed to investigate the risk of NDs in elderly Koreans who were first diagnosed with T2D and determine the association between T2D and NDs. We conducted a retrospective longitudinal cohort study of patients with who were initially diagnosed with T2D using the Korean National Health Information Database. The study participants were categorized into a T2D group (n = 155,459) and a control group (n = 155,459), aged 60-84 years, that were matched for age, sex, and comorbidities. We followed the participants for 10 years to investigate the incidence of NDs. The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for NDs. The numbers of patients diagnosed with ND at the end of follow-up were as follows: 51,096/155,459 (32.9%) in the T2D group and 44,673/155,459 (28.7%) in the control group (χ2 = 622.53, p < 0.001). The incidences of NDs in the T2D and control groups were 44.68 (95% CI: 44.29, 45.07) and 36.89 (95% CI: 36.55, 37.24) cases per 1,000 person-years at risk, respectively. The overall incidence of NDs was higher in the T2D group than that in the control group (HR: 1.23, 95% CI: 1.22, 1.25, p < 0.001). This study revealed a higher incidence of NDs in elderly Koreans who were initially diagnosed with T2D. This suggests that T2D is a risk factor for NDs in elderly Koreans.
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Affiliation(s)
- Hee-Cheol Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
- Brain Research Institute, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Ho-Jun Lee
- Department of Psychiatry, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Yang-Tae Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Byeong-Churl Jang
- Department of Molecular Medicine, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
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3
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Chen W, Li D. Comorbidity and outcomes among hospitalized patients with stroke: a nationwide inpatient analysis. Front Neurol 2023; 14:1217404. [PMID: 37915378 PMCID: PMC10616246 DOI: 10.3389/fneur.2023.1217404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Objective We aimed to characterize healthcare utilization and comorbidity outcomes among hospitalized elderly stroke patients using a nationally representative dataset in the United States. Methods Using the 2019 National Inpatient Sample, patients aged 65 years or older with and without comorbidities who were hospitalized for acute stroke were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patient comorbidities were identified with the use of the Elixhauser Comorbidity Index. The prevalence of comorbidities, in-hospital mortality, length of stay, and total hospital costs were analyzed for these patients. Results Within 451,945 patients (mean age 78 years, 54.1% women, 73.7% white), we observed that more than 90% of patients had a minimum of two comorbidities. The median number of comorbidities was 4.0 (IQR 3.0-6.0). There was significant variation in the prevalence rate of comorbidities. The five most common comorbidities were uncomplicated hypertension (55.4%), paralysis (40.1%), congestive heart failure (39.8%), various neurological illnesses (38.3%), and complex hypertension (32.5%). After adjusting for patient- and hospital-level characteristics, a statistically significant association was observed between comorbidities and various adverse outcomes. Specifically, comorbidities were found to be significantly associated with an increased risk of inpatient mortality (odds ratio: 1.09; 95% CI: 1.08-1.11; P < 0.001), a longer duration of hospitalization (0.68 days; 95% CI: 0.66-0.71; P < 0.001), and higher total cost ($1,874.9; 95% CI: 1,774.6-1,975.2; P < 0.001). Conclusion This national data suggests that comorbidity is common among hospitalized older stroke patients and substantially increases the healthcare burden and inpatient mortality in the United States. These findings underscore the integration of comorbidity management into the care of older stroke patients.
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Affiliation(s)
- Wei Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Dong Li
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States
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4
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Vijiaratnam N, Vadera S, Lefringhausen K, Girges C, Schrag A. Validation of a comorbidity questionnaire in patients with neurological disorders. BMJ Neurol Open 2023; 5:e000464. [PMID: 37663868 PMCID: PMC10471876 DOI: 10.1136/bmjno-2023-000464] [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: 05/19/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023] Open
Abstract
Rational Several tools exist to assess comorbidities in neurological disorders, the most widely used being the Charlson Comorbidity Index (CCI), but it has several limitations. The Comorbidity and General Health Questionnaire (CGHQ) is a newly designed tool, which includes additional comorbidities associated with health-related quality of life (HR-QOL) and outcomes in neurological disorders. Aims and objectives To assess the feasibility and validity of the CGHQ in patients with neurological disease. Method Two hundred patients attending a general neurological clinic were invited to complete the CGHQ along with the EQ-5D-5L questionnaire. The CCI was simultaneously completed by the assessor. CGHQ comorbidity scores were compared with CCI, symptom burden and EQ-5D-5L scores. Results The CGHQ captured 22 additional comorbidities not included on the CCI and more comorbidities were endorsed on the CGHQ. The CGHQ correlated weakly to moderately with CCI comorbidity scores. While both the CGHQ and CCI correlated negatively with the EQ-5D-5L Visual Analogue Scale, only the CGHQ correlated negatively with the EQ-5D-5L summary index. The CGHQ but not the CCI correlated strongly and positively with symptom burden scores. Conclusion The CGHQ allows a more comprehensive assessment of comorbidities than the CCI and better correlates with patients' overall symptom burden and HR-QOL in neurological patients.
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Affiliation(s)
- Nirosen Vijiaratnam
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Shree Vadera
- Department of Medicine, Royal Free Hampstead NHS Trust, London, UK
| | | | - Christine Girges
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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5
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Joundi RA, King JA, Stang J, Nicol D, Hill MD, Quan H, Faris P, Yu AYX, Kapral MK, Smith EE. Association of co-morbidity with acute stroke mortality by age and time since stroke: A population-based study. J Stroke Cerebrovasc Dis 2023; 32:107236. [PMID: 37429113 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107236] [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: 12/11/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To examine whether the association of co-morbidity with mortality after acute stroke is influenced by stroke type, age, sex, or time since stroke. MATERIALS AND METHODS We conducted a province-wide population-based study using linked administrative databases to identify all admissions for acute stroke between 2007-2018 in Alberta, Canada. We used Cox proportional hazard models to determine the association of severe co-morbidity based on the Charlson Co-morbidity Index with 1-year mortality after stroke, assessing for effect modification by stroke type, age, and sex, and with adjustment for estimated stroke severity, comprehensive stroke centre care, hypertension, atrial fibrillation, and year of study. We used a piecewise model to analyze the impact of co-morbidity across four time periods. RESULTS We had 28,672 patients in our final cohort (87.8% ischemic stroke). The hazard of mortality with severe co-morbidity was higher for individuals with ischemic stroke (adjusted hazard ratio [aHR] 2.20, 95% CI 2.07-2.32) compared to those with intracerebral hemorrhage (aHR 1.70, 95% CI 1.51-1.92; pint<0.001), and higher in individuals under age 75 (aHR 3.20, 95% CI 2.90-3.53) compared to age ≥75 (aHR 1.93, 95% CI 1.82-2.05, pint<0.001). There was no interaction by sex. The hazard ratio increased in a graded fashion at younger ages and was higher after the first 30 days of acute stroke. CONCLUSION There was a stronger association between co-morbidity and mortality at younger age and in the subacute phase of stroke. Further research is needed to determine the reason for these findings and identify ways to improve outcomes among those with stroke and co-morbid conditions at young age.
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Affiliation(s)
- Raed A Joundi
- Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, ON, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada.
| | - James A King
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform; Provincial Research Data Services, Alberta Health Services
| | - Jillian Stang
- Data and Analytics (DnA), Alberta Health Services, Alberta, Canada
| | - Dana Nicol
- Data and Analytics (DnA), Alberta Health Services, Alberta, Canada
| | - Michael D Hill
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform; Provincial Research Data Services, Alberta Health Services
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Alberta Canada; Centre for Health Informatics, Calgary, Alberta Canada
| | - Peter Faris
- The O'Brien Institute for Public Health, University of Calgary, Health Services Statistical and Analytic Methods, Data and Analytics (DnA), Alberta Health Services, Foothills Medical Centre, Calgary, AB Canada
| | - Amy Y X Yu
- ICES, Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, ON, Canada
| | - Moira K Kapral
- Department of Medicine (General Internal Medicine), University of Toronto-University Health Network, ON, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences, University of Calgary, Alberta Canada; Centre for Health Informatics, Calgary, Alberta Canada
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Li J, Liu G, Li F, Yang W, Zhang R, Yang J. Development and Validation of a Novel Nomogram to Predict Hypoalbuminemia among Patients with Stroke in the Neurocritical Care Unit. Clin Nurs Res 2023; 32:490-498. [PMID: 36196927 DOI: 10.1177/10547738221128412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate hypoalbuminemia-related factors in patients with stroke in the neurocritical care unit (NCU) and to establish a nomogram model for hypoalbuminemia prediction. Data from 902 patients hospitalized for stroke in the NCU who had normal albumin levels on admission from March 2018 to December 2020 were analyzed. Logistic regression was used to identify the risk factors associated with hypoalbuminemia. A novel nomogram prediction model for hypoalbuminemia was constructed, and it was validated in an independent set (n = 233). The nomogram incorporated seven risk factors, including age, high comorbidity, mechanical ventilation, feeding routes, total protein, high-sensitivity C-reactive protein, and fibrinogen levels, and its area under the curve for predicting hypoalbuminemia in the developmental set and validation set were 0.856 and 0.870, respectively. The novel nomogram facilitates risk prediction of hypoalbuminemia among patients with stroke in the NCU, which might be useful for selecting treatment strategies and management.
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Affiliation(s)
- Junzhuo Li
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Guangwei Liu
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Feng Li
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Wen Yang
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Ruixin Zhang
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Jiajia Yang
- The First Affiliated Hospital of Chongqing Medical University, China
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7
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Chen HH, Lo YC, Pan WS, Liu SJ, Yeh TL, Liu LYM. Association between coronary artery disease and incident cancer risk: a systematic review and meta-analysis of cohort studies. PeerJ 2023; 11:e14922. [PMID: 36855430 PMCID: PMC9968460 DOI: 10.7717/peerj.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Coronary artery disease (CAD) and cancer are the two leading causes of death worldwide. Evidence suggests the existence of shared mechanisms for these two diseases. We aimed to conduct a systematic review and meta-analysis to investigateassociation between CAD and incident cancer risk. Methods We searched Cochrane, PubMed, and Embase from inception until October 20, 2021, without language restrictions. Observational cohort studies were used to investigate the association between CAD and incident cancer risk. Using random-effects models, the odds ratio (OR) and 95% confidence interval (CI) were calculated. We utilized subgroup and sensitivity analyses to determine the potential sources of heterogeneity and explore the association between CAD and specific cancers. This study was conducted under a pre-established, registered protocol on PROSPERO (CRD42022302507). Results We initially examined 8,533 articles, and included 14 cohort studies in our review, 11 of which were eligible for meta-analysis. Patients with CAD had significantly higher odds of cancer risk than those without CAD (OR = 1.15, 95% CI = [1.08-1.22], I2 = 66%). Subgroup analysis revealed that the incident cancer risk was significantly higher in both sexes and patients with CAD with or without myocardial infarction. Sensitivity analysis revealed that the risk remained higher in patients with CAD even after >1 year of follow-up (OR = 1.23, 95% CI = [1.08-1.39], I2 = 76%). Regarding the specific outcome, the incident risk for colorectal and lung cancers was significantly higher (OR = 1.06, 95% CI = [1.03-1.10], I2 = 10%, and OR = 1.36, 95% CI = [1.15-1.60], I2 = 90%, respectively) and that for breast cancer was lower (OR = 0.86, 95% CI = [0.77-0.97], I2 = 57%) in patients with CAD than in those without CAD. Conclusion CAD may be associated with incident cancer risk, particularly for lung and colorectal cancers, in men and women as well as patients with or without myocardial infarction. Early detection of new-onset cancer and detailed cancer surveillance programs should be implemented in patients with CAD to reduce cancer-related morbidity and mortality.
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Affiliation(s)
- Hsin-Hao Chen
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Chi Lo
- Department of Medical Education and Research, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Wei-Sheng Pan
- Department of Medical Education and Research, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Shu-Jung Liu
- Department of Medical Library, MacKay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan
| | - Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Lawrence Yu-Min Liu
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
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Ruksakulpiwat S, Zhou W, Phianhasin L, Benjasirisan C, Salehizadeh S, Wang L, Voss JG. Associations between diagnosis with stroke, comorbidities, and activity of daily living among older adults in the United States. Chronic Dis Transl Med 2023. [DOI: 10.1002/cdt3.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
| | - Wendie Zhou
- School of Nursing Peking University Beijing China
| | - Lalipat Phianhasin
- Department of Medical Nursing, Faculty of Nursing Mahidol University Bangkok Thailand
| | | | | | - Limin Wang
- School of Nursing Zhejiang Chinese Medical University Zhejiang China
| | - Joachim G. Voss
- Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland Ohio USA
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Hornemann D, Marquardt C, Sugg J, Haack C, Rameil P, Fülöpp Z, Buss J, Weigel A, Schmidt-Wilcke T, Summ O, Groß M. [The Respiratory Therapist in Neurology An Evolving Specialization in Germany]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:45-51. [PMID: 35961323 PMCID: PMC9873413 DOI: 10.1055/a-1877-4832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 01/27/2023]
Abstract
In Germany, nurses, physiotherapists and speech and language therapists follow a qualifying training for about 1,5 years to become respiratory therapists (RTs). With respect to neurological illness, RTs diagnose and treat disorders of respiration, cough and swallowing as well as a retention of tracheobronchial secretions. There is an increasing demand for RTs in neurology, in neurointensive care and in neurological and neurosurgical early rehabilitation. The certification of specialized centers for weaning in neurological and neurosurgical early rehabilitation was introduced by the German Society for Neurorehabilitation (DGNR) in 2021. As a certification criterion it includes the employment of a respiratory therapists. In neurological organizations treating critically and severely ill patients, RTs work at an important interdisciplinary intersection of physicians, nurses and therapists. RTs are qualified to train teams, patients and family caregivers and to establish care structures for critically and severely ill neurological patients. Due to the complexity of neurological illnesses RTs working in neurological institutions need specific qualification. Specific training for RTs in neurology and neurorehabilitation might improve care for critically and severely ill neurological patients. Further professionalization of RT in Germany requires standardizing curricula, a professional society for RTs and, finally, academization.
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Affiliation(s)
| | | | | | | | | | - Zsolt Fülöpp
- Universitätsklinikum Schleswig-Holstein, Campus
Lübeck
| | | | | | | | - Oliver Summ
- Evangelisches Krankenhaus Oldenburg
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin (OGNI),
Carl von Ossietzky Universität Oldenburg
| | - Martin Groß
- Evangelisches Krankenhaus Oldenburg
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin (OGNI),
Carl von Ossietzky Universität Oldenburg
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10
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Troeung L, Mann G, Wagland J, Martini A. Effects of comorbidity on post-acute outcomes in acquired brain injury: ABI-RESTaRT 1991-2020. Ann Phys Rehabil Med 2022; 66:101669. [PMID: 35483646 DOI: 10.1016/j.rehab.2022.101669] [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: 11/28/2021] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Current understanding of comorbidities associated with acquired brain injury (ABI) and the effects on post-acute ABI outcomes is poor. OBJECTIVE To describe the prevalence, severity and patterns of comorbidity for the pre-injury, acute and post-acute phases, and to examine the effects of post-acute comorbidities on functional independence and length of stay (LOS) at discharge from post-acute care. METHODS Retrospective whole-population cohort study of n = 1,011 individuals with traumatic (TBI) or non-traumatic brain injury (NTBI), or eligible neurologic conditions admitted to a post-acute neurorehabilitation and disability support service in Western Australia (WA) between 1991 and 2020. Comorbidities were ascertained from internal electronic medical records and linked hospital and emergency department data from the WA Data Linkage System. We measured comorbidities across 14 body systems using the Cumulative Illness Rating Scale (CIRS) and Elixhauser Comorbidity Index (ECI), and functional independence with the UK Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). We used multilevel mixed-effect regression models to determine the effects of comorbidity on post-acute outcomes. RESULTS NTBI was the most common diagnosis (54%), followed by TBI (34%) and neurologic conditions (10%). Pre-injury comorbidities were present in over half the cohort. Comorbidity prevalence increased significantly from 57% to 84% (∆+27%) and severity (mean ECI score) increased significantly from 2.1 to 13.8 (∆+11.7) between pre-injury and the acute phase and remained elevated at admission to post-acute services (82%, mean ECI score 7.3). Psychiatric comorbidity was the most prevalent (56%) and was associated with significantly poorer functional outcomes at discharge and an increase in LOS of 6.5 months. Genitourinary, musculoskeletal, eye, ear nose and throat, and renal comorbidities also had significant effects on post-acute outcomes. CONCLUSIONS ABI has a long-term impact on multiple body systems. Identification and management of comorbidities is critical to maximize functional outcomes and reduce the cost of post-acute care.
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Affiliation(s)
- Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, 355 Scarborough Beach Rd, Osborne Park, WA 6017, Australia.
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, 355 Scarborough Beach Rd, Osborne Park, WA 6017, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Osborne Park, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, 355 Scarborough Beach Rd, Osborne Park, WA 6017, Australia; The University of Western Australia, Crawley, WA, Australia
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11
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Liu H, Song B, Jin J, Liu Y, Wen X, Cheng S, Nicholas S, Maitland E, Wu X, Zhu D. Length of Stay, Hospital Costs and Mortality Associated With Comorbidity According to the Charlson Comorbidity Index in Immobile Patients After Ischemic Stroke in China: A National Study. Int J Health Policy Manag 2022; 11:1780-1787. [PMID: 34380205 PMCID: PMC9808248 DOI: 10.34172/ijhpm.2021.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/03/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In this study, we examined the length of stay (LoS)-predictive comorbidities, hospital costs-predictive comorbidities, and mortality-predictive comorbidities in immobile ischemic stroke (IS) patients; second, we used the Charlson Comorbidity Index (CCI) to assess the association between comorbidity and the LoS and hospitalization costs of stroke; third, we assessed the magnitude of excess IS mortality related to comorbidities. METHODS Between November 2015 and July 2017, 5114 patients hospitalized for IS in 25 general hospitals from six provinces in eastern, western, and central China were evaluated. LoS was the period from the date of admission to the date of discharge or date of death. Costs were collected from the hospital information system (HIS) after the enrolled patients were discharged or died in hospital. The HIS belongs to the hospital's financial system, which records all the expenses of the patient during the hospital stay. Cause of death was recorded in the HIS for 90 days after admission regardless of whether death occurred before or after discharge. Using the CCI, a comorbidity index was categorized as zero, one, two, and three or more CCI diseases. A generalized linear model with a gamma distribution and a log link was used to assess the association of LoS and hospital costs with the comorbidity index. Kaplan-Meier survival curves was used to examine overall survival rates. RESULTS We found that 55.2% of IS patients had a comorbidity. Prevalence of peripheral vascular disease (21.7%) and diabetes without end-organ damage (18.8%) were the major comorbidities. A high CCI=3+ score was an effective predictor of a high risk of longer LoS and death compared with a low CCI score; and CCI=2 score and CCI=3+ score were efficient predictors of a high risk of elevated hospital costs. Specifically, the most notable LoS-specific comorbidities, and cost-specific comorbidities was dementia, while the most notable mortality-specific comorbidities was moderate or severe renal disease. CONCLUSION CCI has significant predictive value for clinical outcomes in IS. Due to population aging, the CCI should be used to identify, monitor and manage chronic comorbidities among immobile IS populations.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | | | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
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12
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Sheehan J, Lannin NA, Laver K, Reeder S, Bhopti A. Primary care practitioners' perspectives of discharge communication and continuity of care for stroke survivors in Australia: A qualitative descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2530-e2539. [PMID: 34957626 DOI: 10.1111/hsc.13696] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/06/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Discharge communication is an important component of care transition between hospitals and community care, particularly for the complex needs of stroke survivors. Despite international research and regulation, ineffective information exchange during care transitions continues to compromise patient outcomes. Primary care practitioners are increasingly responsible for the provision of stroke care in the community, yet it is not known how their role is supported by discharge communication. The aim of this qualitative study was to describe the primary care practitioner perspective of discharge communication, identifying the barriers and enablers relative to continuity of care for stroke survivors. Semi-structured telephone interviews were conducted with primary care practitioners across Australia, between April and September 2020. Data were analysed using thematic analysis with a constant-comparison approach. The findings suggest that discharge communication is often inadequate for the complex care and recovery needs of stroke survivors. The challenges in accessing care plans were noted barriers to continuity of care, while shared understandings of stroke survivors' needs were identified as enablers. As discharge communication processes were perceived to be disconnected, primary care practitioners suggested a team approach across care settings. It is concluded that initiatives are required to increase primary care collaboration with hospital teams (which include stroke survivors and their caregivers) to improve continuity of care after stroke.
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Affiliation(s)
| | - Natasha A Lannin
- La Trobe University, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Kate Laver
- Flinders University, Adelaide, South Australia, Australia
| | | | - Anoo Bhopti
- La Trobe University, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
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13
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Al Alawi AM, Al Busaidi I, Al Shibli E, Al-Senaidi AR, Al Manwari S, Al Busaidi I, Muhanna F, Al Qassabi A. Health outcomes after acute ischemic stroke:retrospective and survival analysis from Oman. Ann Saudi Med 2022; 42:269-275. [PMID: 35933604 PMCID: PMC9357299 DOI: 10.5144/0256-4947.2022.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Stroke mortality and related functional disability have been declining over the last two decades, but stroke continues to represent the second leading cause of cardiovascular death worldwide and the number one cause for acquired long-term disability. OBJECTIVES Assess short- and long-term health outcomes after acute ischemic stroke and analyze factors associated with poor survival and functional outcomes. DESIGN Retrospective and survival analysis SETTING: Inpatient unit at a tertiary care referral hospital. PATIENTS AND METHODS All patients admitted with acute ischemic stroke from 1 January 2017 to 31 August 2018 were included in the study. Functional status was assessed using the modified Rankin Scale (mRS). Other demographic and clinical variables were obtained from medical records. Data were analyzed by multivariable logistic regression, Cox proportional hazards, and the Kaplan-Meier method. Long-term follow-up data, including mortality and mRS was collected by follow-up phone call. MAIN OUTCOME MEASURES Functional dependency and factors associated with mortality. SAMPLE SIZE AND CHARACTERISTICS 110 with mean age of 67.0 (14.7) years; 59 patients (53.6%) were males. RESULTS Hypertension (75.5%), diabetes mellitus (54.6%), and dyslipidemia (29.1%) were common. Sixty-five patients (59.1%) had mRS >2 upon discharge including 18 patients (16.4%) who died during the hospital stay. The cumulative mortality rate was 25.4% (28/110) at 12 months and 30.0% (33/110) at 24 months. Twenty-nine stroke survivors (29/70, 41.4%) remained physically dependent (mRS >2) at the end of follow-up. Old age, atrial fibrillation, history of prior stroke, chronic kidney disease, and peripheral arterial disease were associated with increased mortality and functional dependence. CONCLUSIONS Patients in Oman with acute ischemic stroke tend to have a high comorbidity burden, and their functional dependency and mortality are higher compared to patients from developed countries. Therefore, evidence-based measures such as establishing stroke units are essential to improve the health outcomes of patients with acute ischemic stroke. LIMITATIONS Retrospective at single center. CONFLICT OF INTEREST None.
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Affiliation(s)
- Abdullah M Al Alawi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman.,From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Ikhlas Al Busaidi
- From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Emaad Al Shibli
- From the Internal Medicine Program, Oman Medical Speciality Board, Al-Athaiba, Muscat, Oman
| | - Al-Reem Al-Senaidi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahd Al Manwari
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ibtisam Al Busaidi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Fatema Muhanna
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ahmed Al Qassabi
- From the Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Oman
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14
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Skajaa N, Adelborg K, Horváth-Puhó E, Rothman KJ, Henderson VW, Thygesen LC, Sørensen HT. Stroke and Risk of Mental Disorders Compared With Matched General Population and Myocardial Infarction Comparators. Stroke 2022; 53:2287-2298. [PMID: 35317610 DOI: 10.1161/strokeaha.121.037740] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate estimates of risks of poststroke outcomes from large population-based studies can provide a basis for public health policy decisions. We examined the absolute and relative risks of a spectrum of incident mental disorders following ischemic stroke and intracerebral hemorrhage. METHODS During 2004 to 2018, we used Danish registries to identify patients (≥18 years and with no hospital history of mental disorders), with a first-time ischemic stroke (n=76767) or intracerebral hemorrhage (n=9344), as well as age-,sex-, and calendar year-matched general population (n=464 840) and myocardial infarction (n=92 968) comparators. We computed risk differences, considering death a competing event, and hazard ratios adjusted for income, occupation, education, and history of cardiovascular and noncardiovascular comorbidity. RESULTS Compared with the general population, following ischemic stroke, the 1-year risk difference was 7.3% (95% CI, 7.0-7.5) for mood disorders (driven by depression), 1.4% (95% CI, 1.3-1.5) for organic brain disorders (driven by dementia and delirium), 0.8% (95% CI, 0.7-0.8) for substance abuse disorders (driven by alcohol and tobacco abuse), and 0.5% (95% CI, 0.4-0.5) for neurotic disorders (driven by anxiety and stress disorders). For suicide, risk differences were near null. Hazard ratios were particularly elevated in the first year of follow-up, ranging from a 2- to a 4-fold increased hazard, decreasing thereafter. Compared with myocardial infarction patients, the 1-year risk difference was 4.9% (95% CI, 4.6 to 5.3) for mood disorders, 1.0% (95% CI, 0.8 to 1.1) for organic brain disorders, 0.1% (95% CI, 0.0 to 0.2) for substance abuse disorders, but -0.2% (95% CI, -0.2 to -0.1) for neurotic disorders. Hazard ratios during the first year of follow-up were elevated 1.1- to 1.8-fold for mood, organic brain, and neurotic disorders, while decreased 0.8-fold for neurotic disorders. CONCLUSIONS The considerably greater risks of mental disorders following a stroke, particularly mood disorders, underline the importance of mental health evaluation after stroke.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,National Institute of Public Health, University of Southern Denmark, Copenhagen (N.S., L.C.T.)
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Denmark (K.A.)
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.)
| | - Kenneth J Rothman
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Epidemiology, Boston University School of Public Health, MA (K.J.R., H.T.S.).,RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC (K.J.R.)
| | - Victor W Henderson
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Epidemiology and Population Health, Stanford University, CA (V.W.H., H.T.S.).,Department of Neurology and Neurological Sciences, Stanford University, CA (V.W.H)
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen (N.S., L.C.T.)
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Denmark (N.S., K.A., E.H.-P., K.J.R., V.W.H., H.T.S.).,Department of Epidemiology, Boston University School of Public Health, MA (K.J.R., H.T.S.).,Department of Epidemiology and Population Health, Stanford University, CA (V.W.H., H.T.S.)
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15
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Kao YT, Chang CC, Yeh CC, Hu CJ, Cherng YG, Chen TL, Liao CC. Complications and Mortality after Surgeries in Patients with Prior Stroke Who Received General and Neuraxial Anesthesia: A Propensity-Score Matched Study. J Clin Med 2022; 11:jcm11061490. [PMID: 35329816 PMCID: PMC8949151 DOI: 10.3390/jcm11061490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 12/04/2022] Open
Abstract
Patients who previously suffered a stroke have increased risks of mortality and complications after surgeries, but the optimal anesthesia method is not fully understood. We aimed to compare the outcomes after surgeries for stroke patients who received general anesthesia (GA) and neuraxial anesthesia (NA). Using health insurance research data, we identified 36,149 stroke patients who underwent surgeries from 1 January 2008 to 31 December 2013. For balancing baseline covariates, the propensity-score-matching procedure was used to select adequate surgical patients who received GA and NA at a case–control ratio of 1:1. Multiple logistic regressions were applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative mortality and complications between surgical patients with prior stroke who received GA and NA. Among the 4903 matched pairs with prior stroke, patients with GA had higher risks of pneumonia (OR 2.00, 95% CI 1.62–2.46), pulmonary embolism (OR 3.30, 95% CI 1.07–10.2), acute renal failure (OR 3.51, 95% CI 1.13–2.10), intensive care unit stay (OR 3.74, 95% CI 3.17–4.41), and in-hospital mortality (OR 2.02, 95% CI 1.16–3.51) than those who received NA. Postoperative adverse events were associated with GA in patients aged more than 60 years and those who received digestive surgery (OR 3.11, 95% CI 2.08–4.66). We found that stroke patients undergoing GA had increased postoperative complications and mortality after surgery compared with those who received NA. However, these findings need more validation and evaluation by clinical trials.
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Affiliation(s)
- Yi-Ting Kao
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (Y.-T.K.); (Y.-G.C.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (C.-C.C.); (T.-L.C.)
| | - Chuen-Chau Chang
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (C.-C.C.); (T.-L.C.)
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung 404, Taiwan;
- Department of Surgery, University of Illinois, Chicago, IL 60607, USA
| | - Chaur-Jong Hu
- Division of Neurology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan;
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (Y.-T.K.); (Y.-G.C.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (C.-C.C.); (T.-L.C.)
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (C.-C.C.); (T.-L.C.)
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (C.-C.C.); (T.-L.C.)
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
- Correspondence: or
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16
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Hao R, Qi X, Xia X, Wang L, Li X. Temporal trend of comorbidity and increasing impacts on mortality, length of stay, and hospital costs of first stroke in Tianjin, North of China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:63. [PMID: 34583749 PMCID: PMC8477574 DOI: 10.1186/s12962-021-00316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke patients have a high incidence of comorbidity. Previous studies have shown that comorbidity can impact on the short-term and long-term mortality after stroke. METHODS Our study aimed to explore the trend of comorbidity among patients with first stroke from 2010 to 2020, and the influence of comorbidity on admission mortality, length of stay and hospitalization costs. 5988 eligible patients were enrolled in our study, and divided into 4 comorbidity burden groups according to Charlson comorbidity index (CCI): none, moderate, severe, very severe. Survival analysis was expressed by Kaplan-Meier curve. Cox regression model was used to analyze the effect of comorbidity on 7-day and in-hospital mortality. Generalized linear model (GLM) was used to analyze the association between comorbidity and hospitalization days and cost. RESULTS Compared to patients without comorbidity, those with very severe comorbidity were more likely to be male (342, 57.7%), suffer from ischemic stroke (565, 95.3%), afford higher expense (Midian, 19339.3RMB, IQR13020.7-27485.9RMB), and have a higher in-hospital mortality (60, 10.1%). From 2010 to 2020, proportion of patients with severe and very severe comorbidity increased 12.9%. The heaviest comorbidity burden increased the risk of 7-day mortality (adjusted hazard ratio, 3.51, 95% CI 2.22-5.53) and in-hospital mortality (adjusted hazard ratio, 3.83, 95% CI 2.70-5.45). Patients with very severe comorbidity had a 12% longer LOS and extra 27% expense than those without comorbidity. CONCLUSIONS Comorbidity burden showed an increasing trend year in past eleven years. The heavy comorbidity burden increased in-hospital mortality, LOS, and hospitalization cost, especially in patients aged 55 years or more. The findings also provide some reference on improvement of health care reform policies and allocation of resources.
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Affiliation(s)
- Ruixiao Hao
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China
| | - Xuemei Qi
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Tianjin, 300211, China.
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17
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Hope TMH, Nardo D, Holland R, Ondobaka S, Akkad H, Price CJ, Leff AP, Crinion J. Lesion site and therapy time predict responses to a therapy for anomia after stroke: a prognostic model development study. Sci Rep 2021; 11:18572. [PMID: 34535718 PMCID: PMC8448867 DOI: 10.1038/s41598-021-97916-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/14/2021] [Indexed: 11/10/2022] Open
Abstract
Stroke is a leading cause of disability, and language impairments (aphasia) after stroke are both common and particularly feared. Most stroke survivors with aphasia exhibit anomia (difficulties with naming common objects), but while many therapeutic interventions for anomia have been proposed, treatment effects are typically much larger in some patients than others. Here, we asked whether that variation might be more systematic, and even predictable, than previously thought. 18 patients, each at least 6 months after left hemisphere stroke, engaged in a computerised treatment for their anomia over a 6-week period. Using only: (a) the patients' initial accuracy when naming (to-be) trained items; (b) the hours of therapy that they devoted to the therapy; and (c) whole-brain lesion location data, derived from structural MRI; we developed Partial Least Squares regression models to predict the patients' improvements on treated items, and tested them in cross-validation. Somewhat surprisingly, the best model included only lesion location data and the hours of therapy undertaken. In cross-validation, this model significantly out-performed the null model, in which the prediction for each patient was simply the mean treatment effect of the group. This model also made promisingly accurate predictions in absolute terms: the correlation between empirical and predicted treatment response was 0.62 (95% CI 0.27, 0.95). Our results indicate that individuals' variation in response to anomia treatment are, at least somewhat, systematic and predictable, from the interaction between where and how much lesion damage they have suffered, and the time they devoted to the therapy.
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Affiliation(s)
- Thomas M H Hope
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK.
- Wellcome Centre for Human Neuroimaging, University College London, London, UK.
| | - Davide Nardo
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK
- MRC Cognition and Brain Sciences Unit, Cambridge University, London, UK
| | - Rachel Holland
- Division of Language and Communication Science, City University of London, London, UK
| | - Sasha Ondobaka
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK
| | - Haya Akkad
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Alexander P Leff
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Jenny Crinion
- Institute of Cognitive Neuroscience, University College London, 17-19 Queen Square, London, WC1N 3AR, UK
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18
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Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients. Nutrients 2021; 13:nu13051641. [PMID: 34068135 PMCID: PMC8152968 DOI: 10.3390/nu13051641] [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] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.
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19
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Pana TA, Mohamed MO, Mamas MA, Myint PK. Prognosis of Acute Ischaemic Stroke Patients with Cancer: A National Inpatient Sample Study. Cancers (Basel) 2021; 13:cancers13092193. [PMID: 34063601 PMCID: PMC8125286 DOI: 10.3390/cancers13092193] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 12/20/2022] Open
Abstract
Whilst cancer is a risk factor for acute ischaemic stroke (AIS), its impact on AIS prognosis between metastatic and non-metastatic (MC and NMC) disease is poorly understood. Furthermore, the receipt of intravenous thrombolysis (IVT) and endovascular thrombectomy (ET) and their outcomes is poorly researched. AIS admissions from the National Inpatient Sample (NIS) were included (October 2015-December 2017). Multivariable logistic regressions adjusting for a wide range of confounders analysed the relationship between NMC and MC and AIS in-hospital outcomes (mortality, prolonged hospitalisation >4 days and routine home discharge). Interaction terms with IVT and ET were also computed to explore their impact amongst cancer patients. A total of 221,249 records representative of 1,106,045 admissions were included. There were 38,855 (3.51%) AIS admissions with co-morbid cancer: NMC = 53.78% and MC = 46.22%. NMC was associated with 23% increased odds of in-hospital mortality (odds ratio (95% confidence interval) = 1.23 (1.07-1.42)), which was mainly driven by pancreatic and respiratory cancers. This association was entirely offset by both IVT and ET. MC was associated with two-fold increased odds of in-hospital mortality (2.16 (1.90-2.45)), which was mainly driven by respiratory, pancreatic and colorectal cancers. This association was only offset by ET. Both NMC and MC were significantly associated with prolonged hospitalisation and decreased odds of routine discharge. Cancer patients are at higher odds of acute adverse outcomes after AIS and warrant robust primary prevention. IVT and ET improve these outcomes and should thus be offered routinely unless otherwise contraindicated in this group of stroke patients.
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Affiliation(s)
- Tiberiu A. Pana
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent ST4 6QG, UK; (M.O.M.); (M.A.M.); (P.K.M.)
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
- Correspondence:
| | - Mohamed O. Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent ST4 6QG, UK; (M.O.M.); (M.A.M.); (P.K.M.)
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent ST4 6QG, UK; (M.O.M.); (M.A.M.); (P.K.M.)
| | - Phyo K. Myint
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent ST4 6QG, UK; (M.O.M.); (M.A.M.); (P.K.M.)
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
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20
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Vuorlaakso M, Kiiski J, Salonen T, Karppelin M, Helminen M, Kaartinen I. Major Amputation Profoundly Increases Mortality in Patients With Diabetic Foot Infection. Front Surg 2021; 8:655902. [PMID: 33996886 PMCID: PMC8120024 DOI: 10.3389/fsurg.2021.655902] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: An acute diabetic foot infection (DFI) is a serious condition and a leading cause of hospitalization and major amputation in patients with diabetes. Aim of this study was to evaluate the long term survival and risk factors for death and amputation after the DFI requiring hospital treatment. Materials and Methods: A retrospective study included all adult patients hospitalized for DFI treatments during 2010–2014. Overall survival (OS) and amputation free survival (AFS) (without major amputation) was calculated. We performed a Cox regression analysis of several clinical parameters to evaluate the effects of clinical parameters on overall and amputation-free survival. Results: Total of 324 patients with mean age of 66.8 (SD 12.8) years were included. The one- and five-year OS after DFI 81.2% (95%CI 77.5–84.9%) and 49.7% (95%CI 44.8–54.6%), respectively. Major amputation, wound ischemia, older age, and a low glomerular filtration rate reduced the OS after DFI. After a major amputation, the one- and five-year OS was 41.7% (95%CI 13.9–69.5) and 8.3% (95%CI 0.0–24.0%), respectively. Wound ischemia, older age, and elevated C-reactive protein reduced AFS. In contrast, hypertensive medication use was identified as a protective factor. Conclusion: Mortality after a DFI remains high and is significantly increased after a major amputation. Findings highlight the importance of early wound and ischemia management for DFI prevention.
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Affiliation(s)
- Miska Vuorlaakso
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.,Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Juha Kiiski
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.,Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Tampere, Finland
| | - Tapani Salonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Matti Karppelin
- Department of Infectious Diseases, Tampere University Hospital, Tampere, Finland
| | - Mika Helminen
- Tays Research Services, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Ilkka Kaartinen
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital, Tampere, Finland
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21
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Chin WL, Chi PJ, Hung WC, Lin CW, Chen CY, Chen JH. Bariatric Surgery Decreases the Risk of Non-traffic Accident-Related Fractures in Patients with Obesity: Real-world Data from Taiwan. Obes Surg 2021; 31:2231-2240. [PMID: 33604869 DOI: 10.1007/s11695-021-05262-8] [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: 10/24/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study is to investigate the impact of bariatric surgery on non-traffic accident-related fractures in patients with obesity. METHODS This retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. Patients aged 18 to 55 years with obesity diagnosis between 2003 and 2008 were enrolled and divided into two groups: non-surgical and bariatric surgery groups. Patients with endocrine bone disease and malignancy history were excluded. Healthy patients were also randomly selected from the database and assigned to the general population group. The development of fracture was the primary end point. All patients were followed until the end of 2013 or death, whichever came first. RESULTS After propensity score matching, 1322, 1322, and 4359 subjects were included in the bariatric surgery (BS), non-surgical (NS), and general population (GP) groups, respectively. Based on multivariate analysis, the risk of overall fractures is similar between the BS group (hazard ratio [HR] = 0.774, p = 0.164) and the NS group; nevertheless, the risk of overall fractures was higher in the BS group (HR = 2.210, p<0.001) than in the GP group. The BS group had a significantly lower risk of non-traffic accident-related fractures (HR = 0.542, p = 0.010) than the NS group but a higher risk of non-traffic accident-related fractures (HR = 1.693, p = 0.023) than the GP group. CONCLUSIONS Bariatric surgery may decrease the risk of non-traffic accident-related fractures; however, the risk remains higher in patients with obesity than in the general population.
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Affiliation(s)
- Wei Leng Chin
- Bariatric and Metabolic Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.,Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan.,Department of Family Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine College of medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Jui Chi
- Devision of Nephorology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine College of medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Chieh Hung
- Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine College of medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine College of medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chung-Yen Chen
- Bariatric and Metabolic Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.,Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine College of medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jian-Han Chen
- Bariatric and Metabolic Surgery Center, E-Da Hospital, Kaohsiung, Taiwan. .,Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan. .,School of Medicine College of medicine, I-Shou University, Kaohsiung, Taiwan.
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22
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Sennfält S, Pihlsgård M, Norrving B, Ullberg T, Petersson J. Ischemic stroke patients with prestroke dependency: Characteristics and long-term prognosis. Acta Neurol Scand 2021; 143:78-88. [PMID: 32738814 PMCID: PMC7754457 DOI: 10.1111/ane.13328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/29/2020] [Accepted: 07/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This paper aims at examining the clinical characteristics of ischemic stroke patients with different levels of prestroke functional dependency, their long-term outcome, and determinants of five-year mortality. MATERIALS AND METHODS We describe demographics, comorbidity, treatment, as well as long-term mortality, and functional status of 5899 prestroke-dependent ischemic stroke patients stratified by dependency level and compared to a concurrent cohort of 14 148 prestroke-independent patients. The study was based on 2016 survey data from Riksstroke, the Swedish national stroke register, and patients were followed up at three months, 12 months, and either at three or five years. We used Cox regression for mortality predictor analysis and multiple imputation was performed to minimize bias from loss to follow-up. RESULTS With increasing level of prestroke dependency, comorbidity burden was higher, drug prescription lower, and prognosis less favorable. At three years, the proportion that had died or deteriorated were 82.6%, 87.5%, and 86.3% in moderate, moderately severe, and severe dependency, respectively. In moderate dependency, prognosis was relatively favorable: Three-month mortality was half of that seen in severe dependency (25.3% versus 49.6%). Differences in overall outcome between groups of varying prestroke functional dependency level were statistically significant (P < .05) at all follow-up time points. CONCLUSIONS There was great heterogeneity between groups of different level of prestroke dependency; those of moderate dependency had a relatively favorable prognosis. Patients of different prestroke level of dependency need to be addressed separately, and further research is needed characterizing this group and exploring management strategies.
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Affiliation(s)
- Stefan Sennfält
- Stroke Policy and Quality Register Research GroupLund UniversityLundSweden
- Department of NeurologySkåne University HospitalLundSweden
| | | | - Bo Norrving
- Stroke Policy and Quality Register Research GroupLund UniversityLundSweden
- Department of NeurologySkåne University HospitalLundSweden
| | - Teresa Ullberg
- Stroke Policy and Quality Register Research GroupLund UniversityLundSweden
- Department of NeurologySkåne University HospitalLundSweden
| | - Jesper Petersson
- Stroke Policy and Quality Register Research GroupLund UniversityLundSweden
- Department of NeurologySkåne University HospitalLundSweden
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23
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Kelly DM, Rothwell PM. Impact of multimorbidity on risk and outcome of stroke: Lessons from chronic kidney disease. Int J Stroke 2020; 16:758-770. [PMID: 33243088 PMCID: PMC8521355 DOI: 10.1177/1747493020975250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With both an aging population and greater post-stroke survival, multimorbidity is a growing healthcare challenge, affecting over 40% of stroke patients, and rising rapidly and predictably with increasing age. Commonly defined as the co-occurrence of two or more chronic conditions, multimorbidity burden is a strong adverse prognostic factor, associated with greater short- and long-term stroke mortality, worse rehabilitation outcomes, and reduced use of secondary prevention. Chronic kidney disease can be considered as the archetypal comorbidity, being age-dependent and also affecting about 40% of stroke patients. Chronic kidney disease and stroke share very similar traditional cardiovascular risk factor profiles such as hypertension and diabetes, though novel chronic kidney disease-specific risk factors such as inflammation and oxidative stress have also been proposed. Using chronic kidney disease as an exemplar condition, we explore the mechanisms of risk in multimorbidity, implications for management, impact on stroke severity, and downstream consequences such as post-stroke cognitive impairment and dementia.
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Affiliation(s)
- Dearbhla M Kelly
- Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, UK
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, UK
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24
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Scrutinio D, Ricciardi C, Donisi L, Losavio E, Battista P, Guida P, Cesarelli M, Pagano G, D'Addio G. Machine learning to predict mortality after rehabilitation among patients with severe stroke. Sci Rep 2020; 10:20127. [PMID: 33208913 PMCID: PMC7674405 DOI: 10.1038/s41598-020-77243-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
Stroke is among the leading causes of death and disability worldwide. Approximately 20–25% of stroke survivors present severe disability, which is associated with increased mortality risk. Prognostication is inherent in the process of clinical decision-making. Machine learning (ML) methods have gained increasing popularity in the setting of biomedical research. The aim of this study was twofold: assessing the performance of ML tree-based algorithms for predicting three-year mortality model in 1207 stroke patients with severe disability who completed rehabilitation and comparing the performance of ML algorithms to that of a standard logistic regression. The logistic regression model achieved an area under the Receiver Operating Characteristics curve (AUC) of 0.745 and was well calibrated. At the optimal risk threshold, the model had an accuracy of 75.7%, a positive predictive value (PPV) of 33.9%, and a negative predictive value (NPV) of 91.0%. The ML algorithm outperformed the logistic regression model through the implementation of synthetic minority oversampling technique and the Random Forests, achieving an AUC of 0.928 and an accuracy of 86.3%. The PPV was 84.6% and the NPV 87.5%. This study introduced a step forward in the creation of standardisable tools for predicting health outcomes in individuals affected by stroke.
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Affiliation(s)
| | - Carlo Ricciardi
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy. .,Department of Advanced Biomedical Sciences, University Hospital of Naples "Federico II", Naples, Italy.
| | - Leandro Donisi
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.,Department of Advanced Biomedical Sciences, University Hospital of Naples "Federico II", Naples, Italy
| | | | | | - Pietro Guida
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Mario Cesarelli
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.,Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Gaetano Pagano
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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25
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Skajaa N, Ording AG, Darvalics B, Horvath-Puho E, Sørensen HT. Long-term mortality in young and middle-aged adults hospitalised with chronic disease: a Danish cohort study. BMJ Open 2020; 10:e038131. [PMID: 33046469 PMCID: PMC7552875 DOI: 10.1136/bmjopen-2020-038131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine the long-term outcomes for patients hospitalised with chronic diseases at age 30, 40 or 50 years. DESIGN Nationwide, population-based cohort study. SETTING All Danish hospitals, 1979-1989, with follow-up through 2014. PARTICIPANTS Patients hospitalised during the study period with one, two or three or more chronic diseases and age-matched and sex-matched persons from the general population without chronic disease leading to hospitalisation: age-30 group: 13 857 patients and 69 285 comparators; age-40 group: 24 129 patients and 120 645 comparators; and age-50 group, 37 807 patients and 189 035 comparators. MAIN OUTCOME MEASURES Twenty-five-year mortality risks based on Kaplan-Meier estimates, years-of-life-lost (YLLs) and mortality rate ratios based on Cox regression analysis. YLLs were computed for each morbidity level, as well as in strata of income, employment, education and psychiatric conditions. RESULTS Twenty-five-year mortality risks and YLLs increased steadily with increasing number of morbidities leading to hospitalisation and age, but the risk difference with general population comparators remained approximately constant across age cohorts. In the age-30 cohort, the risk differences for patients compared with comparators were 35.0% (95% CI 32.5 to 37.5) with two diseases and 62.5% (54.3% to 70.3%) with three or more diseases. In the age-50 cohort, these differences were, respectively, 48.4% (47.4 to 49.3) and 61.7% (60.1% to 63.0%). Increasing morbidity burden augmented YLLs resulting from low income, unemployment, low education level and psychiatric conditions. In the age-30 cohort, YYLs attributable to low income were 2.4 for patients with one disease, 6.2 for patients with two diseases and 11.5 for patients with three or more diseases. CONCLUSIONS Among patients with multiple chronic diseases, the risk of death increases steadily with the number of chronic diseases and with age. Multimorbidity augments the already increased mortality among patients with low socioeconomic status.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bianka Darvalics
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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26
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Würtz M, Grove EL, Corraini P, Adelborg K, Sundbøll J, Komjáthiné Szépligeti S, Horváth-Puhó E, Sørensen HT. Comorbidity and risk of venous thromboembolism after hospitalization for first-time myocardial infarction: A population-based cohort study. J Thromb Haemost 2020; 18:1974-1985. [PMID: 32319179 DOI: 10.1111/jth.14865] [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: 11/01/2019] [Revised: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is a risk factor for venous thromboembolism (VTE). Although comorbidities affect MI prognosis, it is unclear whether they affect VTE risk after MI. OBJECTIVES We examined the impact of comorbidity on VTE risk after MI. METHODS We used nationwide population-based registries to identify first-time hospitalizations for MI and subsequent occurrence of VTE in Denmark (1995-2013). We included a comparison cohort from the general population matched 5:1 with MI patients by sex, age, and comorbidities. We computed 30-day and 1- to 12-month cumulative risks, rates, and hazard ratios of VTE. We also assessed the interaction between MI and comorbidity, defined as excess VTE risk in patients with both MI and comorbidity, by computing interaction contrasts and attributable fractions relating to the interaction. RESULTS Thirty-day and 1- to 12-month VTE risks were 0.6% and 0.5% in the MI cohort (n = 160 338) and 0.03% and 0.3% in the comparison cohort (n = 792 384). The 30-day hazard ratio for VTE in the MI cohort was 23 (95% confidence interval, 20-27), which decreased during 1-year follow-up. Thirty days after MI, interactions between MI and comorbidity accounted for 16% and 39% of VTE rates in MI patients with low-to-moderate and high comorbidity, respectively. The interactions were driven primarily by hemiplegia and cancer. CONCLUSIONS Thirty-day VTE risk was substantially increased after MI compared with the general population. Although the absolute VTE risk was low, comorbidity substantially increased this risk, especially hemiplegia and cancer. VTE prophylaxis might be indicated in such high-risk patients but warrants further investigation.
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Affiliation(s)
- Morten Würtz
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Priscila Corraini
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Diagnostic Centre, Department of Clinical Medicine, Silkeborg Regional Hospital, University Research Clinic for Innovative Patient Pathways, Aarhus University, Silkeborg, Denmark
| | | | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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27
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Liu H, Wu X, Cao J, Jiao J, Zhu C, Song B, Jin J, Liu Y, Wen X, Cheng S. Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay and Mortality Among Immobile Hemorrhagic Stroke Patients Younger Than 50 Years. Front Neurol 2020; 11:487. [PMID: 32625159 PMCID: PMC7314940 DOI: 10.3389/fneur.2020.00487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: The burden of comorbidity among young patients with hemorrhagic stroke is high. This study examines the effect of comorbidity on the length of stay (LoS) and mortality among immobile hemorrhagic stroke patients younger than 50 years. Materials and Methods: A retrospective post-hoc analysis study design was used. A total of 767 younger adults (mean age 41.64 ± 8.16 years) hospitalized for hemorrhagic stroke between November 2015 and July 2017 were evaluated. All-cause mortality was recorded for 90 days after admission regardless of whether death occurred before or after discharge. Comorbidity was assessed using the Charlson Comorbidity Index (CCI), categorized as low (0–1) and high (≥2). A multiple linear regression model was applied to examine the association between CCI and LoS. Survival was evaluated with Kaplan–Meier and Cox regression analyses. Results: The mean CCI of all patients was 1.25 (SD ± 0.79) and median was 1.0 (IQR 1, 1). The average LoS for patients with a low CCI was 17.73 (± 11.59) days compared with 19.49 (± 15.21) days in those with a high CCI (p = 0.142). The mortality rate was 6.0% (12.10% for high CCI vs. 4.82% for low CCI, p = 0.002). After controlling for confounders, high CCI was not associated with longer LoS (regression coefficient 0.825, 95% CI −1.155 to 2.805; p = 0.413), whereas high CCI was associated with greater likelihood of death than a low CCI (hazard ratio 3.417, 95% CI 1.626 to 7.180; p = 0.001). Conclusions: High global comorbidity was associated with increased short-term mortality but not with LoS. Measures to manage comorbidities aimed at reducing negative clinical impacts of stroke among younger adults are warranted.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Chen Zhu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingfen Jin
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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28
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Sewell K, Tse T, Harris E, Matyas T, Churilov L, Ma H, Davis SM, Donnan GA, Carey LM. Pre-existing Comorbidity Burden and Patient Perceived Stroke Impact. Int J Stroke 2020; 16:273-279. [PMID: 32326843 DOI: 10.1177/1747493020920838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pre-existing comorbidities can compromise recovery post-stroke. However, the association between comorbidity burden and patient-rated perceived impact has not been systematically investigated. To date, only observer-rated outcome measures of function, disability, and dependence have been used, despite the complexity of the impact of stroke on an individual. AIM Our aim was to explore the association between comorbidity burden and patient-rated perceived impact and overall recovery, within the first-year post-stroke, after adjusting for stroke severity, age, and sex. METHODS The sample comprised 177 stroke survivors from 18 hospitals throughout Australia and New Zealand. Comorbidity burden was calculated using the Charlson Comorbidity Index. Perceived impact and recovery were measured by the Stroke Impact Scale index and Stroke Impact Scale overall recovery scale. Quantile regression models were applied to investigate the association between comorbidity burden and perceived impact and recovery. RESULTS Significant negative associations between the Charlson Comorbidity Index and the Stroke Impact Scale index were found at three months. At the .25 quantile, a one-point increase on the Charlson Comorbidity Index was associated with 6.80-points decrease on the Stroke Impact Scale index (95%CI: -11.26, -2.34; p = .003). At the median and .75 quantile, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 3.58-points decrease (95%CI: -5.62, -1.54; p = .001) and 1.76-points decrease (95%CI: -2.80, -0.73; p = .001) on the Stroke Impact Scale index. At 12 months, at the .25 and .75 quantiles, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 6.47-points decrease (95%CI: -11.05, -1.89; p = .006) and 1.26-points decrease (95%CI: -2.11, -0.42; p = .004) on the Stroke Impact Scale index. For the Stroke Impact Scale overall recovery measure, significant negative associations were found only at the median at three months and at the .75 quantile at 12 months. CONCLUSION Comorbidity burden is independently associated with patient-rated perceived impact within the first-year post-stroke. The addition of patient-rated impact measures in personalized rehabilitation may enhance the use of conventional observer-rated outcome measures.
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Affiliation(s)
- Katherine Sewell
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Tamara Tse
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Department of Occupational Therapy, St Vincent's Hospital, Fitzroy, Australia
| | - Elizabeth Harris
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Thomas Matyas
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Faculty of Medicine and Health Sciences, Melbourne Medical School, University of Melbourne, Parkville, Australia.,Melbourne Brain Centre, Royal Melbourne and Austin Hospitals, University of Melbourne, Parkville, Australia
| | - Henry Ma
- Department of Medicine, Monash Health, Monash University, Clayton, Australia
| | - Stephen M Davis
- Melbourne Brain Centre, Royal Melbourne and Austin Hospitals, University of Melbourne, Parkville, Australia.,Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, Royal Melbourne and Austin Hospitals, University of Melbourne, Parkville, Australia
| | - Leeanne M Carey
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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29
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Scrutinio D, Battista P, Guida P, Lanzillo B, Tortelli R. Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke. Front Neurol 2020; 11:84. [PMID: 32132967 PMCID: PMC7040356 DOI: 10.3389/fneur.2020.00084] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023] Open
Abstract
Objective: We sought to determine sex differences in outcomes in patients with severe stroke who had been admitted to inpatient rehabilitation. Methods: We studied 1,316 patients aged 18 to 99 (mean 72) classified as case-mix groups 0108, 0109, and 0110 of the Medicare case-mix classification system. These groups encompass the most severe strokes. Three outcomes were analyzed: (1) 3-year mortality from admission to rehabilitation; (2) combined outcome of transfer to acute care or death within 90 days from admission to rehabilitation; (3) functional outcome, including proportional recovery in motor functioning and good functional outcome as defined by achievement of a Functional Independence Measure (FIM)-motor score ≥65 points at discharge. Multivariable regression analyses were used to assess sex-difference in each outcome between women and men. The covariates examined included age, marital status, comorbidities, time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission. Results: Kaplan-Meier estimated 3-year mortality rate was 20.7% in women and 22.0% in men. The crude hazard ratio (HR) of death for women compared with men was 0.94 (95% CI 0.74-1.20). After adjustment for significant covariates, the HR of 3-year mortality was 0.73 (95% CIs 0.56-0.96; p = 0.025). Comorbidity, including diabetes, anemia, coronary artery disease, atrial fibrillation, and chronic obstructive pulmonary disease, significantly increased mortality risk by 49-88%. The incidence of the combined outcome was 8.3% in women and 8.4% in men. The crude HR of the combined end-point for women compared with men was 1.05 (95% CI 0.72-1.53). After adjustment for significant covariates, the HR was 0.95 (95% CIs 0.65-1.40; p = 0.810). Likewise, no significant difference in proportional recovery or in the rate of achievement of a good functional outcome between women and men was observed. Conclusion: Among patients admitted to inpatient rehabilitation after severe stroke, women and men had comparable crude mortality rates at 3 years. After multivariable adjustment, however, women had lower mortality risk. No sex-differences in the risk of being transferred to acute care or dying within 90 days from admission to rehabilitation or in responsiveness to rehabilitation were observed.
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Affiliation(s)
- Domenico Scrutinio
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Petronilla Battista
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Pietro Guida
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Bernardo Lanzillo
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Rosanna Tortelli
- Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, London, United Kingdom
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30
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Sennfält S, Pihlsgård M, Petersson J, Norrving B, Ullberg T. Long-term outcome after ischemic stroke in relation to comorbidity - An observational study from the Swedish Stroke Register (Riksstroke). Eur Stroke J 2019; 5:36-46. [PMID: 32232168 DOI: 10.1177/2396987319883154] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/26/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose Comorbidity in stroke is common, but comprehensive reports are sparse. We describe prevalence of comorbidity and the prognostic impact on mortality and functional outcome in a large national ischemic stroke cohort. Methods We used outcome data from a long-term follow-up survey conducted in 2016 by the Swedish Stroke Register (Riksstroke). Those included in the study were 11 775 pre-stroke functionally independent patients with first-ever ischemic stroke followed up at three months and 12 months (all patients), and three years (2013 cohort) or five years (2011 cohort). Pre-stroke comorbidity data for 16 chronic conditions were obtained from the Swedish National Patient Register, the Swedish Prescribed Drugs Register and the Riksstroke register. Individuals were grouped according to number of conditions: none (0), low (1), moderate (2-3) or high (≥4). Co-occurrence was analysed using hierarchical clustering, and multivariable analyses were used to estimate the prognostic significance of individual conditions. Results The proportion of patients without comorbidity was 24.8%; 31.8% had low comorbidity; 33.5% had moderate comorbidity and 9.9% had high comorbidity. At 12 months, the proportion of poor outcome (dead or dependent: mRS ≥3) was 24.8% (no comorbidity), 34.7% (low), 45.2% (moderate) and 59.4% (high). At five years, these proportions were 37.7%, 50.3%, 64.3%, and 81.7%, respectively. There was clustering of cardiovascular conditions and substantial negative effects of dementia, kidney, and heart failure. Conclusion Comorbidity is common and has a strong impact on mortality and functional outcome. Our results highlight the need for health systems to shift focus to a comprehensive approach in stroke care that includes multimorbidity as a key component.
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Affiliation(s)
- Stefan Sennfält
- Stroke Policy and Quality Register Research Group, Department of Neurology, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Mats Pihlsgård
- Division of Geriatric medicine, Lund University, Lund, Sweden
| | - Jesper Petersson
- Stroke Policy and Quality Register Research Group, Department of Neurology, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Bo Norrving
- Stroke Policy and Quality Register Research Group, Department of Neurology, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Teresa Ullberg
- Stroke Policy and Quality Register Research Group, Department of Neurology, Lund University, and Skåne University Hospital, Lund, Sweden
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Chen CM, Lee M, Yang YH, Huang SS, Lin CH. Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke. Sci Rep 2019; 9:11521. [PMID: 31395912 PMCID: PMC6687732 DOI: 10.1038/s41598-019-47975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/m2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson–Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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32
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Affiliation(s)
- Katie I. Gallacher
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Bhautesh D. Jani
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Peter Hanlon
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Barbara I. Nicholl
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Frances S. Mair
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
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33
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Savchenko AA, Pavlova OM, Khalo NV, Gvozdev II. [Neutrophil respiratory burst and the state of hemostasis in patients with ischemic and hemorrhagic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:75-80. [PMID: 30830121 DOI: 10.17116/jnevro201811812275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To study the relationship between the state of the respiratory burst of neutrophils and the indices of hemostasis in patients with ischemic (IS) and hemorrhagic (HS) strokes. MATERIAL AND METHODS Thirty-three patients with IS and 31 patients with HS were examined in the first 24 hours after an acute cerebrovascular accident (ACA). The diagnosis of ASA was confirmed by neuroimaging methods: computed tomography and magnetic resonance imaging. The determination of the respiratory burst state of blood neutrophils was carried out using chemiluminescence analysis. Indicators of vascular-platelet and coagulation hemostasis were determined in all patients. RESULTS AND CONCLUSION There were changes in the kinetics and activity of neutrophil respiratory burst in stroke patients. Patients with HS had higher (compared to those of patients with IS) level of spontaneous and induced synthesis of secondary ROS but with a decrease in metabolic resources for their synthesis. Activation of spontaneous and ADP-induced platelet aggregation was detected only in HS. Patients with HS had a higher level of fibrinolytic activity as compared to the patients with IS. There were positive correlations between the kinetic parameters of blood coagulation and the synthesis of primary ROS by neutrophils in patients with HS, whereas the intensity of all ROS synthesis negatively correlated with activated partial thromboplastin time. Therefore, in patients with HS the synergistic relationship between the respiratory burst of neutrophils (pro-inflammatory activity) and coagulation hemostasis was more pronounced compared to patients with IS.
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Affiliation(s)
- A A Savchenko
- Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Sciences, Research Institute of Medical Problems of the North', Krasnoyarsk, Russia
| | - O M Pavlova
- Non State Healthcare Institution 'Railway Clinical Hospital on Station Krasnoyarsk Open Joint-stock Company 'RRW', Krasnoyarsk, Russia
| | - N V Khalo
- Krasnoyarsk State Budget Healthcare Institution 'Berzon Krasnoyarsk Interdistrict Clinical Hospital #20', Krasnoyarsk, Russia
| | - I I Gvozdev
- Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Sciences, Research Institute of Medical Problems of the North', Krasnoyarsk, Russia
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