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Barassin L, Pradon D, Roche N, Slawinski J. Does Accelerometry at the Centre of Mass Accurately Predict the Gait Energy Expenditure in Patients with Hemiparesis? SENSORS (BASEL, SWITZERLAND) 2023; 23:7177. [PMID: 37631714 PMCID: PMC10458941 DOI: 10.3390/s23167177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The aim of this study was to compare energy expenditure (EE) predicted by accelerometery (EEAcc) with indirect calorimetry (EEMETA) in individuals with hemiparesis. METHODS Twenty-four participants (12 with stroke and 12 healthy controls) performed a six-minute walk test (6MWT) during which EEMETA was measured using a portable indirect calorimetry system and EEACC was calculated using Bouten's equation (1993) with data from a three-axis accelerometer positioned between L3 and L4. RESULTS The median EEMETA was 9.85 [8.18;11.89] W·kg-1 in the stroke group and 5.0 [4.56;5.46] W·kg-1 in the control group. The median EEACC was 8.57 [7.86;11.24] W·kg-1 in the control group and 8.2 [7.05;9.56] W·kg-1 in the stroke group. The EEACC and EEMETA were not significantly correlated in either the control (p = 0.8) or the stroke groups (p = 0.06). The Bland-Altman method showed a mean difference of 1.77 ± 3.65 W·kg-1 between the EEACC and EEMETA in the stroke group and -2.08 ± 1.59 W·kg-1 in the controls. CONCLUSIONS The accuracy of the predicted EE, based on the accelerometer and the equations proposed by Bouten et al., was low in individuals with hemiparesis and impaired gait. This combination (sensor and Bouten's equation) is not yet suitable for use as a stand-alone measure in clinical practice for the evaluation of hemiparetic patients.
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Affiliation(s)
- Léo Barassin
- UMR 1179 END-ICAP, UVSQ, 78000 Versailles, France; (L.B.); (D.P.); (N.R.)
- Pôle Parasport Santé, CHU Raymond Poincaré, APHP, 92380 Garches, France
- ISPC Synergies, 75008 Paris, France
| | - Didier Pradon
- UMR 1179 END-ICAP, UVSQ, 78000 Versailles, France; (L.B.); (D.P.); (N.R.)
- Pôle Parasport Santé, CHU Raymond Poincaré, APHP, 92380 Garches, France
- ISPC Synergies, 75008 Paris, France
| | - Nicolas Roche
- UMR 1179 END-ICAP, UVSQ, 78000 Versailles, France; (L.B.); (D.P.); (N.R.)
- Service Explorations Fonctionnelles, CHU Raymond Poincaré, APHP, 92380 Garches, France
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Shao K, Zhang F, Li Y, Cai H, Paul Maswikiti E, Li M, Shen X, Wang L, Ge Z. A Nomogram for Predicting the Recurrence of Acute Non-Cardioembolic Ischemic Stroke: A Retrospective Hospital-Based Cohort Analysis. Brain Sci 2023; 13:1051. [PMID: 37508983 PMCID: PMC10377670 DOI: 10.3390/brainsci13071051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Non-cardioembolic ischemic stroke (IS) is the predominant subtype of IS. This study aimed to construct a nomogram for recurrence risks in patients with non-cardioembolic IS in order to maximize clinical benefits. From April 2015 to December 2019, data from consecutive patients who were diagnosed with non-cardioembolic IS were collected from Lanzhou University Second Hospital. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection. Multivariable Cox regression analyses were used to identify the independent risk factors. A nomogram model was constructed using the "rms" package in R software via multifactor Cox regression. The accuracy of the model was evaluated using the receiver operating characteristic (ROC), calibration curve, and decision curve analyses (DCA). A total of 729 non-cardioembolic IS patients were enrolled, including 498 (68.3%) male patients and 231 (31.7%) female patients. Among them, there were 137 patients (18.8%) with recurrence. The patients were randomly divided into training and testing sets. The Kaplan-Meier survival analysis of the training and testing sets consistently revealed that the recurrence rates in the high-risk group were significantly higher than those in the low-risk group (p < 0.01). Moreover, the receiver operating characteristic curve analysis of the risk score demonstrated that the area under the curve was 0.778 and 0.760 in the training and testing sets, respectively. The nomogram comprised independent risk factors, including age, diabetes, platelet-lymphocyte ratio, leukoencephalopathy, neutrophil, monocytes, total protein, platelet, albumin, indirect bilirubin, and high-density lipoprotein. The C-index of the nomogram was 0.752 (95% CI: 0.705~0.799) in the training set and 0.749 (95% CI: 0.663~0.835) in the testing set. The nomogram model can be used as an effective tool for carrying out individualized recurrence predictions for non-cardioembolic IS.
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Affiliation(s)
- Kangmei Shao
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Fan Zhang
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Hongbin Cai
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Ewetse Paul Maswikiti
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Mingming Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Xueyang Shen
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Longde Wang
- Expert Workstation of Academician Wang Longde, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Zhaoming Ge
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
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Tollitt J, Allan SM, Chinnadurai R, Odudu A, Hoadley M, Smith C, Kalra PA. Does previous stroke modify the relationship between inflammatory biomarkers and clinical endpoints in CKD patients? BMC Nephrol 2022; 23:38. [PMID: 35042473 PMCID: PMC8767689 DOI: 10.1186/s12882-021-02625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chronic kidney disease (CKD) is an independent risk factor for stroke. Stroke is also an independent risk factor for worse CKD outcomes and inflammation may contribute to this bidirectional relationship. This study aims to investigate inflammatory biomarkers in patients with non-dialysis CKD (ND-CKD) with and without stroke.
Methods
A propensity matched sample from > 3000 Salford Kidney Study (SKS) patients, differentiated by previous stroke at study recruitment, had stored plasma analyzed for interleukin- 6 (IL-6), Von Willebrand Factor (VWF) and C-reactive protein (CRP). Multivariable cox regression analysis investigated associations between inflammation and death, end-stage renal disease (ESRD) and future non-fatal cardiovascular events (NFCVE).
Results
A total of 157 previous stroke patients were compared against 162 non-stroke patients. There were no significant differences in inflammatory biomarkers between the two groups. Previous stroke was associated with greater mortality risk, hazard ratio (HR) (95% CI) was 1.45 (1.07–1.97). Higher inflammatory biomarker concentrations were independently associated with death but not ESRD or NFCVE in the total population. For each 1 standard deviation (SD) increase in log IL-6, VWF and CRP, the HR for all-cause mortality were 1.35 (1.10–1.70), 1.26 (1.05–1.51) and 1.34 (1.12–1.61), respectively. CRP retained its independent association (HR 1.47 (1.15–1.87)) with death in the stroke population.
Conclusion
Previous stroke is an important determinant of mortality. However, the adverse combination of stroke and ND-CKD does not seem to be driven by higher levels of inflammation detected after the stroke event. Biomarkers of inflammation were associated with worse outcome in both stroke and non-stroke ND-CKD patients.
Trial registration
15/NW/0818.
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Jiang X, Morgenstern LB, Cigolle CT, Wang L, Claflin ES, Lisabeth LD. Multiple Chronic Conditions Explain Ethnic Differences in Functional Outcome Among Patients With Ischemic Stroke. Stroke 2022; 53:120-127. [PMID: 34517767 PMCID: PMC8712371 DOI: 10.1161/strokeaha.120.032595] [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: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Mexican Americans (MAs) have worse stroke outcomes and a different profile of multiple chronic conditions (MCC) compared with non-Hispanic White people. MCC has implications for stroke treatment, complications, and poststroke care, which impact poststroke functional outcome (FO). We sought to assess the contribution of MCC to the ethnic difference in FO at 90 days between MAs and non-Hispanic White people. METHODS In a prospective cohort of ischemic stroke patients (2008-2016) from Nueces County, Texas, data were collected from patient interviews, medical records, and hospital discharge data. MCC was assessed using a stroke-specific and function-relevant index (range, 0-35; higher scores greater MCC burden). Poststroke FO was measured by an average score of 22 activities of daily living (ADLs) and instrumental ADLs at 90 days (range, 1-4; higher scores worse FO). The contribution of MCC to the ethnic difference in FO was assessed using Tobit regression. Effect modification by ethnicity was examined. RESULTS Among the 896 patients, 70% were MA and 51% were women. Mean age was 68±12.2 years; 33% of patients were dependent in ADL/instrumental ADLs (FO score >3, representing a lot of difficulty with ADL/instrumental ADLs) at 90 days. MAs had significantly higher age-adjusted MCC burden compared with non-Hispanic White people. Patients with high MCC score (at the 75th percentile) on average scored 0.70 points higher in the FO score (indicating worse FO) compared with those with low MCC score (at the 25th percentile) after adjusting for age, initial National Institutes of Health Stroke Scale, and sociodemographic factors. MCC explained 19% of the ethnic difference in FO, while effect modification by ethnicity was not statistically significant. CONCLUSIONS MAs had a higher age-adjusted MCC burden, which partially explained the ethnic difference in FO. The prevention and treatment of MCC could potentially mitigate poststroke functional impairment and lessen ethnic disparities in stroke outcomes.
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Affiliation(s)
- Xiaqing Jiang
- Department of Epidemiology, School of Public Health, University of Michigan
| | - Lewis B. Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Stroke Program, University of Michigan Medical School
| | - Christine T. Cigolle
- Department of Family Medicine and Internal Medicine, University of Michigan Medical School, Geriatric Research, Education and Clinical Center, VA Ann Arbor Healthcare System
| | - Lu Wang
- Department of Biostatistics, School of Public Health, University of Michigan
| | - Edward S. Claflin
- Stroke Program, University of Michigan Medical School, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Stroke Program, University of Michigan Medical School
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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis. World Neurosurg 2021; 163:e1-e42. [PMID: 34728391 DOI: 10.1016/j.wneu.2021.10.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to systematically review the utility of serum biomarkers in the setting of ischemic stroke (IS) to predict long-term outcome. METHODS A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986-2018. All studies assessing long-term functional outcome (defined as 30 days or greater) following IS with respect to serum biomarkers were included. Data were extracted and pooled using a meta-analysis of odds ratios. RESULTS Of the total 2928 articles in the original literature search, 183 studies were ultimately selected. A total of 127 serum biomarkers were included. Biomarkers were grouped into several categories: inflammatory (32), peptide/enzymatic (30), oxidative/metabolic (28), hormone/steroid based (23), and hematologic/vascular (14). The most commonly studied biomarkers in each category were found to be CRP, S100β, albumin, copeptin, and D-dimer. With the exception of S100β, all were found to be statistically associated with >30-day outcome after ischemic stroke. CONCLUSIONS Serum-based biomarkers have the potential to predict functional outcome in IS patients. This meta-analysis has identified CRP, albumin, copeptin, and D-dimer to be significantly associated with long-term outcome after IS. These biomarkers have the potential to serve as a platform for prognosticating stroke outcomes after 30 days. These serum biomarkers, some of which are routinely ordered, can be combined with imaging biomarkers and used in artificial intelligence algorithms to provide refined predictive outcomes after injury. Ultimately these tools will assist physicians in providing guidance to families with regards to long-term independence of patients.
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McCabe JJ, O'Reilly E, Coveney S, Collins R, Healy L, McManus J, Mulcahy R, Moynihan B, Cassidy T, Hsu F, Worrall B, Murphy S, O'Donnell M, Kelly PJ. Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence after ischaemic stroke: Systematic review and meta-analysis. Eur Stroke J 2021; 6:62-71. [PMID: 33817336 PMCID: PMC7995315 DOI: 10.1177/2396987320984003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023] Open
Abstract
Background Recent randomised trials showed benefit for anti-inflammatory therapies in coronary disease but excluded stroke. The prognostic value of blood inflammatory markers after stroke is uncertain and guidelines do not recommend their routine measurement for risk stratification. Methods We performed a systematic review and meta-analysis of studies investigating the association of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen and risk of recurrent stroke or major vascular events (MVEs). We searched EMBASE and Ovid Medline until 10/1/19. Random-effects meta-analysis was performed for studies reporting comparable effect measures. Results Of 2,515 reports identified, 39 met eligibility criteria (IL-6, n = 10; CRP, n = 33; fibrinogen, n = 16). An association with recurrent stroke was reported in 12/26 studies (CRP), 2/11 (fibrinogen) and 3/6 (IL-6). On random-effects meta-analysis of comparable studies, CRP was associated with an increased risk of recurrent stroke [pooled hazard ratio (HR) per 1 standard-deviation (SD) increase in loge-CRP (1.14, 95% CI 1.06-1.22, p < 0.01)] and MVEs (pooled HR 1.21, CI 1.10-1.34, p < 0.01). Fibrinogen was also associated with recurrent stroke (HR 1.26, CI 1.07-1.47, p < 0.01) and MVEs (HR 1.31, 95% CI 1.15-1.49, p < 0.01). Trends were identified for IL-6 for recurrent stroke (HR per 1-SD increase 1.17, CI 0.97-1.41, p = 0.10) and MVEs (HR 1.22, CI 0.96-1.55, p = 0.10). Conclusion Despite evidence suggesting an association between inflammatory markers and post-stroke vascular recurrence, substantial methodological heterogeneity was apparent between studies. Individual-patient pooled analysis and standardisation of methods are needed to determine the prognostic role of blood inflammatory markers and to improve patient selection for randomised trials of inflammatory therapies.
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Affiliation(s)
- J J McCabe
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Medicine for the Elderly Department/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - E O'Reilly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
| | - S Coveney
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,Department of Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - R Collins
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - L Healy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - J McManus
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, University Hospital Limerick, Ireland
| | - R Mulcahy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, Waterford University Hospital, Waterford, Ireland
| | - B Moynihan
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - T Cassidy
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - F Hsu
- The Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - S Murphy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Medicine for the Elderly Department/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - M O'Donnell
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland.,Department of Translational Medicine, National University of Ireland Galway, Ireland
| | - P J Kelly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Neurovascular Unit for Applied Translational and Therapeutics Research, Catherine McAuley Centre, Dublin, Ireland.,Department of Neurology/Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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Robba C, Battaglini D, Samary CS, Silva PL, Ball L, Rocco PRM, Pelosi P. Ischaemic stroke-induced distal organ damage: pathophysiology and new therapeutic strategies. Intensive Care Med Exp 2020; 8:23. [PMID: 33336314 PMCID: PMC7746424 DOI: 10.1186/s40635-020-00305-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 01/09/2023] Open
Abstract
Acute ischaemic stroke is associated with a high risk of non-neurological complications, which include respiratory failure, cardiovascular dysfunction, kidney and liver injury, and altered immune and endocrine function. The aim of this manuscript is to provide an overview of the main forms of stroke-induced distal organ damage, providing new pathophysiological insights and recommendations for clinical management.Non-neurological complications of stroke can affect outcomes, with potential for serious short-term and long-term consequences. Many of these complications can be prevented; when prevention is not feasible, early detection and proper management can still be effective in mitigating their adverse impact. The general care of stroke survivors entails not only treatment in the acute setting but also prevention of secondary complications that might hinder functional recovery. Acute ischaemic stroke triggers a cascade of events-including local and systemic activation of the immune system-which results in a number of systemic consequences and, ultimately, may cause organ failure. Understanding the pathophysiology and clinical relevance of non-neurological complications is a crucial component in the proper treatment of patients with acute stroke.Little evidence-based data is available to guide management of these complications. There is a clear need for improved surveillance and specific interventions for the prevention, early diagnosis, and proper management of non-neurological complications during the acute phase of ischaemic stroke, which should reduce morbidity and mortality.
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Affiliation(s)
- Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Largo Rosanna Benzi 10, 16100, Genoa, Italy.
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Largo Rosanna Benzi 10, 16100, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Cynthia S Samary
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro L Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Largo Rosanna Benzi 10, 16100, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Largo Rosanna Benzi 10, 16100, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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8
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Lin B, Zhang Z, Mei Y, Wang C, Xu H, Liu L, Wang W. Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis. Neurol Sci 2020; 42:61-71. [PMID: 33040195 DOI: 10.1007/s10072-020-04797-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stroke is still the main cause of death and disability worldwide, numerous studies of recurrence risk have been reported, while systematic estimates of stroke recurrence risk in the last 10 years are variable. This review aims to estimate the cumulative stroke recurrence risk in the last 10 years for secondary prevention management in future. METHODS A systematic search from January 2009 to March 2019 was conducted through PubMed, EMBASE, Web of Science, Wan-fang, and CNKI. Search terms were in English and Chinese. RESULTS A total of 37 studies involving 1,075,014 stroke patients were included. The pooled stroke recurrence rate was 7.7% at 3 months, 9.5% at 6 months, 10.4% at 1 year, 16.1% at 2 years, 16.7% at 3 years, 14.8% at 5 years, 12.9% at 10 years, and 39.7% at 12 years after the initial stroke. In addition, the pooled recurrence rate of 32 studies including stroke patients over 50 years only at seven time points except for subgroup of 10 years was 7.7%, 9.5%, 11.2%, 16.1%, 19.3%, 18.1%, and 39.7%, respectively. Meta-regression showed that the time points explained 23.02% of the variance among studies, while regions, age, and stroke types showed no significant contribution to heterogeneity. CONCLUSIONS The risk of stroke recurrence varies greatly from 3 months to over 10 years and increases significantly over time in both young and old subgroup. The heterogeneity may be explained by follow-up time, regions, age, methodology differences, and stroke types, which was needed further exploration in future.
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Affiliation(s)
- Beilei Lin
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China.,Academic of Medical Science, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Zhenxiang Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China.
| | - Yongxia Mei
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou City, Henan Province, China.
| | - Hui Xu
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Lamei Liu
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Wenna Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
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Increased One-Year Recurrent Ischemic Stroke after First-Ever Ischemic Stroke in Males with Benign Prostatic Hyperplasia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155360. [PMID: 32722374 PMCID: PMC7432020 DOI: 10.3390/ijerph17155360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
Abstract
(1) Background: Patients with benign prostatic hyperplasia (BPH) were questioned about quality of life and sleep. Most BPH patients were treated with alpha-1 adrenergic receptor antagonists, which could improve cerebral blood flow for 1–2 months. Patients with ischemic stroke (IS) could experience cerebral autoregulation impairment for six months. The relationship between BPH and recurrent IS remains unclear. The aim of this study was to determine the risk of one-year recurrent IS conferred by BPH. (2) Methods: We used data from the Taiwanese National Health Insurance Database to identify newly diagnosed IS cases entered from 1 January 2008 to 31 December 2008. Patients were followed until the recurrent IS event or 365 days after the first hospitalization. The risk factors associated with one-year recurrent IS were assessed using Cox proportional hazards regression. (3) Results: Patients with BPH had a higher risk of recurrent IS (12.11% versus 8.15%) (adjusted hazard ratio (HR): 1.352; 95% confidence interval (CI): 1.028–1.78, p = 0.031). Other risk factors included hyperlipidemia (adjusted HR: 1.338; 95% CI: 1.022–1.751, p = 0.034), coronary artery disease (adjusted HR: 1.487; 95% CI: 1.128–1.961, p = 0.005), chronic obstructive pulmonary disease (adjusted HR: 1.499; 95% CI: 1.075–2.091, p = 0.017), and chronic kidney disease (adjusted HR: 1.523; 95% CI: 1.033–2.244, p = 0.033). (4) Conclusion: Patients with BPH who had these risk factors had an increased risk of one-year recurrent IS. The modification of risk factors may prevent recurrent IS.
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Chen J, Li S, Zheng K, Wang H, Xie Y, Xu P, Dai Z, Gu M, Xia Y, Zhao M, Liu X, Xu G. Impact of Smoking Status on Stroke Recurrence. J Am Heart Assoc 2020; 8:e011696. [PMID: 30955409 PMCID: PMC6507189 DOI: 10.1161/jaha.118.011696] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Smoking is a well‐established risk factor of stroke and smoking cessation has been recommended for stroke prevention; however, the impact of smoking status on stroke recurrence has not been well studied to date. Methods and Results Patients with first‐ever stroke were enrolled and followed in the NSRP (Nanjing Stroke Registry Program). Smoking status was assessed at baseline and reassessed at the first follow‐up. The primary end point was defined as fatal or nonfatal recurrent stroke after 3 months of the index stroke. The association between smoking and the risk of stroke recurrence was analyzed with multivariate Cox regression model. At baseline, among 3069 patients included, 1331 (43.4%) were nonsmokers, 263 (8.6%) were former smokers, and 1475 (48.0%) were current smokers. At the first follow‐up, 908 (61.6%) patients quit smoking. After a mean follow‐up of 2.4±1.2 years, 293 (9.5%) patients had stroke recurrence. With nonsmokers as the reference, the adjusted hazard ratios for stroke recurrence were 1.16 (95% CI, 0.75–1.79) in former smokers, 1.31 (95% CI, 0.99–1.75) in quitters, and 1.93 (95% CI, 1.43–2.61) in persistent smokers. Among persistent smokers, hazard ratios for stroke recurrence ranged from 1.68 (95% CI, 1.14–2.48) in those who smoked 1 to 20 cigarettes daily to 2.72 (95% CI, 1.36–5.43) in those who smoked more than 40 cigarettes daily (P for trend <0.001). Conclusions After an initial stroke, persistent smoking increases the risk of stroke recurrence. There exists a dose–response relationship between smoking quantity and the risk of stroke recurrence.
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Affiliation(s)
- Jingjing Chen
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Shun Li
- 2 Department of Neurology Jinling Hospital Southern Medical University Jiangsu China
| | - Kuo Zheng
- 3 Department of Colorectal Surgery Changhai Hospital Second Military Medical University Shanghai China
| | - Huaiming Wang
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Yi Xie
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Pengfei Xu
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Zhengze Dai
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Mengmeng Gu
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Yaqian Xia
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Min Zhao
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Xinfeng Liu
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China.,2 Department of Neurology Jinling Hospital Southern Medical University Jiangsu China.,4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Gelin Xu
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China.,2 Department of Neurology Jinling Hospital Southern Medical University Jiangsu China.,4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
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11
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Tollitt J, Odudu A, Flanagan E, Chinnadurai R, Smith C, Kalra PA. Impact of prior stroke on major clinical outcome in chronic kidney disease: the Salford kidney cohort study. BMC Nephrol 2019; 20:432. [PMID: 31771527 PMCID: PMC6880597 DOI: 10.1186/s12882-019-1614-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/31/2019] [Indexed: 01/14/2023] Open
Abstract
Background Chronic kidney disease (CKD) is an independent risk factor for stroke in the general population. The impact of prior stroke on major clinical outcomes in CKD populations is poorly characterised. Methods The Salford Kidney Study is a UK prospective cohort of more than 3000 patients recruited since 2002 and followed until March 2018. Multivariable Cox regression examined associations of stroke at two time points; cohort inception, and at dialysis initiation, with risks of death, non-fatal cardiovascular events (NFCVE) and end stage renal disease (ESRD). Results 277 (9.1%) of 3060 patients suffered a prior stroke and this was associated with mortality, ESRD and future NFCVE after cardiovascular risk factor adjustments. Median survival for prior stroke patients was 40 months vs 77 months in patients without a stroke. Prior stroke was independently associated with mortality (HR 1.20 95%CI 1.0–1.43, p = 0.05). Of 579 patients who reached ESRD and commenced dialysis, a prior stroke (N = 48) was independently associated with mortality. Median survival for the prior stroke group was 29 months compared with 50 months for the non-stroke group. Only 70 and 75% of patients who had suffered an ischaemic stroke were prescribed antiplatelets or statins respectively. Conclusions A diagnosis of stroke is strongly and independently associated with several adverse clinical outcomes for patients with CKD. Prior stroke profoundly alters cardiovascular risk in CKD patients. Greater attention to primary and secondary preventive strategies is warranted which may improve these outcomes.
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Affiliation(s)
- James Tollitt
- Renal Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK. .,Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK.
| | - Aghogho Odudu
- Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Emma Flanagan
- Informatics Department, Salford Royal NHS Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Renal Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.,Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Craig Smith
- Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK.,Stroke department, Salford Royal NHS Trust, Salford, UK
| | - Philip A Kalra
- Renal Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.,Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, UK
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12
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Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines. Kidney Int 2019; 97:266-278. [PMID: 31866114 DOI: 10.1016/j.kint.2019.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/06/2019] [Accepted: 09/26/2019] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease is strongly associated with an increased risk of stroke, small vessel disease, and vascular dementia. Common vascular factors for stroke, such as hypertension, diabetes, and atrial fibrillation, are more prevalent in patients with chronic kidney disease, accounting for this association. However, factors unique to these patients, such as uremia, oxidative stress, and mineral and bone abnormalities, as well as dialysis-related factors are also believed to contribute to risk. Despite improvements in stroke treatment and survival in the general population, the rate of improvement in patients with chronic kidney disease, especially those who are dialysis dependent, has lagged behind. There is a lack of or conflicting evidence that those with renal disease, particularly when advanced or older, consistently derive benefit from currently available preventive and therapeutic interventions for stroke in the general population. In this review, we explore the complexities and challenges of these interventions in the population with renal disease.
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13
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Kim MS, Joo MC, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YS, Han EY, Han J, Ahn J, Chang WH, Kim YH. Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study. J Clin Neurol 2019; 15:54-61. [PMID: 30618217 PMCID: PMC6325355 DOI: 10.3988/jcn.2019.15.1.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Few studies have investigated the relationship between the specific functional factors potentially associated with functional level and stroke recurrence. We conducted a study of patients with noncardioembolic ischemic stroke (NCIS) to determine the functional factors affecting recurrence within the first year. Methods In total, 568 first-ever NCIS patients (age=65.1±17.4 years, mean±SD) were analyzed in a multicenter, prospective cohort study registered from August 2012. Demographic characteristics, past medical history, comorbidities, laboratory data, stroke features in neuroimaging, acute treatments, and medications at discharge were assessed. Functional factors reflecting gross functional impairment, ambulatory function, motor function, activities of daily living, cognition, language ability, swallowing function, mood, and quality of life were comprehensively evaluated in face-to-face assessments using standardized tools at the time of discharge. Results The cumulative incidence of stroke recurrence in NCIS was 6.0% (n=34) at 1 year. The period from admission to discharge was 34.4±7.0 days. The independent predictors of stroke recurrence within 1 year in multivariate Cox proportional-hazards regression analyses were 1) age [per-year hazard ratio (HR)=1.04, 95% confidence interval (CI)=0.97–1.06, p=0.048], 2) Charlson Comorbidity Index higher than 2 (HR=1.72, 95% CI=1.26–2.22, p=0.016), 3) modified Rankin Scale score of 3 or more at discharge (HR=1.56, 95% CI=1.22–1.94, p=0.032), and 4) Functional Ambulation Category of 3 or less at discharge (HR=2.56, 95% CI=1.84–3.31, p=0.008). Conclusions In addition to patient age, moderate-to-severe functional impairment requiring the help of others (especially for ambulation) at the time of discharge and the severity of comorbidity were independent predictors of stroke recurrence within 1 year of the first NCIS.
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Affiliation(s)
- Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea.
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sam Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
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14
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Åsberg S, Farahmand B, Hasvold P, Johansson S, Appelros P. Non-cardioembolic TIA and ischemic stroke: Implications of severity. Acta Neurol Scand 2018; 138:369-376. [PMID: 29920644 DOI: 10.1111/ane.12974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our purpose was to explore major vascular and bleeding outcomes in relation to risk and severity scores (ABCD2 or NIHSS) in patients with transient ischemic attack (TIA) or acute ischemic stroke (AIS). METHODS This nationwide observational study was based on data from 4 national registries. Outcomes were assessed by Kaplan-Meier and Cox regression analyses. RESULTS The total cohort comprised 21 268 patients (median age 73 years, 47.6% females). Based on ABCD2-score, the TIA-population (n = 10 174) was divided into low-risk (0-3 p, n = 3463) and high-risk (4-7 p, n = 6711). Based on NIHSS-score, the AIS-population (n = 11 454) was divided into minor (0-5 p, n = 8596), moderate (6-10 p, n = 1630) and severe (≥11 p, n = 1228). During follow-up (mean 1.7 years), the composite endpoint of stroke, myocardial infarction or death occurred in 3572 (16.5%) of all the patients, and major bleeding in 668 (3.1%) patients. Using low-risk TIA as reference, the adjusted hazard ratios (HR, 95% CI) of the composite endpoint were 1.41 (1.23-1.62) for high-risk TIA, 1.94 (1.70-2.22) for minor, 2.86 (2.45-3.34) for moderate and 4.18 (3.57-4.90) for severe stroke. When analyzed separately, the association with increased risk remained significant for stroke and death, but not for myocardial infarction. The HR of major bleeding were 1.31 (0.99-1.73) for high-risk TIA, 1.49 (1.13-1.95) for minor, 1.54 (1.08-2.21) for moderate and 2.10 (1.44-3.05) for severe stroke. CONCLUSIONS This study confirms the association between severity of the index ischemic stroke and risk of future major vascular and bleeding events, and highlights the increased risk also for patients with high-risk TIA.
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Affiliation(s)
- S. Åsberg
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | | | - P. Hasvold
- AstraZeneca Nordic Baltic; Södertälje Sweden
| | | | - P. Appelros
- Faculty of Medicine and Health; University Health Care Research Center; Örebro University; Örebro Sweden
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15
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Deng Q, Li S, Zhang H, Wang H, Gu Z, Zuo L, Wang L, Yan F. Association of serum lipids with clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis. J Clin Neurosci 2018; 59:236-244. [PMID: 30243601 DOI: 10.1016/j.jocn.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/28/2018] [Accepted: 09/10/2018] [Indexed: 12/31/2022]
Abstract
Serum lipid levels have been investigated as prognostic markers in patients with acute ischaemic stroke. However, these results remain inconsistent. This study aimed at assessing the association between serum lipid and clinical outcomes in acute ischaemic stroke. Relevant data were obtained from Cochrane Library, PubMed and Web of Science databases. The heterogeneity of pooled results was determined by the Cochran's Q test and Higgins I-squared statistic. The random-effect model was performed to calculate the pooled results if PH < 0.05 for Q-test, otherwise the fixed-effect model was applied. The primary results were death, and the secondary were recurrence, dependency, mRS score ≥3, and early neurological deterioration. A total of 21 full-text studies was included in the present study. For primary results, the pooled results from 5 studies with 4119 patients showed that triglyceride (TG) was a significant predictor for death (OR = 0.65, 95%CI = 0.43-0.98, PH = 0.028). The pooled data from 11 studies with 12,486 patients for total cholesterol (TC), 4 studies with 7593 patients for low-density lipoprotein cholesterol (LDL-C), and 5 studies with 6933 patients for high-density lipoprotein cholesterol (HDL-C) suggested that TC (OR = 0.79, 95%CI = 0.56-1.13, PH < 0.001), LDL-C (OR = 1.02, 95%CI = 0.66-1.57, PH = 0.042), and HDL-C (OR = 1.18, 95%CI = 0.75-1.86, PH = 0.003) were not associated with death in acute ischaemic stroke. For secondary results, the pooled results of 2 studies with 867 patients indicated that TG was positively associated with early neurological deterioration. This study suggested that serum TG was associated with death and early neurological deterioration in acute ischaemic stroke.
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Affiliation(s)
- Qiwen Deng
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China; Department of Neurology, Nanjing First Hospital, Nanjing Medical University. Nanjing, China
| | - Shuo Li
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Hanqing Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Huan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Zhengtian Gu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China
| | - Lei Zuo
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Lvyue Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
| | - Fuling Yan
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University. Nanjing, China.
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16
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Hayden D, McCarthy C, Akijian L, Callaly E, Ní Chróinín D, Horgan G, Kyne L, Duggan J, Dolan E, O’ Rourke K, Williams D, Murphy S, O’Meara Y, Kelly PJ. Renal dysfunction and chronic kidney disease in ischemic stroke and transient ischemic attack: A population-based study. Int J Stroke 2017. [DOI: 10.1177/1747493017701148] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and purpose The prevalence of chronic kidney disease (estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 for ≥3 months, chronic kidney disease (CKD)) in ischemic stroke and transient ischemic attack (TIA) is unknown, as estimates have been based on single-point estimates of renal function. Studies investigating the effect of renal dysfunction (eGFR < 60 mL/min per 1.73 m2, renal dysfunction) on post-stroke outcomes are limited to hospitalized cohorts and have provided conflicting results. Methods We investigated rates, determinants and outcomes of renal dysfunction in ischemic stroke and TIA in the North Dublin Population Stroke Study. We also investigate the persistence of renal dysfunction in 90-day survivors to determine the prevalence of CKD. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using Kaplan–Meier survival curves and Cox proportional hazards modeling. Results In 547 patients (ischemic stroke in 76.4%, TIA in 23.6%), the mean eGFR at presentation was 63.7 mL/min/1.73 m2 (SD 22.1). Renal dysfunction was observed in 44.6% (244/547). Among 90-day survivors, 31.2% (139/446) met criteria for CKD. After adjusting for age and stroke severity, eGFR < 45 mL/min/1.73 m2 (hazard ratio 2.53, p = 0.01) independently predicted 28-day fatality but not at two years. Poor post-stroke functional outcome (Modified Rankin Scale 3–5) at two years was more common in those with renal dysfunction (52.5% vs. 20.6%, p < 0.001). After adjusting for age, stroke severity and pre-stroke disability, renal dysfunction (OR 2.17, p = 0.04) predicted poor functional outcome. Conclusion Renal dysfunction and CKD are common in ischemic stroke and TIA. Renal dysfunction is associated with considerable post-stroke morbidity and mortality. Further studies are needed to investigate if modifiable mechanisms underlie these associations.
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Affiliation(s)
- Derek Hayden
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christine McCarthy
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Layan Akijian
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Danielle Ní Chróinín
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gillian Horgan
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lorraine Kyne
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph Duggan
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eamon Dolan
- Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Killian O’ Rourke
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - David Williams
- Royal College of Surgeons In Ireland, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - Sean Murphy
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - Yvonne O’Meara
- Nephrology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter J Kelly
- Neurovascular Unit For Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland
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17
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Abstract
Neurological symptoms commonly occur in chronic kidney disease and may result from its treatments and complications. Impaired renal function also influences treatments for other neurological conditions, requiring various cautions, dose adjustments and timing considerations, particularly in the context of renal replacement therapy. In this review, we present six illustrative clinical vignettes to highlight these challenges.
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Affiliation(s)
- Dearbhla M Kelly
- Department of Neurology, Cork University Hospital, Cork, Ireland.,Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | | | - Simon Cronin
- Department of Neurology, Cork University Hospital, Cork, Ireland .,Department of Clinical Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
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18
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Tsuruya K, Fujisaki K. Cerebrovascular disease in end-stage kidney disease. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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19
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High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease. Cardiol Rev 2016; 24:273-281. [DOI: 10.1097/crd.0000000000000124] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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Wang P, Wang Y, Zhao X, Du W, Wang A, Liu G, Liu L, Ji R, Wang C, Dong K, Wang Y. In-hospital medical complications associated with stroke recurrence after initial ischemic stroke: A prospective cohort study from the China National Stroke Registry. Medicine (Baltimore) 2016; 95:e4929. [PMID: 27631271 PMCID: PMC5402614 DOI: 10.1097/md.0000000000004929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In-hospital medical complications are common and strongly associated with the risk of death and dependency in stroke patients. Whether similar associations extend to stroke recurrence is unclear. We prospectively and systematically investigated whether in-hospital medical complications are associated with recurrent stroke of patients in the China National Stroke Registry (CNSR). We examined patients with initial ischemic stroke enrolled in CNSR between 2007 and 2008. Recurrent stroke at 3, 6, and 12 months post-stroke was used as stroke outcome. Medical complications were associated with stroke outcomes using multivariable logistic regression.Of the 7593 study patients, recurrent stroke occurred in 1115 (14.7%) within 12 months after stroke onset. In-hospital medical complications were independent risk factors for stroke recurrence in patients with initial ischemic stroke at 3 months (adjusted odds ratio (OR) = 2.19, 95% confidence interval (CI) 1.85 to 2.60), 6 months (adjusted OR = 2.04, 95% CI 1.74 to 2.38), and 12 months (adjusted OR = 1.88; 95% CI 1.62 to 2.19) after onset. The persistence of secondary prevention medications in patients with complications was lower than that in patients without complications.Stroke recurrence post-acute ischemic stroke is significantly associated with in-hospital medical complications.
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Affiliation(s)
- Penglian Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Wanliang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Ruijun Ji
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Kehui Dong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Correspondence: Yongjun Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China (e-mail: )
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21
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Synhaeve NE, van Alebeek ME, Arntz RM, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, de Kort PL, van der Vlugt MJ, Van Dijk EJ, Wetzels JF, de Leeuw FE. Kidney Dysfunction Increases Mortality and Incident Events after Young Stroke: The FUTURE Study. Cerebrovasc Dis 2016; 42:224-31. [DOI: 10.1159/000444683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/28/2016] [Indexed: 11/19/2022] Open
Abstract
Background: In about 30% of young stroke patients, no cause can be identified. In elderly patients, kidney dysfunction has been suggested as a contributing risk factor for mortality as well as stroke. There are hypotheses that novel non-traditional risk factors, like chronic inflammation and oxidative stress, are involved in chronic kidney disease, affecting the cerebral microvasculature that would in turn lead to stroke. Our objective is to investigate the influence of kidney dysfunction on long-term mortality and incident vascular events after stroke in young adults aged 18 through 50 and if this relationship would be independent of other cardiovascular risk factors. Methods: We prospectively included 460 young stroke patients with an ischemic stroke or transient ischemic attack admitted to our department between January 1, 1980 and November 1, 2010. Follow-up was done between 2014 and 2015. Estimated glomerular filtration rate (eGFR) was calculated from baseline creatinine levels and was divided in 3 subgroups: eGFR <60, 60-120 and >120 ml/min/1.73 m2. Cox proportional hazard models were used to determine the effect of kidney dysfunction on mortality and incident vascular events, adjusting for cardiovascular risk factors. Results: An eGFR <60 (HR 4.6; 95% CI 2.6-8.2) was associated with an increased risk of death and an increased risk of incident stroke (HR 4.1; 95% CI 1.9-9.0) independent of cardiovascular risk factors, but it was not associated with other vascular events. The point estimate for the 15-year cumulative mortality was 70% (95% CI 46-94) for patients with a low eGFR, 24% (95% CI 18-30) for patients with a normal eGFR and 30% (95% CI 12-48) for patients with a high eGFR. The point estimate for the 15-year cumulative risk of incident stroke was 45% (95% CI 16-74) for patients with a low eGFR, 13% (95% CI 9-17) for patients with a normal eGFR and 8% (95% CI 0-18) for patients with a high eGFR. Conclusions: Kidney dysfunction is related to long-term mortality and stroke recurrence, but not to incident cardiovascular disease, on average 11 years after young stroke. This warrants a more intensive follow-up of young stroke patients with signs of kidney dysfunction in the early phase. In addition, the clear association between kidney dysfunction and incident stroke seen in our young stroke population might be a first step in the recognition of kidney dysfunction as a new risk factor for the development of stroke at young age. Also, it can lead to new insights in the etiological differences between cardiovascular and cerebrovascular disease.
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Genetics meets epigenetics: Genetic variants that modulate noncoding RNA in cardiovascular diseases. J Mol Cell Cardiol 2015; 89:27-34. [DOI: 10.1016/j.yjmcc.2015.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 12/30/2022]
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Hosomi N, Nagai Y, Kohriyama T, Ohtsuki T, Aoki S, Nezu T, Maruyama H, Sunami N, Yokota C, Kitagawa K, Terayama Y, Takagi M, Ibayashi S, Nakamura M, Origasa H, Fukushima M, Mori E, Minematsu K, Uchiyama S, Shinohara Y, Yamaguchi T, Matsumoto M. The Japan Statin Treatment Against Recurrent Stroke (J-STARS): A Multicenter, Randomized, Open-label, Parallel-group Study. EBioMedicine 2015; 2:1071-8. [PMID: 26501105 PMCID: PMC4588424 DOI: 10.1016/j.ebiom.2015.08.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Although statin therapy is beneficial for the prevention of initial stroke, the benefit for recurrent stroke and its subtypes remains to be determined in Asian, in whom stroke profiles are different from Caucasian. This study examined whether treatment with low-dose pravastatin prevents stroke recurrence in ischemic stroke patients. METHODS This is a multicenter, randomized, open-label, blinded-endpoint, parallel-group study of patients who experienced non-cardioembolic ischemic stroke. All patients had a total cholesterol level between 4.65 and 6.21 mmol/L at enrollment, without the use of statins. The pravastatin group patients received 10 mg of pravastatin/day; the control group patients received no statins. The primary endpoint was the occurrence of stroke and transient ischemic attack (TIA), with the onset of each stroke subtype set to be one of the secondary endpoints. FINDING Although 3000 patients were targeted, 1578 patients (491 female, age 66.2 years) were recruited and randomly assigned to pravastatin group or control group. During the follow-up of 4.9 ± 1.4 years, although total stroke and TIA similarly occurred in both groups (2.56 vs. 2.65%/year), onset of atherothrombotic infarction was less frequent in pravastatin group (0.21 vs. 0.64%/year, p = 0.0047, adjusted hazard ratio 0.33 [95%CI 0.15 to 0.74]). No significant intergroup difference was found for the onset of other stroke subtypes, and for the occurrence of adverse events. INTERPRETATION Although whether low-dose pravastatin prevents recurrence of total stroke or TIA still needs to be examined in Asian, this study has generated a hypothesis that it may reduce occurrence of stroke due to larger artery atherosclerosis. FUNDING This study was initially supported by a grant from the Ministry of Health, Labour and Welfare, Japan. After the governmental support expired, it was conducted in collaboration between Hiroshima University and the Foundation for Biomedical Research and Innovation.
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Affiliation(s)
- Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoji Nagai
- Foundation for Biomedical Research and Innovation Translational Research Informatics Center, Kobe, Japan
| | | | | | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Norio Sunami
- Department of Neurological Surgery, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Chiaki Yokota
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuo Terayama
- Department of Neurology, Iwate Medical University, Morioka, Japan
| | - Makoto Takagi
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | | | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Masanori Fukushima
- Foundation for Biomedical Research and Innovation Translational Research Informatics Center, Kobe, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Shinichiro Uchiyama
- Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Japan
| | - Yukito Shinohara
- Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan
| | | | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Zhao L, Wang R, Song B, Tan S, Gao Y, Fang H, Lu J, Xu Y. Association between Atherogenic Dyslipidemia and Recurrent Stroke Risk in Patients with Different Subtypes of Ischemic Stroke. Int J Stroke 2015; 10:752-8. [PMID: 25924059 DOI: 10.1111/ijs.12471] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/24/2014] [Indexed: 11/27/2022]
Abstract
Background The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. Aims We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. Methods We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol <40 mg/dl and triglycerides ≥200 mg/dl. Ischemic stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The patients were followed up at 3, 6,12 and 24 months after stroke onset. The association between atherogenic dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. Results In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24–6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85–3·37). Conclusions Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship.
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Affiliation(s)
- Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ruihao Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Song Tan
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Fang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Lu
- Department of Medical Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Toyoda G, Bokura H, Mitaki S, Onoda K, Oguro H, Nagai A, Yamaguchi S. Association of mild kidney dysfunction with silent brain lesions in neurologically normal subjects. Cerebrovasc Dis Extra 2015; 5:22-7. [PMID: 25873927 PMCID: PMC4376920 DOI: 10.1159/000373916] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/07/2015] [Indexed: 11/25/2022] Open
Abstract
Background Chronic kidney disease (CKD) has been closely associated with stroke. Although a large number of studies reported the relationship between CKD and different types of asymptomatic brain lesions, few comprehensive analyses have been performed for all types of silent brain lesions. Methods We performed a cross-sectional study involving 1,937 neurologically normal subjects (mean age 59.4 years). Mild CKD was defined as an estimated glomerular filtration rate between 30 and 60 ml/min/1.73 m2 or positive proteinuria. Results The prevalence of mild CKD was 8.7%. Univariate analysis revealed an association between CKD and all silent brain lesions, including silent brain infarction, periventricular hyperintensity, subcortical white matter lesion, and microbleeds, in addition to hypertension and diabetes mellitus after adjusting for age and sex. In binary logistic regression analysis, the presence of CKD was a significant risk factor for all types of silent brain lesions, independent of other risk factors. Conclusions These results suggest that mild CKD is independently associated with all types of silent brain lesions, even in neurologically normal subjects.
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Affiliation(s)
- Genya Toyoda
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hirokazu Bokura
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shingo Mitaki
- Department of Neurology, Shimane University, Izumo, Japan
| | - Keiichi Onoda
- Department of Neurology, Shimane University, Izumo, Japan
| | - Hiroaki Oguro
- Department of Neurology, Shimane University, Izumo, Japan
| | - Atsushi Nagai
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, Izumo, Japan
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Toyoda K. Cerebral small vessel disease and chronic kidney disease. J Stroke 2015; 17:31-7. [PMID: 25692105 PMCID: PMC4325633 DOI: 10.5853/jos.2015.17.1.31] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 01/23/2023] Open
Abstract
Chronic kidney disease, defined by a decreased glomerular filtration rate or albuminuria, is recognized as a major global health burden, mainly because it is an established risk factor for cardiovascular and cerebrovascular diseases. The magnitude of the effect of chronic kidney disease on incident stroke seems to be higher in persons of Asian ethnicity. Since the kidney and brain share unique susceptibilities to vascular injury due to similar anatomical and functional features of small artery diseases, kidney impairment can be predictive of the presence and severity of cerebral small vessel diseases. Chronic kidney disease has been reported to be associated with silent brain infarcts, cerebral white matter lesions, and cerebral microbleeds, independently of vascular risk factors. In addition, chronic kidney disease affects cognitive function, partly via the high prevalence of cerebral small vessel diseases. Retinal artery disease also has an independent relationship with chronic kidney disease and cognitive impairment. Stroke experts are no longer allowed to be ignorant of chronic kidney disease. Close liaison between neurologists and nephrologists can improve the management of cerebral small vessel diseases in kidney patients.
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Galanth S, Tressieres B, Lannuzel A, Foucan P, Alecu C. Factors Influencing Prognosis and Functional Outcome One Year After a First-Time Stroke in a Caribbean Population. Arch Phys Med Rehabil 2014; 95:2134-9. [DOI: 10.1016/j.apmr.2014.07.394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 07/07/2014] [Accepted: 07/12/2014] [Indexed: 11/29/2022]
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Kuwashiro T, Ago T, Kamouchi M, Matsuo R, Hata J, Kuroda J, Fukuda K, Sugimori H, Fukuhara M, Awano H, Isomura T, Suzuki K, Yasaka M, Okada Y, Kiyohara Y, Kitazono T. Significance of plasma adiponectin for diagnosis, neurological severity and functional outcome in ischemic stroke - Research for Biomarkers in Ischemic Stroke (REBIOS). Metabolism 2014; 63:1093-103. [PMID: 24929894 DOI: 10.1016/j.metabol.2014.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 04/23/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although adiponectin is a major adipocytokine that affects the pathogenesis of various cardiovascular diseases, its clinical significance in stroke remains controversial. We investigated the clinical significance of plasma adiponectin for the diagnosis, neurological severity and functional outcomes of patients with ischemic stroke. METHODS We prospectively enrolled 171 patients with ischemic stroke and 171 age- and sex-matched healthy controls. Blood samples and clinical information were obtained at day 0, 3, 7, 14 and 90 after stroke onset. RESULTS Average adiponectin values at day 0 did not significantly differ between the controls and the patients, but were significantly lower and higher in patients with atherothrombotic brain (ATBI) (p=0.047) and cardioembolic (CE) (p=0.008) infarction, respectively, than in the controls. Multivariate logistic regression analyses showed that the adiponectin value at day 0 could predict ATBI (odds ratio, 0.75; 95% confidence interval, 0.58 to 0.91, p=0.009, per 1-μg/mL increase). Adiponectin values at day 0 were positively associated with neurological severity as evaluated by the National Institute of Health Stroke Scale upon admission (r=0.420, p=0.003) and were higher in the groups with poor outcomes (modified Rankin Scale (mRS) ≥ 3 on day 90) than in those with good ones (mRS ≤ 2) in all stroke subtypes, with statistical significance in ATBI (p=0.015). CONCLUSIONS Plasma adiponectin values may help to classify stroke subtypes and predict neurological severity and functional outcome in ischemic stroke patients.
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Affiliation(s)
- Takahiro Kuwashiro
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka.
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka.
| | - Masahiro Kamouchi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Jun Hata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka; Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Junya Kuroda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Kenji Fukuda
- Department of Cerebrovascular Disease, St. Mary's Hospital, Fukuoka
| | - Hiroshi Sugimori
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Masayo Fukuhara
- Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | | | | | | | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
| | - Yutaka Kiyohara
- Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
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Toyoda K, Ninomiya T. Stroke and cerebrovascular diseases in patients with chronic kidney disease. Lancet Neurol 2014; 13:823-33. [DOI: 10.1016/s1474-4422(14)70026-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ogata T, Kamouchi M, Matsuo R, Hata J, Kuroda J, Ago T, Sugimori H, Inoue T, Kitazono T. Gastrointestinal bleeding in acute ischemic stroke: recent trends from the fukuoka stroke registry. Cerebrovasc Dis Extra 2014; 4:156-64. [PMID: 25276117 PMCID: PMC4174757 DOI: 10.1159/000365245] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/14/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) hemorrhage is a potentially serious complication of acute stroke, but its incidence appears to be decreasing. The aim of this study was to elucidate the etiology of GI bleeding and its impact on clinical outcomes in patients with acute ischemic stroke in recent years. METHODS Using the database of the Fukuoka Stroke Registry, 6,529 patients with acute ischemic stroke registered between June 2007 and December 2012 were included in this study. We recorded clinical data including any previous history of peptic ulcer, prestroke drug history including the use of antiplatelets, anticoagulants, steroids and nonsteroidal anti-inflammatory drugs (NSAIDs), and poststroke treatment with suppressing gastric acidity. GI bleeding was defined as any episode of hematemesis or melena on admission or during hospitalization. The cause and origin of bleeding were diagnosed endoscopically. Logistic regression analysis was used to identify risk factors for GI bleeding and its influence on deteriorating neurologic function, death, and poor outcome. RESULTS GI bleeding occurred in 89 patients (1.4%) under the condition that 66% of the total patients received acid-suppressing agents after admission. Multivariate analysis revealed that GI bleeding was associated with the absence of dyslipidemia (p = 0.03), a previous history of peptic ulcer (p < 0.001), and the severity of baseline neurologic deficit (p = 0.002) but not with antiplatelet drugs, anticoagulants, and NSAIDs. The source was the upper GI tract in 51% of the cases; causes included peptic ulceration (28%) and malignancies (12%), and other or unidentified causes accounted for 60%. GI bleeding mostly occurred within 1 week after stroke onset. Hemoglobin concentration fell by a median value of 2.5 g/dl in patients with GI bleeding. Among them, 28 patients underwent blood transfusion (31.5%). After adjustment for confounding factors, GI bleeding was independently associated with neurologic deterioration (OR 3.9, 95% CI 2.3-6.6, p < 0.001), in-hospital death (OR 6.1, 95% CI 3.1-12.1, p < 0.001), and poor outcome at 3 months (OR 6.8, 95% CI 3.7-12.7, p < 0.001). These associations were significant irrespective of whether patients underwent red blood cell transfusion. CONCLUSIONS GI bleeding infrequently occurred in patients with acute ischemic stroke, which was mostly due to etiologies other than peptic ulcer. GI bleeding was associated with poor clinical outcomes including neurologic deterioration, in-hospital mortality, and poor functional outcome.
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Affiliation(s)
- Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan ; Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan
| | - Junya Kuroda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Sugimori
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan
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Jamrozik E, Hyde Z, Alfonso H, Flicker L, Almeida O, Yeap B, Norman P, Hankey G, Jamrozik K. Validity of self-reported versus hospital-coded diagnosis of stroke: a cross-sectional and longitudinal study. Cerebrovasc Dis 2014; 37:256-62. [PMID: 24686404 DOI: 10.1159/000358583] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Population-based studies, as well as clinicians, often rely on self-report and hospital records to obtain a history of stroke. This study aimed to compare the validity of the diagnosis of stroke by self-report and by hospital coding according to their cross-sectional association with prevalent vascular risk factors, and longitudinal association with recurrent stroke and major cardiovascular outcomes in a large cohort of older Australian men. METHODS Between 1996 and 1999, 11,745 older men were surveyed for a self-reported history of stroke as part of the Health in Men Study (HIMS). Previous hospitalization for stroke was obtained with consent from linked medical records via the Western Australian Data Linkage System (WADLS). Subjects were followed by WADLS until December 31, 2010, for hospitalization for stroke, cardiovascular events, and all-cause mortality. The primary outcome was hospitalisation for stroke during follow-up. Secondary outcomes included incident vascular events and composite vascular endpoints. RESULTS At baseline, a history of stroke was reported by 903 men (7.7%), previous hospitalisation for stroke was recorded in 717 (6.1%), both self-report and hospitalisation in 467 (4.0%), and no history of stroke in 10,696 men (91.1%). Prevalent cardiovascular disease and peripheral arterial disease were more common among men with previous hospitalisation for stroke than a history of self-reported stroke (p < 0.001). In longitudinal analyses, incident aortic aneurysm was also more common among men with baseline history of hospitalization for stroke (adjusted hazard ratio (HR) 1.71, 95% CI 1.12-2.60) than among men with self-reported stroke (HR 0.88, 95% CI 0.56-1.36) compared to men with no history of stroke. With regard to the primary outcome, the rate of hospitalisation for stroke during follow-up was significantly higher among men with self-reported stroke (HR 2.44, 95% CI 2.03-2.94), hospital-coded stroke (adjusted HR 3.02, 2.42-3.78) and both self-reported and hospital-coded stroke (adjusted HR 3.33, 2.82-3.92) compared to participants with no previous stroke. Time to recurrent stroke was similar among different methods of initial stroke diagnosis (p = 0.067). CONCLUSIONS Self-reported stroke and hospital-coded stroke have a similar prognostic value for predicting the risk of recurrent stroke. This supports the use of these ways of assessing a history of stroke for the clinical purposes of secondary prevention and for further epidemiological studies.
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Affiliation(s)
- Euzebiusz Jamrozik
- Western Australian Centre for Healthy Ageing (WACHA), Centre for Medical Research, WA Institute for Medical Research, Perth, W.A., Australia
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Kuwashiro T, Sugimori H, Ago T, Kuroda J, Kamouchi M, Kitazono T. Predictive role of C reactive protein in stroke recurrence after cardioembolic stroke: the Fukuoka Stroke Registry. BMJ Open 2013; 3:e003678. [PMID: 24231460 PMCID: PMC3831094 DOI: 10.1136/bmjopen-2013-003678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We investigated the clinical characteristics of patients with stroke recurrence in the first year after cardioembolic stroke, and determined the predictors associated with recurrence. DESIGN A prospective cohort study. SETTING Multicentre study at the Fukuoka prefecture in Japan. PARTICIPANTS We enroled 2084 consecutive patients who were hospitalised in stroke centres within 7 days of onset from June 2007 to October 2009. The clinical characteristics of patients were assessed on admission, and the clinical course of all patients was followed for 1 year. RESULTS Of all patients, 425 (234 men, 76±11 years of age) had cardioembolic stroke and were included in this study. Fifty-one patients (12%) suffered a recurrence during the follow-up period. Age (HR 1.04, 95% CI 1.01 to 1.06, p=0.014), and level of C reactive protein (HR 1.01, 95% CI 1.00 to 1.02, p=0.018) on admission were significantly associated with recurrence in the univariate analyses. Male gender (HR 0.61, 95% CI 0.35 to 1.05, p=0.076), body mass index (HR 0.94, 95% CI 0.87 to 1.01, p=0.093), hypertension (HR 0.59, 95% CI 0.33 to 1.06, p=0.079), diastolic blood pressure (HR 0.99, 95% CI 0.97 to 1.00, p=0.087) and haematocrit (HR 0.95, 95% CI 0.91 to 1.00, p=0.052) were marginally significant in the univariate Cox analyses. Multivariate Cox proportional hazards analysis showed that age (HR 1.03, 95% CI 1.00 to 1.06, p=0.031, per 1-year increase), and C reactive protein (HR 1.01, 95% CI 1.00 to 1.02, p=0.022, per 1 mg/L increase) were independent predictors of a recurrence in the first year after cardioembolic stroke. CONCLUSIONS In patients with cardioembolic ischaemic stroke, age and C reactive protein are independent risk factors for recurrence in the first year after onset.
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Affiliation(s)
- Takahiro Kuwashiro
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Sugimori
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junya Kuroda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Wu S, Shi Y, Wang C, Jia Q, Zhang N, Zhao X, Liu G, Wang Y, Liu L, Wang Y. Glycated hemoglobin independently predicts stroke recurrence within one year after acute first-ever non-cardioembolic strokes onset in A Chinese cohort study. PLoS One 2013; 8:e80690. [PMID: 24236195 PMCID: PMC3827473 DOI: 10.1371/journal.pone.0080690] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/07/2013] [Indexed: 12/30/2022] Open
Abstract
Objective Hyperglycemia is related to stroke. Glycated hemoglobin (HbA1c) can reflect pre-stroke glycaemia status. However, the information on the direct association between HbA1c and recurrence after non-cardioembolic acute ischemic strokes is rare and there is no consistent conclusion. Methods The ACROSS-China database comprised of 2186 consecutive first-ever acute ischemic stroke patients with baseline HbA1c values. After excluding patients who died from non-stroke recurrence and patients lost to follow up, 1817 and 1540 were eligible for 3-month and 1-year analyses, respectively. Multivariate Cox regression was performed to evaluate the associations between HbA1c and 3-month and 1-year stroke recurrence. Results The HbA1c values at admission were divided into 4 levels by quartiles: Q1 (<5.5%); Q2 (5.5 to <6.1%); Q3 (6.1% to <7.2%); and Q4 (≥7.2%). The cumulative recurrence rates were 8.3% and 11.0% for 3 months and 1 year, respectively. In multivariate analyses, when compared with Q1, the adjusted hazard ratios (AHRs) were 2.83 (95% confidence interval (CI) 1.28-6.26) in Q3 and 3.71(95% CI 1.68-8.21) in Q4 for 3-month stroke recurrence; 3.30 (95% CI 1.31-8.34) in Q3 and 3.35 (95% CI 1.36-8.21) in Q4 for 1-year stroke recurrence. Adding fasting plasma glucose in the multivariate analyses did not modify the association: AHRs were 2.75 (95% CI 1.24-6.11) in Q3 and 3.67 (95% CI 1.59-8.53) in Q4 for 3-month analysis; AHRs were 3.08 (95% CI 1.10-8.64) in Q3 and 3.31(95% CI 1.35-8.14) in Q4 for 1-year analysis. Conclusions A higher “normal” HbA1c level reflecting pre-stroke glycaemia status independently predicts stroke recurrence within one year after non-cardioembolic acute ischemic stroke onset. HbA1c is recommended as a routine test in acute ischemic stroke patients.
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Affiliation(s)
- Shuolin Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuzhi Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail:
| | - Qian Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Sibolt G, Curtze S, Melkas S, Pohjasvaara T, Kaste M, Karhunen PJ, Oksala NKJ, Vataja R, Erkinjuntti T. Post-stroke depression and depression-executive dysfunction syndrome are associated with recurrence of ischaemic stroke. Cerebrovasc Dis 2013; 36:336-43. [PMID: 24193249 DOI: 10.1159/000355145] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depression and depression-executive dysfunction syndrome (DES) are common neuropsychiatric consequences of stroke. We hypothesized that if stroke as a cerebrovascular event causes depression, this so-called post-stroke depression will further increase the risk of recurrent stroke. The objective of the study was to investigate whether patients with post-stroke depression or DES have increased rates of stroke recurrence. METHODS We included 223 patients from the Helsinki Stroke Aging Memory cohort (n = 486) admitted to Helsinki University Central Hospital with a follow-up of 12 years. We included only patients with first-ever ischaemic stroke who were testable for depression and executive dysfunction. For follow-up, national register data were reviewed for all diagnosis codes of ischaemic stroke, survival data and causes of death. Neuropsychological and neuropsychiatric evaluations for depression and executive functions were performed 12-20 weeks after the index stroke. Univariate analysis was performed using χ(2), Mantel-Haenszel, ANOVA, and Kaplan-Meier log rank analyses. A Cox multivariable model with forced entry was used to adjust for stroke risk factors (age, gender, smoking, atrial fibrillation, hypertension, diabetes, peripheral arterial disease, hypercholesterolaemia). RESULTS The mean time to first recurrent stroke was shorter for the depressed patient group (8.15, 95% CI 7.11-9.19 vs. 9.63, 8.89-10.38 years) and even shorter for patients with DES (7.15, 5.55-8.75 vs. 9.75, 9.09-10.41 years) compared to the remaining groups, respectively. The cumulative risk for recurrent ischaemic stroke in the 12-year follow-up was higher for the depression group (log rank p = 0.04) and for the DES group (log rank p = 0.01) compared to the remaining groups, respectively. Cox multivariable analyses revealed that the older age of the patient (1.05; 1.01-1.08/year), the absence of hypercholesterolaemia (0.24; 0.09-0.59), depression (1.68; 1.07-2.63), and DES (1.95; 1.14-3.33) were all associated with recurrent stroke. CONCLUSIONS Depression and especially DES are associated with a shorter interval to recurrence of ischaemic stroke but executive dysfunction alone is not associated with a more rapid stroke recurrence. Diagnosis and treatment of depressive syndromes should be considered as a part of secondary prevention in patients with ischaemic stroke.
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Affiliation(s)
- Gerli Sibolt
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Micozkadioglu H, Ozelsancak R, Giray S, Arlier Z. CKD is associated with recurrent ischemia but not with hemorrhagic transformation in acute ischemic stroke patients. Ren Fail 2013; 36:217-21. [PMID: 24168712 DOI: 10.3109/0886022x.2013.846794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND We investigated the associations of Recurrent Ischemic Stroke (RIS) and Hemorrhagic Transformation (HT) with CKD in acute ischemic stroke patients. METHOD The subjects were 160 patients, divided into two groups: with eGFR <60 mL/min/1.73 m2 (CKD), with eGFR ≥60 mL/min/1.73 m2 (without CKD). RESULTS Subjects having DM (p = 0.018), CKD (p = 0.025) and treated with ACEI/ARB (p = 0.039) revealed association with RIS. Regression analysis disclosed only CKD (p = 0.04). Carotid artery stenosis (p = 0.030) and serum calcium levels (p = 0.013) showed significant association with HT. CONCLUSION Our results disclosed that CKD could be a risk factor for RIS. There is no relation between CKD and HT.
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Sandow N, von Weitzel-Mudersbach P, Rosenbaum S, König S, Buchert R, Mehl SR, Garbe A, Vajkoczy P. Extra-intracranial standard bypass in the elderly: perioperative risk, bypass patency and outcome. Cerebrovasc Dis 2013; 36:228-35. [PMID: 24135535 DOI: 10.1159/000354159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. Due to demographic changes, an increasing number of elderly patients presents with cerebrovascular hemodynamic insufficiency. So far, little data for EC-IC bypass surgery in elderly patients suffering occlusive cerebrovascular disease are available. We therefore designed a retrospective study to address the question whether EC-IC bypass is a safe and efficient treatment in a patient cohort ≥70 years. METHODS 50 patients underwent EC-IC standard bypass surgery with translocation of the superficial temporal artery to an M2 segment of the medial cerebral artery. Criteria for bypass surgery were presence of symptomatic occlusive cerebrovascular disease of the anterior circulation and proof of a severely restricted or abrogated reserve capacity (detected by H2O-photon emission tomography or single photon emission computer tomography - before and after forced vessel dilatation by diamox). The incidence of perioperative neurological and surgical complications, bypass patency, bypass function and short-term outcome were retrospectively analyzed. RESULTS The study cohort consisted of 16 patients ≥70 years (mean = 74.3 years, SE 1.3). It was compared to a cohort of 34 patients <70 years (mean = 61.2 years, SE 1.0). Both groups underwent EC-IC bypass surgery after careful preoperative work-up. Both patient groups did not differ significantly in gender, vascular pathology, previous history of diseases/comorbidity or clinical symptoms. The number of patients which underwent stenting or other endovascular treatments of the internal or common carotid artery prior to EC-IC bypass surgery was significantly higher in the group of patients ≥70 years (37.5 vs. 0%, p < 0.001). Perioperative stroke rate was 0% in both groups and mild morbidity occurred in 18.8 and 14.7%, respectively (p = 0.699). One 84-year-old female patient died due to perioperative endocarditis. Initial bypass patency was 93.8% in patients above the age of 70 years and 97.1% in the younger group (p = 0.542). Secondary occlusion rate was low in both groups (≥70 years: 0% vs. <70 years 3.7%). No new neurologic deficit occurred in patients with a patent bypass during the follow-up period (median 18 ± 13.1 months). Two patients with an initially occluded bypass and one with a secondary bypass occlusion suffered from new neurological symptoms. CONCLUSIONS Our data show comparable safety and efficiency of EC-IC bypass surgery in patients under and above the age of 70 years due to a careful preoperative work-up and a strict indication for bypass surgery.
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Affiliation(s)
- Nora Sandow
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
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Faggioli G, Pini R, Mauro R, Gargiulo M, Freyrie A, Stella A. Perioperative Outcome of Carotid Endarterectomy According to Type and Timing of Neurologic Symptoms and Computed Tomography Findings. Ann Vasc Surg 2013; 27:874-82. [DOI: 10.1016/j.avsg.2012.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 11/11/2012] [Accepted: 12/28/2012] [Indexed: 11/16/2022]
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Kamouchi M, Sakai H, Kiyohara Y, Minematsu K, Hayashi K, Kitazono T. Acute kidney injury and edaravone in acute ischemic stroke: the Fukuoka Stroke Registry. J Stroke Cerebrovasc Dis 2013; 22:e470-6. [PMID: 23800495 DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/29/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND A free radical scavenger, edaravone, which has been used for the treatment of ischemic stroke, was reported to cause acute kidney injury (AKI) as a fatal adverse event. The aim of the present study was to clarify whether edaravone is associated with AKI in patients with acute ischemic stroke. METHODS From the Fukuoka Stroke Registry database, 5689 consecutive patients with acute ischemic stroke who were hospitalized within 24 hours of the onset of symptoms were included in this study. A logistic regression analysis for the Fukuoka Stroke Registry cohort was done to identify the predictors for AKI. A propensity score-matched nested case-control study was also performed to elucidate any association between AKI and edaravone. RESULTS Acute kidney injury occurred in 128 of 5689 patients (2.2%) with acute ischemic stroke. A multivariate analysis revealed that the stroke subtype, the basal serum creatinine level, and the presence of infectious complications on admission were each predictors of developing AKI. In contrast, a free radical scavenger, edaravone, reduced the risk of developing AKI (multivariate-adjusted odds ratio [OR] .45, 95% confidence interval [CI] .30-.67). Propensity score-matched case-control study confirmed that edaravone use was negatively associated with AKI (propensity score-adjusted OR .46, 95% CI .29-.74). CONCLUSIONS Although AKI has a significant impact on the clinical outcome of hospital inpatients, edaravone has a protective effect against the development of AKI in patients with acute ischemic stroke.
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Affiliation(s)
- Masahiro Kamouchi
- Department of Nephrology, Hypertension and Strokology, Kyushu University Hospital, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Pang MY, Charlesworth SA, Lau RW, Chung RC. Using Aerobic Exercise to Improve Health Outcomes and Quality of Life in Stroke: Evidence-Based Exercise Prescription Recommendations. Cerebrovasc Dis 2013; 35:7-22. [DOI: 10.1159/000346075] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 11/23/2012] [Indexed: 11/19/2022] Open
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Kuwashiro T, Sugimori H, Ago T, Kuroda J, Kamouchi M, Kitazono T. The impact of predisposing factors on long-term outcome after stroke in diabetic patients: the Fukuoka Stroke Registry. Eur J Neurol 2013; 20:921-7. [DOI: 10.1111/ene.12100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 12/12/2012] [Indexed: 12/15/2022]
Affiliation(s)
- T. Kuwashiro
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka; Japan
| | - H. Sugimori
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka; Japan
| | - T. Ago
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka; Japan
| | - J. Kuroda
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka; Japan
| | - M. Kamouchi
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka; Japan
| | - T. Kitazono
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka; Japan
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Eun MY, Seo WK, Lee J, Kim M, Kim J, Kim JH, Oh K, Koh SB. Age-Dependent Predictors for Recurrent Stroke: The Paradoxical Role of Triglycerides. Eur Neurol 2012; 69:171-8. [DOI: 10.1159/000345480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 10/20/2012] [Indexed: 01/22/2023]
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Yuan M, Zhan Q, Duan X, Song B, Zeng S, Chen X, Yang Q, Xia J. A functional polymorphism at miR-491-5p binding site in the 3'-UTR of MMP-9 gene confers increased risk for atherosclerotic cerebral infarction in a Chinese population. Atherosclerosis 2012; 226:447-52. [PMID: 23257658 DOI: 10.1016/j.atherosclerosis.2012.11.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 10/23/2012] [Accepted: 11/22/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND and purpose: Matrix metalloproteinases 9 (MMP-9) has been reported to play a critical role in the pathophysiology of atherosclerotic cerebral infarction (ACI). Here we assessed association of MMP-9 polymorphisms with ACI susceptibility and the function of SNPs through microRNA mediated regulation. METHODS Genotyping was performed using MALDI-TOF mass spectrometry. Reporter gene plasmids with the MMP-9 3'UTR carrying either the mutant or the wild-type MMP-9 allele were constructed. Also, we constructed pcDNA-3.1-miR-491-5p recombinant plasmid, which transiently co-transfected human umbilical vein endothelial cells (HUVEC) with the reporter plasmids. Reporter plasmids, miR-491-5p mimics and inhibitor were transfected into HUVE cells line by lipofectamine. MMP-9 mRNA expression in HUVEC was detected by RT-PCR and protein level by ELISA. RESULTS The rs1802908 and rs2664517 polymorphisms were not observed in all subjects from Hunan Han Chinese. No significant difference in genotype distribution of rs20544 and rs9509 between cases and controls were observed (p>0.05). The rs1056628CC genotype had a significantly increased risk for ACI as compared with carries of the rs1056628 A allele (total χ(2) = 12.041, P = 0.002). Reporter gene assay revealed that the rs1056628 A allele showed lower reporter activity than the rs1056628C allele. Hsa-miR-491-5p had effect on modulation of MMP-9 gene in vitro. The rs1056628 A→C variant in the 3'-UTR of the MMP-9 increased MMP-9 protein expression in cultured HUVECs. CONCLUSIONS Our data suggested that the rs1056629A→C variation contributes to an increased risk of ACI by increasing MMP-9 expression through affecting binding of miR-491 to the polymorphic site in the 3'-UTR of MMP-9.
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Affiliation(s)
- Mei Yuan
- Institute of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Kamouchi M, Kumagai N, Okada Y, Origasa H, Yamaguchi T, Kitazono T. Risk Score for Predicting Recurrence in Patients with Ischemic Stroke: The Fukuoka Stroke Risk Score for Japanese. Cerebrovasc Dis 2012; 34:351-7. [DOI: 10.1159/000343503] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/14/2012] [Indexed: 11/19/2022] Open
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