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Wu D, Shen S, Luo D. Association of lactate-to-albumin ratio with in-hospital and intensive care unit mortality in patients with intracerebral hemorrhage. Front Neurol 2023; 14:1198741. [PMID: 37521289 PMCID: PMC10374360 DOI: 10.3389/fneur.2023.1198741] [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: 04/02/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a severe stroke subtype with a high mortality rate; the lactate-to-albumin ratio (LAR) is a new biomarker for predicting clinical outcomes in patients with ICH. However, the relationship between LAR and mortality in patients with ICH treated in the intensive care unit (ICU) remains controversial. Therefore, in this study, we aimed to investigate the association between LAR and in-hospital and ICU mortality in patients with ICH. Methods Patients with ICH were selected from the Medical Information Mart for Intensive Care III (MIMIC-III) database; their clinical information, including baseline characteristics, vital signs, comorbidities, laboratory test results, and scoring systems, was extracted. Univariate and multivariate Cox proportional hazards analyses were used to investigate the association of LAR with in-hospital and ICU mortality. The maximum selection statistical method and subgroup analysis were used to investigate these relationships further. Kaplan-Meier (KM) analysis was used to draw survival curves. Results This study enrolled 237 patients with ICH whose lactate and albumin levels, with median values of 1.975 and 3.6 mg/dl, respectively, were measured within the first 24 h after ICU admission. LAR had an association with increased risk of in-hospital mortality [unadjusted hazards ratio (HR), 1.79; 95% confidence interval (CI), 1.32-2.42; p < 0.001] and ICU mortality (unadjusted HR, 1.88; 95% CI, 1.38-2.55; p < 0.001). A cut-off value of 0.963 mg/dl was used to classify patients into high LAR (≥0.963) and low LAR (<0.963) groups, and survival curves suggested that those two groups had significant survival differences (p = 0.0058 and 0.0048, respectively). Furthermore, the high LAR group with ICH had a significantly increased risk of in-hospital and ICU mortality compared to the low LAR group. Conclusion Our study suggests that a high LAR is associated with an increased risk of in-hospital and ICU mortality in patients with ICH. Thus, the LAR is a useful prognostic predictor of clinical outcomes in patients with ICH.
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Affiliation(s)
- Dongjie Wu
- Anhui University of Technology School of Microelectronics and Data Science, Ma’anshan, Anhui, China
- Anhui Provincial Joint Key Laboratory of Disciplines for Industrial Big Data Analysis and Intelligent Decision, Ma’anshan, Anhui, China
| | - Siyuan Shen
- Anhui University of Technology School of Microelectronics and Data Science, Ma’anshan, Anhui, China
- Anhui Provincial Joint Key Laboratory of Disciplines for Industrial Big Data Analysis and Intelligent Decision, Ma’anshan, Anhui, China
| | - Dongmei Luo
- Anhui University of Technology School of Microelectronics and Data Science, Ma’anshan, Anhui, China
- Anhui Provincial Joint Key Laboratory of Disciplines for Industrial Big Data Analysis and Intelligent Decision, Ma’anshan, Anhui, China
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Gibler WB, Racadio JM, Hirsch AL, Roat TW. Management of Severe Bleeding in Patients Treated With Oral Anticoagulants: Proceedings Monograph From the Emergency Medicine Cardiac Research and Education Group-International Multidisciplinary Severe Bleeding Consensus Panel October 20, 2018. Crit Pathw Cardiol 2019; 18:143-166. [PMID: 31348075 DOI: 10.1097/hpc.0000000000000181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this Emergency Medicine Cardiac Research and Education Group (EMCREG)-International Proceedings Monograph from the October 20, 2018, EMCREG-International Multidisciplinary Consensus Panel on Management of Severe Bleeding in Patients Treated With Oral Anticoagulants held in Orlando, FL, you will find a detailed discussion regarding the treatment of patients requiring anticoagulation and the reversal of anticoagulation for patients with severe bleeding. For emergency physicians, critical care physicians, hospitalists, cardiologists, internists, surgeons, and family physicians, the current approach and disease indications for treatment with anticoagulants such as coumadin, factor IIa, and factor Xa inhibitors are particularly relevant. When a patient treated with anticoagulants presents to the emergency department, intensive care unit, or operating room with severe, uncontrollable bleeding, achieving rapid, controlled hemostasis is critically important to save the patient's life. This EMCREG-International Proceedings Monograph contains multiple sections reflecting critical input from experts in Emergency Cardiovascular Care, Prehospital Emergency Medical Services, Emergency Medicine Operations, Hematology, Hospital Medicine, Neurocritical Care, Cardiovascular Critical Care, Cardiac Electrophysiology, Cardiology, Trauma and Acute Care Surgery, and Pharmacy. The first section provides a description of the current indications for the treatment of patients using oral anticoagulants including coumadin, the factor IIa (thrombin) inhibitor dabigatran, and factor Xa inhibitors such as apixaban and rivaroxaban. In the remaining sections, the treatment of patients presenting to the hospital with major bleeding becomes the focus. The replacement of blood components including red blood cells, platelets, and clotting factors is the critically important initial treatment for these individuals. Reversing the anticoagulated state is also necessary. For patients treated with coumadin, infusion of vitamin K helps to initiate the process of protein synthesis for the vitamin K-dependent coagulation proteins II, VII, IX, and X and the antithrombotic protein C and protein S. Repletion of clotting factors for the patient with 4-factor prothrombin complex concentrate, which includes factors II (prothrombin), VII, IX, and X and therapeutically effective concentrations of the regulatory proteins (protein C and S), provides real-time ability to slow bleeding. For patients treated with the thrombin inhibitor dabigatran, treatment using the highly specific, antibody-derived idarucizumab has been demonstrated to reverse the hypocoagulable state of the patient to allow blood clotting. In May 2018, andexanet alfa was approved by the US Food and Drug Administration to reverse the factor Xa anticoagulants apixaban and rivaroxaban in patients with major bleeding. Before the availability of this highly specific agent, therapy for patients treated with factor Xa inhibitors presenting with severe bleeding usually included replacement of lost blood components including red blood cells, platelets, and clotting factors and 4-factor prothrombin complex concentrate, or if not available, fresh frozen plasma. The evaluation and treatment of the patient with severe bleeding as a complication of oral anticoagulant therapy are discussed from the viewpoint of the emergency physician, neurocritical and cardiovascular critical care intensivist, hematologist, trauma and acute care surgeon, hospitalist, cardiologist, electrophysiologist, and pharmacist in an approach we hope that the reader will find extremely practical and clinically useful. The clinician learner will also find the discussion of the resumption of oral anticoagulation for the patient with severe bleeding after effective treatment important because returning the patient to an anticoagulated state as soon as feasible and safe prevents thrombotic complications. Finally, an EMCREG-International Severe Bleeding Consensus Panel algorithm for the approach to management of patients with life-threatening oral anticoagulant-associated bleeding is provided for the clinician and can be expanded in size for use in a treatment area such as the emergency department or critical care unit.
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Murphy MP, Kuramatsu JB, Leasure A, Falcone GJ, Kamel H, Sansing LH, Kourkoulis C, Schwab K, Elm JJ, Gurol ME, Tran H, Greenberg SM, Viswanathan A, Anderson CD, Schwab S, Rosand J, Shi FD, Kittner SJ, Testai FD, Woo D, Langefeld CD, James ML, Koch S, Huttner HB, Biffi A, Sheth KN. Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage. Stroke 2018; 49:2652-2658. [PMID: 30355194 PMCID: PMC6211810 DOI: 10.1161/strokeaha.118.021799] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/10/2018] [Indexed: 01/10/2023]
Abstract
Background and Purpose- Whether to resume oral anticoagulation treatment after intracerebral hemorrhage (ICH) remains an unresolved question. Previous studies focused primarily on recurrent stroke after ICH. We sought to investigate the association between cardioembolic stroke risk, oral anticoagulation therapy resumption, and functional recovery among ICH survivors in the absence of recurrent stroke. Methods- We conducted a joint analysis of 3 observational studies: (1) the multicenter RETRACE study (German-Wide Multicenter Analysis of Oral Anticoagulation Associated Intracerebral Hemorrhage); (2) the Massachusetts General Hospital ICH study (n=166); and (3) the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage; n=131). We included 941 survivors of ICH in the setting of active oral anticoagulation therapy for prevention of cardioembolic stroke because of nonvalvular atrial fibrillation and without evidence of ischemic stroke and recurrent ICH at 1 year from the index event. We created univariable and multivariable models to explore associations between cardioembolic stroke risk (based on CHA2DS2-VASc scores) and functional recovery after ICH, defined as achieving modified Rankin Scale score of ≤3 at 1 year for participants with modified Rankin Scale score of >3 at discharge. Results- In multivariable analyses, the CHA2DS2-VASc score was associated with a decreased likelihood of functional recovery (odds ratio, 0.83 per 1 point increase; 95% CI, 0.79-0.86) at 1 year. Anticoagulation resumption was independently associated with a higher likelihood of recovery, regardless of CHA2DS2-VASc score (odds ratio, 1.89; 95% CI, 1.32-2.70). We found an interaction between CHA2DS2-VASc score and anticoagulation resumption in terms of association with increased likelihood of functional recovery (interaction P=0.011). Conclusions- Increasing cardioembolic stroke risk is associated with a decreased likelihood of functional recovery at 1 year after ICH, but this association was weaker among participants resuming oral anticoagulation therapy. These findings support, including recovery metrics, in future studies of anticoagulation resumption after ICH.
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Affiliation(s)
- Meredith P Murphy
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Center for Genomic Medicine, Massachusetts General Hospital (MGH), Boston (M.P.M., C.K., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Joji B Kuramatsu
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany (J.B.K., S.S., H.B.H.)
| | - Audrey Leasure
- Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
| | - Guido J Falcone
- Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
| | - Hooman Kamel
- Department of Neurology, Weill Cornell College of Medicine, New York, NY (H.K.)
| | - Lauren H Sansing
- Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
| | - Christina Kourkoulis
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Center for Genomic Medicine, Massachusetts General Hospital (MGH), Boston (M.P.M., C.K., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Kristin Schwab
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Jordan J Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E.)
| | - M Edip Gurol
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Huy Tran
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque (H.T.)
| | - Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Anand Viswanathan
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Christopher D Anderson
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Center for Genomic Medicine, Massachusetts General Hospital (MGH), Boston (M.P.M., C.K., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Stefan Schwab
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany (J.B.K., S.S., H.B.H.)
| | - Jonathan Rosand
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Center for Genomic Medicine, Massachusetts General Hospital (MGH), Boston (M.P.M., C.K., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Fu-Dong Shi
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (F.-D.S.)
| | - Steven J Kittner
- Department of Neurology, Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore (S.J.K.)
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago (F.D.T.)
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W.)
| | - Carl D Langefeld
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.L.)
| | - Michael L James
- Department of Anesthesiology, Duke University, Durham, NC (M.L.J.)
| | - Sebastian Koch
- Baltimore Veterans Administration Medical Center, University of Maryland, Baltimore (S.K.)
| | - Hagen B Huttner
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany (J.B.K., S.S., H.B.H.)
| | - Alessandro Biffi
- From the Department of Neurology, Massachusetts General Hospital, Boston (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
- Center for Genomic Medicine, Massachusetts General Hospital (MGH), Boston (M.P.M., C.K., C.D.A., J.R., A.B.)
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, MGH, Boston, MA (M.P.M., C.K., K.S., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.)
| | - Kevin N Sheth
- Divisions of Neurocritical Care & Emergency Neurology and Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (A.L., G.J.F., L.H.S., K.N.S.)
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