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Guo R, Yan S, Li Y, Liu K, Wu F, Feng T, Chen R, Liu Y, You C, Tian R. A Novel Machine Learning Model for Predicting Stroke-Associated Pneumonia After Spontaneous Intracerebral Hemorrhage. World Neurosurg 2024; 189:e141-e152. [PMID: 38843972 DOI: 10.1016/j.wneu.2024.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Pneumonia is one of the most common complications after spontaneous intracerebral hemorrhage (sICH), i.e., stroke-associated pneumonia (SAP). Timely identification of targeted patients is beneficial to reduce poor prognosis. So far, there is no consensus on SAP prediction, and application of existing predictors is limited. The aim of this study was to develop a machine learning model to predict SAP after sICH. METHODS We retrospectively reviewed 748 patients diagnosed with sICH and collected data from 4 dimensions-demographic features, clinical features, medical history, and laboratory tests. Five machine learning algorithms-logistic regression, gradient boosting decision tree, random forest, extreme gradient boosting, and category boosting-were used to build and validate the predictive model. We also applied recursive feature elimination with cross-validation to obtain the best feature combination for each model. Predictive performance was evaluated by area under the receiver operating characteristic curve. RESULTS SAP was diagnosed in 237 patients. The model developed by category boosting yielded the most satisfactory outcomes overall with area under the receiver operating characteristic curves in the training set and test set of 0.8307 and 0.8178, respectively. CONCLUSIONS The incidence of SAP after sICH in our center was 31.68%. Machine learning could potentially provide assistance in the prediction of SAP after sICH.
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Affiliation(s)
- Rui Guo
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyu Yan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Yansheng Li
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Kejia Liu
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Fatian Wu
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Tianyu Feng
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Ruiqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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Ahmad M, Ayaz Z, Sinha T, Soe TM, Tutwala N, Alrahahleh AA, Arrey Agbor DB, Ali N. Risk Factors for the Development of Pneumonia in Stroke Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e57077. [PMID: 38681338 PMCID: PMC11052642 DOI: 10.7759/cureus.57077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Pneumonia is one of the most prevalent medical complications post-stroke. It can have negative impacts on the prognosis of stroke patients. This study aimed to determine the predictors of pneumonia in stroke patients. The authors devised, reviewed, and enhanced the search strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were gathered from various electronic databases, including Medline, CINAHL, Cochrane, Embase, and Web of Science, from January 1st, 2011, to February 25th, 2024. The review encompassed studies involving patients aged 18 years and older who were hospitalized for acute stroke care. Inclusion criteria required patients to have received a clinical diagnosis of stroke, confirmed via medical imaging (CT or MRI), hospital primary diagnosis International Classification of Diseases 10th Revision discharge codes, or pathology reporting. A total of 35 studies met the criteria and were included in our pooled analysis. Among them, 23 adopted a retrospective design, while the remaining 12 were prospective. The pooled incidence of pneumonia among patients with stroke was found to be 14% (95% confidence interval = 13%-15%). The pooled analysis reported that advancing age, male gender, a history of chronic obstructive pulmonary disease (COPD), the presence of a nasogastric tube, atrial fibrillation, mechanical ventilation, stroke severity, dysphagia, and a history of diabetes were identified as significant risk factors for pneumonia development among stroke patients. Our results underscore the importance of proactive identification and management of these factors to mitigate the risk of pneumonia in stroke patients.
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Affiliation(s)
| | - Zeeshan Ayaz
- Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Tanya Sinha
- Medical Education, Tribhuvan University, Kirtipur, NPL
| | - Thin M Soe
- Medicine, University of Medicine 1, Yangon, Yangon, MMR
| | - Nimish Tutwala
- Obstetrics and Gynaecology, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND
| | | | - Divine Besong Arrey Agbor
- Clinical Research and Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Neelum Ali
- Internal Medicine, University of Health Sciences, Lahore, PAK
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Xiao Y, He S, Cheng X, Peng L, Tian Y, Li T, He J, Hao P, Chong W, Hai Y, You C, Fang F, Peng Z, Zhang Y. Elevated lactate dehydrogenase predicts pneumonia in spontaneous intracerebral hemorrhage. Heliyon 2024; 10:e26109. [PMID: 38404841 PMCID: PMC10884414 DOI: 10.1016/j.heliyon.2024.e26109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
Background Although a variety of risk factors for pneumonia after spontaneous intracerebral hemorrhage have been established, an objective and easily obtainable predictor is still needed. Lactate dehydrogenase is a nonspecific inflammatory biomarker. In this study, we aimed to assess the association between lactate dehydrogenase and pneumonia in spontaneous intracerebral hemorrhage patients. Methods Our study was a retrospective, multicenter cohort study, undertaken in 7562 patients diagnosed with spontaneous intracerebral hemorrhage from 3 hospitals. All serum Lactate dehydrogenase was collected within 7 days from admission and divided into four groups as quartile(Q). We conducted a multivariable logistic regression analysis to assess the association of Lactate dehydrogenase with pneumonia. Results Among a total of 7562 patients, 2971 (39.3%) patients were diagnosed with pneumonia. All grades of elevated lactate dehydrogenase were associated with increased raw and risk-adjusted risk of pneumonia. Multiple logistic regression analysis showed odds ratios for Q2-Q4 compared with Q1 were 1.21 (95% CI, 1.04-1.42), 1.64(95% CI, 1.41-1.92), and 1.92 (95% CI, 1.63-2.25) respectively. The odds ratio after adjustment was 4.42 (95% CI, 2.94-6.64) when lactate dehydrogenase was a continuous variable after log-transformed. Conclusions Elevated lactate dehydrogenase is significantly associated with an increase in the odds of pneumonia and has a predictive value for severe pneumonia in patients with pneumonia. Lactate dehydrogenase may be used to predict pneumonia events in spontaneous intracerebral hemorrhage patients as a laboratory marker.
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Affiliation(s)
- Yangchun Xiao
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Shuanghong He
- Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyuan Peng
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yixin Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tiangui Li
- Department of Neurosurgery, The First People's Hospital of Longquanyi District Chengdu, Sichuan, China
| | - Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pengfei Hao
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zongjun Peng
- Department of Neurosurgery, Sichuan Friendship Hospital, China
| | - Yu Zhang
- Department of Neurosurgery, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
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Deng YM, Sun JJ, Gu HQ, Yang KX, Wang YJ, Li ZX, Zhao XQ. Predictors of dysphagia screening and pneumonia among patients with intracerebral haemorrhage in China: a cross-sectional hospital-based retrospective study. BMJ Open 2024; 14:e073977. [PMID: 38238044 PMCID: PMC10806472 DOI: 10.1136/bmjopen-2023-073977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/19/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES This study aimed to investigate factors associated with undergoing dysphagia screening (DS) and developing pneumonia, as well as the relationship between DS and pneumonia in patients with intracerebral haemorrhage (ICH). DESIGN Our study was a cross-sectional hospital-based retrospective study. STUDY DESIGN AND SETTINGS We derived data from the China Stroke Centre Alliance, a nationwide clinical registry of ICH from 1476 participating hospitals in mainland China. To identify predictors for pneumonia, multivariable logistic regression models were used to identify patient characteristics that were independently associated with DS and pneumonia. PARTICIPANTS We included 31 546 patients in this study with patient characteristics, admission location, medical history, hospital characteristics and hospital grade from August 2015 to July 2019. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were DS and pneumonia during acute hospitalisation. RESULTS In total, 25 749 (81.6%) and 7257 (23.0%) patients with ICH underwent DS and developed pneumonia. Compared with patients without pneumonia, those who developed pneumonia were older and had severe strokes (Glasgow Coma Scale 9-13: 52.7% vs 26.9%). Multivariable analyses revealed that a higher pneumonia risk was associated with dysphagia (OR, 4.34; 95% CI, 4.02 to 4.68), heart failure (OR, 1.85; 95% CI, 1.24 to 2.77) and smoking (OR, 1.12; 95% CI, 1.12 to 0.20). DS was associated with lower odds of pneumonia (OR, 0.65; 95% CI, 0.44 to 0.95). CONCLUSION Our findings further confirm that dysphagia is an independent risk factor for pneumonia; one-fifth of patients with ICH did not undergo DS. However, comprehensive dysphagia evaluation and effective management are crucial. Nursing processes ensure the collection of complete and accurate information during evaluation of patients. There is a need to increase the rate of DS in patients with ICH, especially those with severe stroke or older. Further, randomised controlled trials are warranted to determine the effectiveness of DS on clinical outcomes.
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Affiliation(s)
- Yong-Mei Deng
- Nursing Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Jin-Ju Sun
- Nursing Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research centre for Neurological Diseases, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research centre for Neurological Diseases, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research centre for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research centre for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xing-Quan Zhao
- China National Clinical Research centre for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
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Chen Y, Aishan G, Fan S, Wang T, Wu J, Chia C, Liu G, Wang L, Hu R. Predictors of long-term decannulation in patients with disorders of consciousness. Front Neurol 2023; 14:1099307. [PMID: 37849837 PMCID: PMC10577412 DOI: 10.3389/fneur.2023.1099307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/21/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose The predictors of tracheostomy decannulation in patients with disorders of consciousness (DOC) are not comprehensively understood, making prognosis difficult. The primary objective of this study was to identify predictors of tracheostomy decannulation in patients with disorders of consciousness (DOC). The secondary aim was to evaluate the feasibility and safety of the modified Evans blue dye test (MEBDT) in tracheostomized DOC patients. Methods This retrospective study included all patients with disorders of consciousness (DOC) who underwent tracheostomy and were admitted between January 2016 and September 2022. Age, sex, etiology, initial Glasgow coma scale (GCS), initial Coma Recovery Scale-Revised (CRS-R), diagnosis of unresponsive wakefulness syndrome (UWS) or minimal consciousness state (MCS), MEBDT, initial modified Rankin scale (mRS), and initial Functional Oral Intake Scale (FOIS) were collected upon study enrollment. The relationship between clinical characteristics and cannulation status was investigated through a Cox regression model. Results A total of 141 patients were included in the study. The average age of these patients was 52.5 ± 16.7 years, with 42 (29.8%) being women. During the study period, 86 subjects (61%) underwent successful decannulation. Univariate analysis revealed that decannulated patients exhibited a significantly better conscious state compared to those without decannulation (CRS-R: p < 0.001; GCS: p = 0.023; MCS vs. UWS: p < 0.001). Additionally, a negative modified Evans blue dye test (MEBDT) result was significantly associated with tracheostomy decannulation (p < 0.001). In the multivariate analysis, successful decannulation was associated with a higher level of consciousness (MCS vs. UWS, p < 0.001, HR = 6.694) and a negative MEBDT result (negative vs. positive, p = 0.006, HR = 1.873). The Kaplan-Meier analysis further demonstrated that MEBDT-negative patients and those in the MCS category had a higher probability of decannulation at 12 months (p < 0.001). Conclusion The findings of this study indicate that a negative MEBDT result and a higher level of consciousness can serve as predictive factors for successful tracheostomy decannulation in DOC patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ruiping Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Wang R, Zhang J, He M, Chen H, Xu J. Procalcitonin as a biomarker of nosocomial pneumonia in aneurysmal subarachnoid hemorrhage patients treated in neuro-ICU. Clin Neurol Neurosurg 2023; 231:107870. [PMID: 37421741 DOI: 10.1016/j.clineuro.2023.107870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Nosocomial pneumonia commonly develops in aneurysmal subarachnoid hemorrhage (aSAH) patients and is associated with poor prognosis of these patients. This study is designed to verify the predictive value of procalcitonin (PCT) on nosocomial pneumonia in aSAH patients. METHODS 298 aSAH patients received treatments in the neuro-intensive care unit (NICU) of West China hospital were included. Logistic regression was conducted to verify the association between PCT level and nosocomial pneumonia and to construct a model for predicting pneumonia. Area under the receiver operating characteristic curve (AUC) were calculated to evaluate the accuracy of the single PCT and the constructed model. RESULTS 90 (30.2%) patients developed pneumonia during hospitalizations among included aSAH patients. Pneumonia group had higher procalcitonin level (p < 0.001) than non-pneumonia group. The mortality (p < 0.001), mRS (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (p < 0.001) were both higher or longer in pneumonia group. Multivariate logistic regression indicated WFNS (p = 0.001), acute hydrocephalus (p = 0.007), WBC (p = 0.021), PCT (p = 0.046) and C-reactive protein (CRP) (p = 0.031) were independently associated with the development of pneumonia in included patients. The AUC value of procalcitonin for predicting nosocomial pneumonia was 0.764. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, the predictive model for pneumonia has higher AUC of 0.811. CONCLUSIONS PCT is an available and effective predictive marker of nosocomial pneumonia in aSAH patients. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, our constructed predictive model is helpful for clinicians to evaluate the risk of nosocomial pneumonia and guide therapeutics in aSAH patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hongxu Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Yang G, Xu M, Chen W, Qiao X, Shi H, Hu Y. A brain CT-based approach for predicting and analyzing stroke-associated pneumonia from intracerebral hemorrhage. Front Neurol 2023; 14:1139048. [PMID: 37332986 PMCID: PMC10272424 DOI: 10.3389/fneur.2023.1139048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Stroke-associated pneumonia (SAP) is a common complication of stroke that can increase the mortality rate of patients and the burden on their families. In contrast to prior clinical scoring models that rely on baseline data, we propose constructing models based on brain CT scans due to their accessibility and clinical universality. Methods Our study aims to explore the mechanism behind the distribution and lesion areas of intracerebral hemorrhage (ICH) in relation to pneumonia, we utilized an MRI atlas that could present brain structures and a registration method in our program to extract features that may represent this relationship. We developed three machine learning models to predict the occurrence of SAP using these features. Ten-fold cross-validation was applied to evaluate the performance of models. Additionally, we constructed a probability map through statistical analysis that could display which brain regions are more frequently impacted by hematoma in patients with SAP based on four types of pneumonia. Results Our study included a cohort of 244 patients, and we extracted 35 features that captured the invasion of ICH to different brain regions for model development. We evaluated the performance of three machine learning models, namely, logistic regression, support vector machine, and random forest, in predicting SAP, and the AUCs for these models ranged from 0.77 to 0.82. The probability map revealed that the distribution of ICH varied between the left and right brain hemispheres in patients with moderate and severe SAP, and we identified several brain structures, including the left-choroid-plexus, right-choroid-plexus, right-hippocampus, and left-hippocampus, that were more closely related to SAP based on feature selection. Additionally, we observed that some statistical indicators of ICH volume, such as mean and maximum values, were proportional to the severity of SAP. Discussion Our findings suggest that our method is effective in classifying the development of pneumonia based on brain CT scans. Furthermore, we identified distinct characteristics, such as volume and distribution, of ICH in four different types of SAP.
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Affiliation(s)
- Guangtong Yang
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Min Xu
- Neurointensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Wei Chen
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xu Qiao
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Hongfeng Shi
- Neurointensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Yongmei Hu
- School of Control Science and Engineering, Shandong University, Jinan, China
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Ding Y, Ji Z, Liu Y, Niu J. Braden scale for predicting pneumonia after spontaneous intracerebral hemorrhage. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:904-911. [PMID: 35946766 PMCID: PMC9574960 DOI: 10.1590/1806-9282.20211339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Stroke-associated pneumonia is an infection that commonly occurs in patients with spontaneous intracerebral hemorrhage and causes serious burdens. In this study, we evaluated the validity of the Braden scale for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage. METHODS Patients with spontaneous intracerebral hemorrhage were retrospectively included and divided into pneumonia and no pneumonia groups. The admission clinical characteristics and Braden scale scores at 24 h after admission were collected and compared between the two groups. Receiver operating characteristic curve analysis was performed to assess the predictive validity of the Braden scale. Multivariable analysis was conducted to identify the independent risk factors associated with pneumonia after intracerebral hemorrhage. RESULTS A total of 629 intracerebral hemorrhage patients were included, 150 (23.8%) of whom developed stroke-associated pneumonia. Significant differences were found in age and fasting blood glucose levels between the two groups. The mean score on the Braden scale in the pneumonia group was 14.1±2.4, which was significantly lower than that in the no pneumonia group (16.5±2.6), p<0.001. The area under the curve for the Braden scale for the prediction of pneumonia after intracerebral hemorrhage was 0.760 (95%CI 0.717-0.804). When the cutoff point was 15 points, the sensitivity was 74.3%, the specificity was 64.7%, the accuracy was 72.0%, and the Youden's index was 39.0%. Multivariable analysis showed that a lower Braden scale score (OR 0.696; 95%CI 0.631-0.768; p<0.001) was an independent risk factor associated with stroke-associated pneumonia after intracerebral hemorrhage. CONCLUSION The Braden scale, with a cutoff point of 15 points, is moderately valid for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage.
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Affiliation(s)
- Yunlong Ding
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Neurology – Jiangsu, China
| | - Zhanyi Ji
- Zhoukou Central Hospital, Department of Neurology – Henan, China
| | - Yan Liu
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Neurology – Jiangsu, China
| | - Jiali Niu
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Clinical Pharmacy – Jiangsu, China
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Peng J, Zhu G, Xiao S, Liu S. Elevated Homocysteine Levels Predict Hospital-Acquired Pneumonia and Poor Functional Outcomes in Primary Intracerebral Hemorrhage. Front Neurol 2022; 13:926963. [PMID: 35812113 PMCID: PMC9263362 DOI: 10.3389/fneur.2022.926963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHomocysteine (Hcy) has been extensively acknowledged to be correlated with inflammation. In this study, the relationship between Hcy and hospital-acquired pneumonia (HAP) in primary intracerebral hemorrhage (pICH) was explored.MethodsWe conducted a hospital-based study on screened eligible patients with primary intracerebral hemorrhage admitted within 24 h after symptom onset from January 2019 to June 2021. The associations between Hcy and HAP and poor outcomes in pICH were investigated using univariate and multivariate logistic regression analyses. The predictive accuracy of Hcy was assessed by the receiver operating characteristic curve and the optimal cutoff value of Hcy was determined by Youden Index. The patterns and magnitudes of associations between Hcy and HAP and poor outcomes were evaluated using a restricted cubic spline (RCS).ResultsA total of 579 patients with pICH were included in the study. Hcy level was significantly higher in patients with HAP and poor outcomes (p < 0.001). The univariate and multivariate logistic regression analyses demonstrated that elevated Hcy was independently associated with both HAP and poor outcomes (p < 0.001). Furthermore, receiver operating characteristic analysis indicated that Hcy exhibited a moderate predictive accuracy for both HAP and poor outcomes after pICH. The RCS model showed that there were linear relationships between Hcy and HAP and poor outcomes.ConclusionsHigher Hcy level was independently associated with HAP and poor outcomes in patients with pICH.
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Affiliation(s)
- Jun Peng
- Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Guanghua Zhu
- Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Sheng Xiao
- Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Shucheng Liu
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- *Correspondence: Shucheng Liu
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Zhang JZ, Chen H, Wang X, Xu K. Risk factors of mortality and severe disability in the patients with cerebrovascular diseases treated with perioperative mechanical ventilation. World J Clin Cases 2022; 10:5230-5240. [PMID: 35812679 PMCID: PMC9210878 DOI: 10.12998/wjcc.v10.i16.5230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/07/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognosis of cerebrovascular diseases treated with mechanical ventilation during perioperative has not been clearly reported.
AIM To analyze mortality and functional disability and to determine predictors of unfavorable outcome in the patients with cerebrovascular diseases treated with mechanical ventilation.
METHODS A retrospective follow-up study of 111 cerebrovascular disease patients who underwent mechanical ventilation during the perioperative period in the First Hospital of Jilin University from June 2016 to June 2019 was performed. Main measurements were mortality and functional outcome in-hospital and after 3-month follow-up. According to the modified rankin scale (mRS), the functional outcome was divided into three groups: Good recovery (mRS ≤ 3), severe disability (mRS = 4 or 5) and death (mRS = 6). Univariate analysis was used to compare the differences between three functional outcomes. Multivariate logistic regression analysis was used to for risk factors of mortality and severe disability.
RESULTS The average age of 111 patients was 56.46 ± 12.53 years, 59 (53.15%) were males. The mortality of in-hospital and 3-month follow-up were 36.9% and 45.0%, respectively. Of 71 discharged patients, 46.47% were seriously disabled and 12.67% died after three months follow-up. Univariate analysis showed that preoperative glasgow coma scale, operation start time and ventilation reasons had statistically significant differences in different functional outcomes. Multiple logistic regression analysis showed that the cause of ventilation was related to the death and poor prognosis of patients with cerebrovascular diseases. Compared with brainstem compression, the risk of death or severe disability of pulmonary disease, status epilepticus, impaired respiratory center function, and shock were 0.096 (95%CI: 0.028-0.328), 0.026 (95%CI: 0.004-0.163), 0.095 (95%CI: 0.013-0.709), 0.095 (95%CI: 0.020-0.444), respectively.
CONCLUSION The survival rate and prognostic outcomes of patients with cerebrovascular diseases treated with mechanical ventilation during the perioperative period were poor. The reason for mechanical ventilation was a statistically significant predictor for mortality and severe disability.
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Affiliation(s)
- Jin-Zhu Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hao Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xin Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Erfani Z, Jelodari Mamaghani H, Rawling JA, Eajazi A, Deever D, Mirmoeeni S, Azari Jafari A, Seifi A. Pneumonia in Nervous System Injuries: An Analytic Review of Literature and Recommendations. Cureus 2022; 14:e25616. [PMID: 35784955 PMCID: PMC9249029 DOI: 10.7759/cureus.25616] [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] [Accepted: 06/02/2022] [Indexed: 11/09/2022] Open
Abstract
Pneumonia is one of the most common complications in intensive care units and is the most common nosocomial infection in this setting. Patients with neurocritical conditions who are admitted to ICUs are no exception, and in fact, are more prone to infections such as pneumonia because of factors such as swallow dysfunction, need for mechanical ventilation, longer length of stay in hospitals, etc. Common central nervous system pathologies such as ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, neuromuscular disorders, status epilepticus, and demyelinating diseases can cause long in-hospital admissions and increase the risk of pneumonia each with a mechanism of its own. Brain injury-induced immunosuppression syndrome is usually considered the common mechanism through which patients with critical central nervous system conditions become susceptible to different kinds of infection including pneumonia. Evaluating the patients and assessment of the risk factors can lead our attention toward better infection control in this population and therefore decrease the risk of infections in central nervous system injuries.
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12
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Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
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13
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Yang H, Fan Y, Li C, Zhang M, Liu W. A retrospective study on risk factors and disease burden for hospital-acquired pneumonia caused by multi-drug-resistant bacteria in patients with intracranial cerebral hemorrhage. Neurol Sci 2021; 43:2461-2467. [PMID: 34750685 PMCID: PMC8575346 DOI: 10.1007/s10072-021-05721-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Hospital-acquired pneumonia (HAP) is becoming a serious problem in China, especially caused by multi-drug resistant (MDR), which is a risk factor for poor prognosis of intracranial cerebral hemorrhage (ICH). We investigate the risk factors for HAP among patients with ICH and study the antibiotic use and medical costs of MDR infection. METHODS We performed a retrospective, case-control, parallel study in Xiangya Hospital. Patients included in this study and diagnosed with basal ganglia hemorrhage were admitted between January 2017 and December 2019. RESULTS Univariate analysis discovered some personal risk factors including gender (p = .002), age (p = .023), and underlying conditions such as diabetes (p = .036), coronary heart disease (p = .009), and renal insufficiency (p = .001). Invasive medical operations including endotracheal intubation, tracheotomy, ventilator use, lumbar puncture, urinary catheter insertion, and peripherally inserted central catheter (PICC) (p < .001 all) were also risk factors for HAP. Binary logistics regression indicated hospital duration, antibiotic exposure, and urinary catheter insertion explained 91.4% of the variance on HAP (p < 0.01). As for the antibiotic treatment, there were no difference in the duration of use days and total dose per patient between MDR and non-MDR group, except for Tigecycline. Antibiotic costs for the MDR group were significantly higher than those for the non-MDR group and no infection group (p < 0.001). CONCLUSION To better prevent HAP particularly caused by MDR bacteria, we emphasize the aseptic technique especially in the management of equipment in patient care.
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Affiliation(s)
- Haojun Yang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Yishu Fan
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Chunhui Li
- Infection Control Center, Xiangya Hospital, Central South University, Changsha Hunan, 410008, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China.
| | - Weiping Liu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China.
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14
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Liu X, Cao Z, Gu H, Yang K, Ji R, Li Z, Zhao X, Wang Y. Uric Acid and Clinical Outcomes Among Intracerebral Hemorrhage Patients: Results From the China Stroke Center Alliance. Front Neurol 2021; 11:609938. [PMID: 33424760 PMCID: PMC7793938 DOI: 10.3389/fneur.2020.609938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/06/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Purpose: The effect of uric acid (UA) levels on severity and prognosis of spontaneous intracerebral hemorrhage (ICH) remains controversial. We aimed to explore the association of admission UA levels with stroke severity and outcomes in ICH patients. Materials and Methods: The patients enrolled in this study were from the China Stroke Center Alliance study (CSCA). Patients were divided into four groups (Q1–Q4) according to the quartiles of UA levels at admission. The primary outcome was in-hospital mortality. The secondary outcomes included stroke severity, in-hospital complications, and discharge disposition. Multivariate logistic regression was adopted to explore the association of UA levels with outcomes after ICH. Results: Patients (84,304) with acute ICH were included in the final analysis; the median (interquartile range) of UA was 277 (210, 354) μmol/L. The four groups were defined as follows: Q1 ≤ 210 μmol/L, 210 μmol/L < Q2 ≤ 277 μmol/L, 277 μmol/L < Q3 ≤ 354 μmol/L, Q4 > 354 μmol/L. There was no significant evidence indicating that UA levels were correlated with the discharge disposition and in-hospital mortality after ICH. However, compared to Q1, the patients with higher UA levels had decreased odds of severe stroke (NIHSS ≥ 16) at admission (OR 0.89, 95% CI 0.86–0.92). An L-shaped association was found between UA and severe stroke. Among in-hospital complications, decrease in pneumonia, poor swallow function, gastrointestinal bleeding, and deep vein thrombosis (DVT) were significantly associated with higher UA levels compared to Q1 (P for trend < 0.0001). Conclusions: UA was a protective factor for stroke severity and in-hospital complications such as pneumonia, poor swallow function, gastrointestinal bleeding, and DVT. However, no significant evidence indicated that UA levels were predictive of the discharge disposition and in-hospital mortality after ICH.
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Affiliation(s)
- Xinmin Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhentang Cao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongqiu Gu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Kaixuan Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ruijun Ji
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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15
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Miao X, Yuan P, Zhao L, Zhang L, Jiang X, Cao H, Shi H, Li J, Yang R. Risk factors for pneumonia in patients with anti-NMDA receptor encephalitis: A single-center retrospective study. Medicine (Baltimore) 2020; 99:e19802. [PMID: 32332622 PMCID: PMC7220633 DOI: 10.1097/md.0000000000019802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To identify the risk factors of pneumonia in patients with Anti-N-methyl-D-aspartate (Anti-NMDA) receptor encephalitis.This is a retrospective study.Department of Neurology in West China Hospital of Sichuan University.Patients with a definitive diagnosis of anti-NMDA receptor encephalitis.Risk factors associated with pneumonia were examined by bivariate analysis and multivariate logistic regression model.A total of 104 patients were included in this study, of which 41% patients (n = 43) were diagnosed with pneumonia at 7 days (range: 4-40 days) after admission. The occurrence of pneumonia was associated with prolonged hospital stays, a higher rate of poor outcome, and extra healthcare costs. Risk factors associated with pneumonia included Glasgow coma scale score (GCS), abnormal movements and hypokalemia.Pneumonia is a common complication in anti-NMDA receptor encephalitis. In the present study, we found that disorders of consciousness, abnormal movements, and hypokalemia were independent risk factors for pneumonia in inpatients with anti-NMDA receptor encephalitis. Pneumonia prolongs the patients' hospital stay, hospitalization expenditures, and affects the patients' prognosis.
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Affiliation(s)
- Xiaohui Miao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Pingqiao Yuan
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou
| | - Lihong Zhao
- Department of Radiology, West China Hospital of Sichuan University
| | - Le Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Xinyue Jiang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Hanyu Cao
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hongrui Shi
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jinmei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Rong Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan
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16
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Quyet D, Hien NM, Khan MX, Dai PD, Thuan DD, Duc DM, Hai ND, Nam BV, Huy PQ, Ton MD, Truong DT, Nga VT, Duc DP. Risk Factors for Stroke Associated Pneumonia. Open Access Maced J Med Sci 2019; 7:4416-4419. [PMID: 32215105 PMCID: PMC7084006 DOI: 10.3889/oamjms.2019.873] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Stroke patients are at high risk for stroke-associated pneumonia (SAP). If patients suffer from pneumonia their prognosis will worsen. AIM: To identify factors that increases the risk of SAP in stroke patients. METHODS: A group of 508 patients hospitalized within 5 days after the onset of stroke were enrolled prospectively. RESULTS: The incidence of SAP was 13.4%. Some major risk factors for SAP are: mechanical ventilation (MV) had odds ratio (OR) 16.4 (p <0.01); the National Institutes of Health Stroke Scale (NIHSS) > 15 OR 9.1 (p <0.01); the Gugging Swallowing Screen (GUSS) 0-14 OR 11.7 (p <0.01). CONCLUSION: SAP is a frequent complication. We identified some risk factors of SAP, especially stroke severity (NIHSS > 15), swallowing disorder (GUSS < 15) and mechanical ventilation.
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Affiliation(s)
- Do Quyet
- Respiratory Center, Military Hospital 103, Hanoi, Vietnam
| | | | - Mai Xuan Khan
- Respiratory Center, Military Hospital 103, Hanoi, Vietnam
| | - Pham Dinh Dai
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Do Duc Thuan
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Dang Minh Duc
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | | | - Bui Van Nam
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Pham Quoc Huy
- Emergency Department, Military Hospital 103, Hanoi, Vietnam
| | - Mai Duy Ton
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, Danang, Vietnam
| | - Dang Phuc Duc
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
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17
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Abstract
PURPOSE OF REVIEW This article summarizes updated data and knowledge on healthcare-associated infections in the neurocritical care unit, with a focus on central nervous system infections and systemic infectious complications in patients with acute brain disease. It also reviews the concept of brain injury-induced immune modulation, an underlying mechanism to explain why the neuro-ICU population is particularly susceptible to infections. RECENT FINDINGS Healthcare-associated infections in the neuro-ICU are common: up to 40 % of meningitides in the developed world are now healthcare-associated. The number of gram-negative infections is rising. New diagnostic approaches attempt to aid in the diagnosis of healthcare-associated meningitis and ventriculitis. Healthcare-associated infections in the neurocritical care unit remain a challenge for diagnosis, treatment, and prevention. Gaining a better understanding of at-risk patients and development of preventative strategies will be the goal for future investigation.
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Affiliation(s)
- Katharina M Busl
- Departments of Neurology and Neurosurgery, McKnight Brain Institute L3-100, University of Florida College of Medicine, 1149 Newell Drive, Gainesville, FL, 32610, USA.
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18
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Marchina S, Doros G, Modak J, Helenius J, Aycock DM, Kumar S. Acid-suppressive medications and risk of pneumonia in acute stroke patients: A systematic review and meta-analysis. J Neurol Sci 2019; 400:122-128. [DOI: 10.1016/j.jns.2019.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/20/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023]
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Predictors of post-stroke fever and infections: a systematic review and meta-analysis. BMC Neurol 2018; 18:49. [PMID: 29685118 PMCID: PMC5913801 DOI: 10.1186/s12883-018-1046-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/13/2018] [Indexed: 01/21/2023] Open
Abstract
Background Fever after stroke is common, and often caused by infections. In the current study, we aimed to test the hypothesis that pneumonia, urinary tract infection and all-cause fever (thought to include at least some proportion of endogenous fever) have different predicting factors, since they differ regarding etiology. Methods PubMed was searched systematically for articles describing predictors for post-stroke pneumonia, urinary tract infection and all-cause fever. A total of 5294 articles were manually assessed; first by title, then by abstract and finally by full text. Data was extracted from each study, and for variables reported in 3 or more articles, a meta-analysis was performed using a random effects model. Results Fifty-nine articles met the inclusion criteria. It was found that post-stroke pneumonia is predicted by age OR 1.07 (1.04–1.11), male sex OR 1.42 (1.17–1.74), National Institutes of Health Stroke Scale (NIHSS) OR 1.07 (1.05–1.09), dysphagia OR 3.53 (2.69–4.64), nasogastric tube OR 5.29 (3.01–9.32), diabetes OR 1.15 (1.08–1.23), mechanical ventilation OR 4.65 (2.50–8.65), smoking OR 1.16 (1.08–1.26), Chronic Obstructive Pulmonary Disease (COPD) OR 4.48 (1.82–11.00) and atrial fibrillation OR 1.37 (1.22–1.55). An opposite relation to sex may exist for UTI, which seems to be more common in women. Conclusions The lack of studies simultaneously studying a wide range of predictors for UTI or all-cause fever calls for future research in this area. The importance of new research would be to improve our understanding of fever complications to facilitate greater vigilance, monitoring, prevention, diagnosis and treatment.
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Health Care-Associated Infections after Subarachnoid Hemorrhage. World Neurosurg 2018; 115:e393-e403. [PMID: 29678711 DOI: 10.1016/j.wneu.2018.04.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Health care-associated infections (HAIs) after subarachnoid hemorrhage (SAH) are prevalent; however, data describing epidemiology of infection are limited. This study reports incidence rates, risk factors, and the resulting SAH patient-related outcomes. METHODS We studied the incidence of HAIs acquired in the intensive care unit (ICU) over a 6-year period. We used Bayesian Model Averaging to identify risk factors associated with an increased risk of HAIs, particularly urinary tract infections (UTI), pneumonia, and ventriculostomy-associated infections (VAI). We also examined the impact of HAIs on risk of vasospasm, ICU and hospital length of stay, and discharge disposition and adjusted for other risk factors. RESULTS Of 419 patients with SAH, 66 (15.8%) developed 79 HAI episodes. Mean HAI incidence rates (per 1000 ICU-days) were UTI, 7.1; pneumonia, 4.3; and VAI, 2.4. The admission characteristic associated with increased risk of overall HAI, UTI, and VAI was diabetes mellitus. Hunt and Hess grades III-V were associated with increased risk of overall HAI and VAI. Male gender, intraventricular hemorrhage, and blood glucose level (>10) were associated with increased risk of pneumonia, whereas the incidence was lower in the presence of steroids. HAI was associated with increased length of stay of 10 ICU-days and 22 hospital-days, but not vasospasm or poor discharge disposition. CONCLUSIONS HAIs are serious complications after SAH associated with prolonged ICU and hospital length of stay. Additional rigorous infection control measures aimed at patients with identifiable risk factors should trigger prevention, and early detection of nosocomial infections is warranted to further reduce the prevalence of HAIs.
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22
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Update on the Treatment of Spontaneous Intraparenchymal Hemorrhage: Medical and Interventional Management. Curr Treat Options Neurol 2018; 20:1. [PMID: 29397452 DOI: 10.1007/s11940-018-0486-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Spontaneous intraparenchymal hemorrhage (IPH) is a prominent challenge faced globally by neurosurgeons, neurologists, and intensivists. Over the past few decades, basic and clinical research efforts have been undertaken with the goal of delineating biologically and evidence-based practices aimed at decreasing mortality and optimizing the likelihood of meaningful functional outcome for patients afflicted with this devastating condition. Here, the authors review the medical and surgical approaches available for the treatment of spontaneous intraparenchymal hemorrhage, identifying areas of recent progress and ongoing research to delineate the scope and scale of IPH as it is currently understood and treated. RECENT FINDINGS The approaches to IPH have broadly focused on arresting expansion of hemorrhage using a number of approaches. Recent trials have addressed the effectiveness of rapid blood pressure lowering in hypertensive patients with IPH, with rapid lowering demonstrated to be safe and at least partially effective in preventing hematoma expansion. Hemostatic therapy with platelet transfusion in patients on anti-platelet medications has been recently demonstrated to have no benefit and may be harmful. Hemostasis with administration of clotting complexes has not been shown to be effective in reducing hematoma expansion or improving outcomes although correcting these abnormalities as soon as possible remains good practice until further data are available. Stereotactically guided drainage of IPH with intraventricular hemorrhage (IVH) has been shown to be safe and to improve outcomes. Research on new stereotactic surgical methods has begun to show promise. Patients with IPH should have rapid and accurate diagnosis with neuroimaging with computed tomography (CT) and computed tomography angiography (CTA). Early interventions should include control of hypertension to a systolic BP in the range of 140 mmHg for small hemorrhages without intracranial hypertension with beta blockers or calcium channel blockers, correction of any coagulopathy if present, and assessment of the need for surgical intervention. IPH and FUNC (Functional Outcome in Patients with Primary Intracerebral Hemorrhage) scores should be assessed. Patients should be dispositioned to a dedicated neurologic ICU if available. Patients should be monitored for seizures and intracranial pressure issues. Select patients, particularly those with intraventricular extension, may benefit from evacuation of hematoma with a ventriculostomy or stereotactically guided catheter. Once stabilized, patients should be reassessed with CT imaging and receive ongoing management of blood pressure, cerebral edema, ICP issues, and seizures as they arise. The goal of care for most patients is to regain capacity to receive multidisciplinary rehabilitation to optimize functional outcome.
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Early versus late tracheostomy after decompressive craniectomy for stroke. J Intensive Care 2018; 6:1. [PMID: 29308208 PMCID: PMC5753520 DOI: 10.1186/s40560-017-0269-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/07/2017] [Indexed: 12/16/2022] Open
Abstract
Background Stroke patients requiring decompressive craniectomy are at high risk of prolonged mechanical ventilation and ventilator-associated pneumonia (VAP). Tracheostomy placement may reduce the duration of mechanical ventilation. Predicting which patients will require tracheostomy and the optimal timing of tracheostomy remains a clinical challenge. In this study, the authors compare key outcomes after early versus late tracheostomy and develop a useful pre-operative decision-making tool to predict post-operative tracheostomy dependence. Methods We performed a retrospective analysis of prospectively collected registry data. We developed a propensity-weighted decision tree analysis to predict tracheostomy requirement using factors present prior to surgical decompression. In addition, outcomes include probability functions for intensive care unit length of stay, hospital length of stay, and mortality, based on data for early (≤ 10 days) versus late (> 10 days) tracheostomy. Results There were 168 surgical decompressions performed on patients with acute ischemic or spontaneous hemorrhagic stroke between 2010 and 2015. Forty-eight patients (28.5%) required a tracheostomy, 35 (20.8%) developed VAP, and 126 (75%) survived hospitalization. Mean ICU and hospital length of stay were 15.1 and 25.8 days, respectively. Using GCS, SOFA score, and presence of hydrocephalus, our decision tree analysis had 63% sensitivity and 84% specificity for predicting tracheostomy requirement. The early group had fewer ventilator days (7.3 versus 15.2, p < 0.001) and shorter hospital length of stay (28.5 versus 44.4 days, p = 0.014). VAP rates and mortality were similar between the two groups. Withdrawal of treatment interventions shortly post-operatively confounded mortality outcomes. Conclusion Early tracheostomy shortens duration of mechanical ventilation and length of stay after surgical decompression for stroke, but it did not impact mortality or VAP rates. A decision tree is a practical tool that may be helpful in guiding pre-operative decision-making with patients’ families. Electronic supplementary material The online version of this article (10.1186/s40560-017-0269-1) contains supplementary material, which is available to authorized users.
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Bonvento B, Wallace S, Lynch J, Coe B, McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc 2017; 10:391-398. [PMID: 29066907 PMCID: PMC5644554 DOI: 10.2147/jmdh.s118419] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tracheostomies are used to provide artificial airways for increasingly complex patients for a variety of indications. Patients and their families are dependent on knowledgeable multidisciplinary staff, including medical, nursing, respiratory physiotherapy and speech and language therapy staff, dieticians and psychologists, from a wide range of specialty backgrounds. There is increasing evidence that coordinated tracheostomy multidisciplinary teams can influence the safety and quality of care for patients and their families. This article reviews the roles of these team members and highlights the potential for improvements in care.
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Affiliation(s)
- Barbara Bonvento
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Sarah Wallace
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester.,Royal College of Speech and Language Therapists, London, UK
| | - James Lynch
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Barry Coe
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Brendan A McGrath
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
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Joundi RA, Martino R, Saposnik G, Giannakeas V, Fang J, Kapral MK. Dysphagia screening after intracerebral hemorrhage. Int J Stroke 2017; 13:503-510. [DOI: 10.1177/1747493017729265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Dysphagia screening is recommended after acute stroke to identify patients at risk of aspiration and implement appropriate care. However, little is known about the frequency and outcomes of patients undergoing dysphagia screening after intracerebral hemorrhage (ICH). Methods We used the Ontario Stroke Registry from 1 April 2010 to 31 March 2013 to identify patients hospitalized with acute stroke and to compare dysphagia screening rates in those with ICH and ischemic stroke. In patients with ICH we assessed predictors of receiving dysphagia screening, predictors of failing screening, and outcomes after failing screening. Results Among 1091 eligible patients with ICH, 354 (32.4%) patients did not have documented dysphagia screening. Patients with mild ICH were less likely to receive screening (40.4% of patients were omitted, adjusted odds ratio (aOR) 0.40, 95% confidence interval (CI) 0.26–0.63). Older age, greater stroke severity, speech deficits, lower initial level of consciousness, and admission to intensive care unit were predictive of failing the screening test. Failing screening was associated with poor outcomes, including pneumonia (aOR 5.3, 95% CI 2.36–11.88), severe disability (aOR 4.78, 95% CI 3.08–7.41), and 1-year mortality (adjusted hazard ratio 2.1, 95% CI 1.38–3.17). When compared to patients with ischemic stroke, patients with ICH were less likely to receive dysphagia screening (aOR 0.64, 95% CI 0.54–0.76) and more likely to fail screening (aOR 1.98, 95% 1.62–2.42). Conclusion One-third of patients with ICH did not have documented dysphagia screening, increasing to 40% in patients with mild clinical severity. Failing screening was associated with poor outcomes. Patients with ICH were less like to receive screening and twice as likely to fail compared to patients with ischemic stroke, and thus efforts should be made to include ICH patients in dysphagia screening protocols whenever possible.
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Affiliation(s)
- Raed A Joundi
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology and Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Gustavo Saposnik
- Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Vasily Giannakeas
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Jiming Fang
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
- Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, ON, Canada
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Yuan MZ, Li F, Fang Q, Wang W, Peng JJ, Qin DY, Wang XF, Liu GW. Research on the cause of death for severe stroke patients. J Clin Nurs 2017; 27:450-460. [PMID: 28677276 DOI: 10.1111/jocn.13954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the characteristics of mortality among severe stroke patients, analyse their causes of death and provide evidence for improving the survival rate of stroke patients. BACKGROUND Stroke is an important fatal and disabling disease that poses a large burden on its patients, and its high death rates have caused substantial concern to the World Health Organization. DESIGN A retrospective case-control study. METHODS A total of 188 patients who died of stroke in the neurological intensive care unit of the First Affiliated Hospital of Chongqing Medical University from January 2012-December 2015 were selected as cases. Additionally, 188 stroke survivors from the same neurological intensive care unit were randomly selected as paired cases. The clinical characteristics of the severe stroke patient deaths were analysed, and a univariate analysis was conducted to determine potential mortality risk factors. A logistic regression analysis was then conducted to determine the independent risk factors of mortality. RESULTS We investigated a total of 231 cases of death in neurological intensive care unit patients, 188 of whom died of stroke. Therefore, the death rate from stroke accounted for 81.3% of the total population, with ischaemic, haemorrhagic and mixed strokes accounting for 47.19%, 26.84% and 7.36% of the patients, respectively. The leading cause of death was central nervous system-related causes (central respiratory and circulatory failure, brain herniation), followed by multisystemic causes. The independent risk factors of death among the neurological intensive care unit patients were as follows: brain herniation (OR = 18.15), multiple organ failure (OR = 13.12), dyslipidemia (OR = 4.64), community-acquired lung infection (OR = 4.15), use of mechanical ventilation (OR = 3.37), hypoproteinemia (OR = 2.29), history of hypertension (OR = 2.03) and hospital-acquired pneumonia (OR = 1.75). CONCLUSIONS The most common cause of death in stroke patients was damage to the central nervous system. Independent risk factors were brain herniation, multiple organ failure, dyslipidemia, community-acquired lung infection, the use of mechanical ventilation, hypoproteinemia, a history of hypertension and hospital-acquired pneumonia. Clinicians should be aware of the presence and possible effects of these conditions. Early prevention, monitoring and intervention to modify controllable risk factors will improve patient prognosis. RELEVANCE TO CLINICAL PRACTICE Clinicians should be aware of the multiple independent risk factors of death and implement timely treatment measures to reduce the incidence of death in severe stroke patients.
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Affiliation(s)
- Mei-Zhen Yuan
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qin Fang
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wei Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jing-Jing Peng
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - De-Yu Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xue-Feng Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guang-Wei Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Yuan MZ, Li F, Tian X, Wang W, Jia M, Wang XF, Liu GW. Risk factors for lung infection in stroke patients: a meta-analysis of observational studies. Expert Rev Anti Infect Ther 2016; 13:1289-98. [PMID: 26359533 DOI: 10.1586/14787210.2015.1085302] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aims of this meta-analysis were to evaluate the risk factors associated with lung infections in stroke patients and to provide evidence for prevention decisions. METHODS We searched the Embase, PubMed, EBSCO and Web of Science databases to collect studies from January 2000 to July 2015. RESULTS The meta-analysis identified 23 risk factors for lung infections in stroke patients, and the top 5, ranked by order according to odds ratio values (95% confidence interval), were as follows: multiple vertebrobasilar stroke, 22.99 (4.04, 130.83); National Institutes of Health Stroke Scale score >15 points, 14.63 (8.54, 25.08); mechanical ventilation, 10.20 (7.15, 14.57); nasogastric tube use, 9.87 (6.21, 15.70); and dysphagia, 7.50 (2.60, 21.65). CONCLUSION Preventive measures should be taken against these risk factors to reduce the incidence of lung infection.
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Affiliation(s)
- Mei-zhen Yuan
- a 1 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Feng Li
- a 1 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin Tian
- a 1 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Wang
- a 1 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Man Jia
- b 2 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xue-feng Wang
- a 1 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Guang-wei Liu
- a 1 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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The A2DS2 Score as a Predictor of Pneumonia and In-Hospital Death after Acute Ischemic Stroke in Chinese Populations. PLoS One 2016; 11:e0150298. [PMID: 26950337 PMCID: PMC4780726 DOI: 10.1371/journal.pone.0150298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/11/2016] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Stroke-associated pneumonia (SAP) is a common complication and an important cause of death during hospitalization. The A2DS2 (Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity) score was developed from the Berlin Stroke Registry and showed good predictive value for predicting SAP. We sought to identify the association between the A2DS2 score and SAP, and, furthermore, to identify whether the A2DS2 score was a predictor for in-hospital death after acute ischemic stroke in a Chinese population. Methods This was a retrospective study. 1239 acute ischemic stroke patients were classified to low A2DS2 group (0–4) and high A2DS2 score (5–10) group. Primary outcome was in-hospital SAP. Logistic regression analyses were performed to identify the association between the A2DS2 score and SAP, and also the association between the A2DS2 score and in-hospital death. Results The overall incidence rates of SAP and in-hospital mortality after acute ischemic stroke were 7.3% and 2.4%, respectively. The incidence rate of SAP in low and high A2DS2 score groups was separately 3.3% and 24.7% (P<0.001). During hospitalization, 1.2% patients in low score group and 7.8% patients in high score group died (P<0.001). Multivariate regression demonstrated that patients in high score group had a higher risk of SAP (OR = 8.888, 95%CI: 5.552–14.229) and mortality (OR = 7.833, 95%CI: 3.580–17.137) than patients in low score group. Conclusions The A2DS2 score was a strong predictor for SAP and in-hospital death of Chinese acute ischemic stroke patients. The A2DS2 score might be a useful tool for the identification of patients with a high risk of SAP and death during hospitalization.
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In-Hospital Mortality and Complication Rates in Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage in Central Europe: A Population-Based Study. World Neurosurg 2015; 88:306-310. [PMID: 26739904 DOI: 10.1016/j.wneu.2015.11.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Secondary complications (SC) after intracerebral hemorrhage (ICH) can worsen outcome and are associated with early death. The purpose of the present study was to determine in-hospital mortality rates and SC after spontaneous ICH during acute care stay in a population-based cohort in central Europe. METHODS A prospective database of the State of Hesse, Germany, was screened for all patients with the primary diagnosis of spontaneous ICH (International statistical classification-10: I61.0-I61.9) between January 2007 and December 2012. RESULTS In the examined time period 10,029 patients with spontaneous ICH were identified. The cumulative rate of SC was 39.9% (1, 2, or ≥3 SC were documented in 25.0%, 10.1%, and 4.7%, respectively). The most common SC were pneumonia (15.1%), brain edema (6.5%), cardiac decompensation (5.9%), urogenital infection (5.5%), hydrocephalus (4.6%), epilepsy (3.4%), and rebleeding (3.4%). One, 2, or ≥3 SC were found in 2512 patients (25.0%), 1012 (10.1%), 473 (4.7%) patients, respectively. One SC was only a predictor of in-hospital mortality in conservatively treated patients (odds ratio [OR], 1.3; 95% confidence interval [CI] 1.2-1.5, P< 0.001). With an accumulation of SC to ≥3 the chance of in-hospital death increases for surgically (OR, 3.7, 95% CI 2.3-5.9; P< 0.001) and conservatively (OR, 3.0, 95% CI 2.3-3.9; P< 0.001) treated patients. CONCLUSIONS Surgical treatment of hematomas is associated with an increased rate of SC, but not with higher mortality rates compared with conservatively treated patients. The prevention of an accumulation of SC could lead to a decrease of in-hospital mortality after spontaneous ICH.
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Merkler AE, Chu SY, Lerario MP, Navi BB, Kamel H. Temporal relationship between infective endocarditis and stroke. Neurology 2015; 85:512-6. [PMID: 26163428 DOI: 10.1212/wnl.0000000000001835] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/08/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Stroke frequently complicates infective endocarditis (IE). However, the temporal relationship between these diseases is uncertain. METHODS We performed a retrospective study of adult patients hospitalized for IE between July 1, 2007, and June 30, 2011, at nonfederal acute care hospitals in California. Previously validated diagnosis codes were used to identify the primary composite outcome of ischemic or hemorrhagic stroke during discrete 1-month periods from 6 months before to 6 months after the diagnosis of IE. The odds of stroke in these periods were compared with the odds of stroke in the corresponding 1-month period 2 years earlier, which was considered the baseline risk of stroke. RESULTS Among 17,926 patients with IE, 2,275 strokes occurred within the 12-month period surrounding the diagnosis of IE. The risk of stroke was highest in the month after diagnosis of IE (1,640 vs 17 strokes in the corresponding month 2 years prior). This equaled an absolute risk increase of 9.1% (95% confidence interval 8.6%-9.5%) and an odds ratio of 96.5 (95% confidence interval 60.1-166.0). Stroke risk was significantly increased beginning 4 months before the diagnosis of IE and lasting 5 months afterward. Similar temporal patterns were seen when ischemic and hemorrhagic strokes were considered separately. CONCLUSIONS The association between IE and stroke persists for longer than previously reported. Most diagnoses of stroke and IE are made close together in time, but a period of heightened stroke risk becomes apparent several months before the diagnosis of IE and lasts for several months afterward.
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Affiliation(s)
- Alexander E Merkler
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT.
| | - Stacy Y Chu
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
| | - Michael P Lerario
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
| | - Babak B Navi
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
| | - Hooman Kamel
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
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Ho SW, Hsieh MJ, Yang SF, Yeh YT, Wang YH, Yeh CB. Risk of Stroke-Associated Pneumonia With Acid-Suppressive Drugs: A Population-Based Cohort Study. Medicine (Baltimore) 2015. [PMID: 26200649 PMCID: PMC4603020 DOI: 10.1097/md.0000000000001227] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Acid-suppressive drugs, including histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), are common medications used for treating upper gastrointestinal tract disorders. However, acid-suppressive drugs have been reported to increase the risk of pneumonia in numerous disease populations. However, the relationship between acid-suppressive drugs and stroke-associated pneumonia (SAP) remains controversial. The purpose of this study was to investigate the association between acid-suppressive drug usage and pneumonia among patients with stroke by using a nationwide data set. A population-based cohort study was conducted using a data set from the Taiwanese National Health Insurance Research Database. Data on patients with new-onset stroke from 2010 to 2011 were collected. Patients with and without acid-suppressive drug usage were followed up to identify the occurrence of any type of pneumonia. We estimated the adjusted hazard ratios (HRs) by using the Cox proportional hazards model. The study cohort comprised 7965 patients with new-onset stroke. The incidence of pneumonia was 6.9% (552/7965) and more than 40% (225/552) of patients developed pneumonia within 3 months after an acute stroke. Acid-suppressive drug usage was an independent risk factor of pneumonia. The adjusted HR for the risk of pneumonia in patients with new-onset stroke using acid-suppressive drugs was 1.44 (95% confidence interval [CI] = 1.18-1.75, P < 0.01). Only PPI usage increased risk of chronic SAP (adjusted HR = 1.46, 95% CI = 1.04-2.05). Acid-suppressive drug usage was associated with a slightly increased risk of SAP. Physicians should exercise caution when prescribing acid-suppressive drugs to patients with stroke, particularly at the chronic stage.
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Affiliation(s)
- Sai-Wai Ho
- From the Department of Emergency Medicine, School of Medicine, Chung Shan Medical University (S-WH, C-BY); Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung (S-WH, C-BY); Cancer Research Center, Changhua Christian Hospital, Changhua (M-JH); Institute of Medicine, Chung Shan Medical University (M-JH, S-FY); Department of Medical Research, Chung Shan Medical University Hospital (SF-Y, Y-HW); School of Dentistry, Chung Shan Medical University (Y-TY); Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan (Y-TY)
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Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ, Di Napoli M, Kalra L, Langhorne P, Montaner J, Roffe C, Rudd AG, Tyrrell PJ, van de Beek D, Woodhead M, Meisel A, Smith CJ. How Is Pneumonia Diagnosed in Clinical Stroke Research? Stroke 2015; 46:1202-9. [DOI: 10.1161/strokeaha.114.007843] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Diagnosis of pneumonia complicating stroke is challenging, and there are currently no consensus diagnostic criteria. As a first step in developing such consensus-based diagnostic criteria, we undertook a systematic review to identify the existing diagnostic approaches to pneumonia in recent clinical stroke research to establish the variation in diagnosis and terminology.
Methods—
Studies of ischemic stroke, intracerebral hemorrhage, or both, which reported occurrence of pneumonia from January 2009 to March 2014, were considered and independently screened for inclusion by 2 reviewers after multiple searches using electronic databases. The primary analysis was to identify existing diagnostic approaches for pneumonia. Secondary analyses explored potential reasons for any heterogeneity where standard criteria for pneumonia had been applied.
Results—
Sixty-four studies (56% ischemic stroke, 6% intracerebral hemorrhage, 38% both) of 639 953 patients were included. Six studies (9%) reported no information on the diagnostic approach, whereas 12 (19%) used unspecified clinician-reported diagnosis or initiation of antibiotics. The majority used objective diagnostic criteria: 20 studies (31%) used respiratory or other published standard criteria; 26 studies (41%) used previously unpublished ad hoc criteria. The overall occurrence of pneumonia was 14.3% (95% confidence interval 13.2%–15.4%;
I
2
=98.9%). Occurrence was highest in studies applying standard criteria (19.1%; 95% confidence interval 15.1%–23.4%;
I
2
=98.5%). The substantial heterogeneity observed was not explained by stratifying for other potential confounders.
Conclusions—
We found considerable variation in terminology and the diagnostic approach to pneumonia. Our review supports the need for consensus development of operational diagnostic criteria for pneumonia complicating stroke.
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Affiliation(s)
- Amit K. Kishore
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Andy Vail
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Angel Chamorro
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Javier Garau
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Stephen J. Hopkins
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Mario Di Napoli
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Lalit Kalra
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Peter Langhorne
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Joan Montaner
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Christine Roffe
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Anthony G. Rudd
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Pippa J. Tyrrell
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Diederik van de Beek
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Mark Woodhead
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Andreas Meisel
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
| | - Craig J. Smith
- From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre–Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de
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Medical acute complications of intracerebral hemorrhage in young adults. Stroke Res Treat 2015; 2015:357696. [PMID: 25722917 PMCID: PMC4333279 DOI: 10.1155/2015/357696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background. Frequency and impact of medical complications on short-term mortality in young patients with intracerebral hemorrhage (ICH) have gone unstudied. Methods. We reviewed data of all first-ever nontraumatic ICH patients between 16 and 49 years of age treated in our hospital between January 2000 and March 2010 to identify medical complications suffered. Logistic regression adjusted for known ICH prognosticators was used to identify medical complications associated with mortality. Results. Among the 325 eligible patients (59% males, median age 42 [interquartile range 34–47] years), infections were discovered in 90 (28%), venous thrombotic events in 13 (4%), cardiac complications in 4 (1%), renal failure in 59 (18%), hypoglycemia in 15 (5%), hyperglycemia in 165 (51%), hyponatremia in 146 (45%), hypernatremia in 91 (28%), hypopotassemia in 104 (32%), and hyperpotassemia in 27 (8%). Adjusted for known ICH prognosticators and diabetes, the only independent complication associated with 3-month mortality was hyperglycemia (plasma glucose >8.0 mmol/L) (odds ratio: 5.90, 95% confidence interval: 2.25–15.48, P < 0.001). Three or more separate complications suffered also associated with increased mortality (7.76, 1.42–42.49, P = 0.018). Conclusions. Hyperglycemia is a frequent complication of ICH in young adults and is independently associated with increased mortality. However, multiple separate complications increase mortality even further.
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The UK National Tracheostomy Safety Project and the role of speech and language therapists. Curr Opin Otolaryngol Head Neck Surg 2014; 22:181-7. [PMID: 24670488 DOI: 10.1097/moo.0000000000000046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Tracheostomy care is evolving, with the majority of procedures now performed percutaneously to facilitate weaning from mechanical ventilation in the critically ill. Traditional surgical indications remain, but surgical tracheostomies are increasingly performed in more complex patients and procedures. This brings unique challenges for the multidisciplinary professional team in which speech and language therapists (SLTs) have a key role. RECENT FINDINGS Reviews of tracheostomy-related critical incidents have identified recurrent themes associated with adverse outcomes for this high-risk population. Recent research has highlighted the impact of tracheostomy on communication and swallowing, along with the contribution of SLTs to the multidisciplinary professional team, prompting new guidance for SLTs. The UK National Tracheostomy Safety Project has developed educational and practical resources that have been shown to improve care. Similar approaches from around the world led to the newly formed Global Tracheostomy Collaborative. SUMMARY Patients with tracheostomies can benefit from a co-ordinated, truly multidisciplinary approach to care. SLT-specific expertise in assessing and managing communication and swallowing needs is a vital part of this process.
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Ho SW, Tsai MC, Teng YH, Yeh YT, Wang YH, Yang SF, Yeh CB. Population-based cohort study on the risk of pneumonia in patients with non-traumatic intracranial haemorrhage who use proton pump inhibitors. BMJ Open 2014; 4:e006710. [PMID: 25384687 PMCID: PMC4244437 DOI: 10.1136/bmjopen-2014-006710] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This nationwide cohort study investigated the association between proton pump inhibitor (PPI) usage and the risk of pneumonia in patients with non-traumatic intracranial haemorrhage (ICH). DESIGN Nationwide population-based cohort study. SETTING Longitudinal Health Insurance Database 2010 (LHID2010) sampled from the Taiwan National Health Insurance Research Database. PARTICIPANTS 4644 patients with non-traumatic ICH from 2010 to 2011 were identified. Patients aged <18 years and newly diagnosed with non-traumatic ICH complicated with pneumonia during the same admission period were excluded. A total of 2170 participants were eligible for the final analysis. MAIN OUTCOME MEASURE Patients using PPIs or not during the study period were tracked to identify the occurrence of any type of pneumonia. RESULTS The adjusted HR of the risk of pneumonia for ICH patients who used PPIs was 1.61 (95% CI 1.32 to 1.97, p<0.001). The risk of pneumonia was positively associated with the administration of PPIs. We observed a greater risk of pneumonia in patients who used PPIs than in those who did not. Moreover, we observed that the risk of pneumonia in patients who used PPIs was 2.60 and 2.04 (95% CI 2.01 to 3.38, p<0.001; 95% CI 1.34 to 3.10, p<0.001) greater than that in patients who did not use PPIs when the defined daily dose was <30 and 30-60, respectively. CONCLUSIONS The results of this study indicate that the use of PPIs in patients with non-traumatic ICH is associated with an increased risk of pneumonia, and the severity of this risk depends on the defined daily dose. Physicians should exercise caution when prescribing PPIs for patients with non-traumatic ICH.
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Affiliation(s)
- Sai-Wai Ho
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Che Tsai
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ying-Tung Yeh
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Divani AA, Hevesi M, Pulivarthi S, Luo X, Souslian F, Suarez JI, Bershad EM. Predictors of Nosocomial Pneumonia in Intracerebral Hemorrhage Patients: A Multi-center Observational Study. Neurocrit Care 2014; 22:234-42. [DOI: 10.1007/s12028-014-0065-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Primary, spontaneous intracerebral hemorrhage (ICH) confers significant early mortality and long-term morbidity worldwide. Advances in acute care including investigative, diagnostic, and management strategies are important to improving outcomes for patients with ICH. Physicians caring for patients with ICH should anticipate the need for emergent blood pressure reduction, coagulopathy reversal, cerebral edema management, and surgical interventions including ventriculostomy and hematoma evacuation. This article reviews the pathogenesis and diagnosis of ICH, and details the acute management of spontaneous ICH in the critical care setting according to existing evidence and published guidelines.
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Affiliation(s)
- Sheila Chan
- Neurocritical Care Program, Department of Neurology, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - J Claude Hemphill
- Neurocritical Care Program, Department of Neurology, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, Building 1, Room 101, 1001 Potrero Avenue, San Francisco, CA 94110, USA; Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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Ji R, Shen H, Pan Y, Du W, Wang P, Liu G, Wang Y, Li H, Zhao X, Wang Y. Risk score to predict hospital-acquired pneumonia after spontaneous intracerebral hemorrhage. Stroke 2014; 45:2620-8. [PMID: 25028448 DOI: 10.1161/strokeaha.114.005023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to develop a risk score (intracerebral hemorrhage-associated pneumonia score, ICH-APS) for predicting hospital-acquired stroke-associated pneumonia (SAP) after ICH. METHODS The ICH-APS was developed based on the China National Stroke Registry (CNSR), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Variables routinely collected at presentation were used for predicting SAP after ICH. For testing the added value of hematoma volume measure, we separately developed 2 models with (ICH-APS-B) and without (ICH-APS-A) hematoma volume included. Multivariable logistic regression was performed to identify independent predictors. The area under the receiver operating characteristic curve (AUROC), Hosmer-Lemeshow goodness-of-fit test, and integrated discrimination index were used to assess model discrimination, calibration, and reclassification, respectively. RESULTS The SAP was 16.4% and 17.7% in the overall derivation (n=2998) and validation (n=2000) cohorts, respectively. A 23-point ICH-APS-A was developed based on a set of predictors and showed good discrimination in the overall derivation (AUROC, 0.75; 95% confidence interval, 0.72-0.77) and validation (AUROC, 0.76; 95% confidence interval, 0.71-0.79) cohorts. The ICH-APS-A was more sensitive for patients with length of stay >48 hours (AUROC, 0.78; 95% confidence interval, 0.75-0.81) than those with length of stay <48 hours (AUROC, 0.64; 95% confidence interval, 0.55-0.73). The ICH-APS-A was well calibrated (Hosmer-Lemeshow test) in the derivation (P=0.20) and validation (P=0.66) cohorts. Similarly, a 26-point ICH-APS-B was established. The ICH-APS-A and ICH-APS-B were not significantly different in discrimination and reclassification for SAP after ICH. CONCLUSION The ICH-APSs are valid risk scores for predicting SAP after ICH, especially for patients with length of stay >48 hours.
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Affiliation(s)
- Ruijun Ji
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Haipeng Shen
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Yuesong Pan
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Wanliang Du
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Penglian Wang
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Gaifen Liu
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Yilong Wang
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Hao Li
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Xingquan Zhao
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.)
| | - Yongjun Wang
- From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
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van de Beek D. Long-term effect of infections after stroke. Nat Rev Neurol 2013; 9:126-7. [DOI: 10.1038/nrneurol.2013.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Salnikova LE, Smelaya TV, Moroz VV, Golubev AM, Rubanovich AV. Functional polymorphisms in the CYP1A1, ACE, and IL-6 genes contribute to susceptibility to community-acquired and nosocomial pneumonia. Int J Infect Dis 2013; 17:e433-42. [PMID: 23411129 DOI: 10.1016/j.ijid.2013.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/20/2012] [Accepted: 01/06/2013] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To establish the contribution of genetic host factors to the risk of community-acquired pneumonia (CAP) and nosocomial pneumonia (NP) in the population of the Russian Federation. METHODS A total of 796 subjects (CAP: 334 patients, 134 controls; NP: 216 critically ill patients with NP, 105 critically ill patients without NP) were included in two case-control studies. We analyzed 13 polymorphisms in 11 genes (IL-6, TNF-α, MBL2, CCR5, NOS3, CYP1A1 (three sites), GSTM1, GSTT1, ABCB1, ACE, and MTHFR) using a tetra-primer allele-specific PCR method. RESULTS Individual single nucleotide polymorphism (SNP) analysis revealed a strong association between CYP1A1 rs2606345 and CAP (p=3.9 × 10(-5), odds ratio (OR) 0.42, 95% confidence interval (CI) 0.27-0.63). Three genes (CYP1A1, ACE, and IL-6) were identified that account for part of the increase in vulnerability to both diseases, CAP and NP. The carriage of three predisposing genotypes versus protective genotypes increased the CAP risk (p=0.001, OR 7.01, 95% CI 1.99-24.70) and NP risk (p=0.028, OR 4.34, 95% CI 1.15-16.45). CONCLUSIONS Genetic predisposition to CAP and NP is attributed to the cumulative contribution of polymorphisms at the CYP1A1, IL-6, and ACE genes, independently of age, gender, causative pathogen, and the use of mechanical ventilation, in patients in the Russian Federation.
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Affiliation(s)
- Lyubov E Salnikova
- N. I. Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkin Street, Moscow 117971, Russia.
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