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Pinto CS, Ferreira F, Margarido I, Neves AL, Nunes JPL. Alkaline phosphatase and mortality in stroke patients: a systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:412. [PMID: 38213797 PMCID: PMC10777210 DOI: 10.21037/atm-23-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 01/13/2024]
Abstract
Background Increased plasma levels of alkaline phosphatase (ALP) have been associated to a worse prognosis in several types of diseases. In the present review, the authors aimed to study the relationship between plasma levels of ALP and overall mortality in patients with stroke. Methods A systematic review was carried out, searching two databases: Web of Science and Medline/PubMed. Results A total of nine studies that included data on overall mortality in stroke patients were selected. The selected studies were published between 2010 and 2022 and were predominantly from Asia. The articles reviewed quantified ALP levels through different methods: highest versus lowest quintiles of plasma ALP (three reports); highest versus lowest quartiles of plasma ALP (four reports); and plasma ALP levels in deceased versus in surviving patients (two reports). All selected studies showed an increased mortality associated to elevated ALP levels, irrespective of stroke type and length of follow-up, from a mean of 10 days to 2.5 years. The studies comparing the highest to the lowest ALP quintiles showed an aggregate value of 1.8 times greater risk of mortality for the former, when compared to the latter. Whereas, the studies comparing the highest to the lowest ALP quartiles showed an aggregate value of 2.4 times greater risk of mortality for the former, when compared to the latter. Conclusions Elevated ALP levels are associated with increased mortality in stroke patients and provide cost effective prognostic indicators of mortality in stroke.
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Affiliation(s)
| | - Francisca Ferreira
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neurology, University Hospital Center of São João, Porto, Portugal
| | - Inês Margarido
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neurology, University Hospital Center of São João, Porto, Portugal
| | - Ana Lídia Neves
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neurology, University Hospital Center of São João, Porto, Portugal
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Iancu A, Buleu F, Chita DS, Tutelca A, Tudor R, Brad S. Early Hemorrhagic Transformation after Reperfusion Therapy in Patients with Acute Ischemic Stroke: Analysis of Risk Factors and Predictors. Brain Sci 2023; 13:brainsci13050840. [PMID: 37239312 DOI: 10.3390/brainsci13050840] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Background: The standard reperfusion therapy for acute ischemic stroke (AIS) is considered to be thrombolysis, but its application is limited by the high risk of hemorrhagic transformation (HT). This study aimed to analyze risk factors and predictors of early HT after reperfusion therapy (intravenous thrombolysis or mechanical thrombectomy). Material and methods: Patients with acute ischemic stroke who developed HT in the first 24 h after receiving rtPA thrombolysis or performing mechanical thrombectomy were retrospectively reviewed. They were divided into two groups, respectively, the early-HT group and the without-early-HT group based on cranial computed tomography performed at 24 h, regardless of the type of hemorrhagic transformation. Results: A total of 211 consecutive patients were enrolled in this study. Among these patients, 20.37% (n = 43; age: median 70.00 years; 51.2% males) had early HT. Multivariate analysis of independent risk factors associated with early HT found that male gender increased the risk by 2.7-fold, the presence of baseline high blood pressure by 2.4-fold, and high glycemic values by 1.2-fold. Higher values of NIHSS at 24 h increased the risk of hemorrhagic transformation by 1.18-fold, while higher values of ASPECTS at 24 h decreased the risk of hemorrhagic transformation by 0.6-fold. Conclusions: In our study, male gender, baseline high blood pressure, and high glycemic values, along with higher values of NIHSS were associated with the increased risk of early HT. Furthermore, the identification of early-HT predictors is critical in patients with AIS for the clinical outcome after reperfusion therapy. Predictive models to be used in the future to select more careful patients with a low risk of early HT need to be developed in order to minimize the impact of HT associated with reperfusion techniques.
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Affiliation(s)
- Aida Iancu
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
| | - Florina Buleu
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
| | - Dana Simona Chita
- Department of Neurology, Faculty of General Medicine, "Vasile Goldis" Western University of Arad, 310025 Arad, Romania
| | - Adrian Tutelca
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
| | - Raluca Tudor
- County Emergency Clinical Hospital "Pius Brinzeu", 300732 Timisoara, Romania
- Department of Neurology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
| | - Silviu Brad
- Department of Radiology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
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Boutros CF, Khazaal W, Taliani M, Said Sadier N, Salameh P, Hosseini H. One-year recurrence of stroke and death in Lebanese survivors of first-ever stroke: Time-to-Event analysis. Front Neurol 2022; 13:973200. [PMID: 36452174 PMCID: PMC9702576 DOI: 10.3389/fneur.2022.973200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND To date, despite the application of secondary prevention worldwide, first-ever stroke survivors remain at imminent risk of stroke recurrence and death in the short and long term. The present study aimed to assess the cumulative risk rates and identify baseline differences and stroke characteristics of Lebanese survivors. METHODS A prospective longitudinal study was conducted among survivors ≥18 years old who were followed-up for 15 months through a face-to-face interview. Kaplan-Meier method was used to calculate the cumulative rates of stroke mortality and recurrence. Cox-regression univariate and multivariable analyses were performed to identify the predictors of both outcomes. RESULTS Among 150 subjects (mean age 74 ± 12 years; 58.7% men vs. 44.3% women; 95.3% with ischemic stroke vs. 4.3% with intracerebral hemorrhage), high cumulative risk rates of stroke recurrence (25%) and death (21%) were highlighted, especially in the acute phase. Survival rates were lesser in patients with stroke recurrence compared to those without recurrence (Log rank test p < 0.001). Older age was the main predictor for both outcomes (p < 0.02). Large artery atherosclerosis was predominant in patients with stroke recurrence and death compared to small vessel occlusion (p < 0.02). Higher mental component summary scores of quality of life were inversely associated with stroke recurrence (p < 0.01). Lebanese survivors exhibited the highest percentages of depression and anxiety; elevated Hospital Anxiety and Depression Scale (HADS) scores were seen in those with stroke recurrence and those who died (≥80% with mean HADS scores ≥8). Lower Mini-Mental State Examination scores at the acute phase increased the risk of both outcomes by 10% (p < 0.03). Three out of 13 mortalities (23.1%) were presented with early epileptic seizures (p = 0.012). High educational level was the protective factor against stroke recurrence (p = 0.019). Administration of intravenous thrombolysis decreased the risk of both outcomes by 10% (p > 0.05). CONCLUSION Higher rates of stroke recurrence and death were observed in the first year following a stroke in Lebanon. Various factors were identified as significant determinants. Thus, health care providers and officials in Lebanon can use these findings to implement effective preventive strategies to best address the management of these factors to reduce the stroke burden and improve the short and long-term prognosis of stroke survivors.
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Affiliation(s)
- Celina F. Boutros
- Institut Mondor de Recherche Biomédicale (IMRB)-INSERM U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Walaa Khazaal
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - Maram Taliani
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - Najwane Said Sadier
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
- College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Pascale Salameh
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Hassan Hosseini
- Institut Mondor de Recherche Biomédicale (IMRB)-INSERM U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
- Hôpital Henri Mondor, AP-HP, Créteil, France
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Chen J, Zhu Q, Yu L, Li Y, Jia S, Zhang J. Stroke Risk Factors of Stroke Patients in China: A Nationwide Community-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084807. [PMID: 35457673 PMCID: PMC9030671 DOI: 10.3390/ijerph19084807] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Background: Stroke is the leading cause of death in China, and its burdens are rapidly increasing. The prevalence and control of stroke risk factors among stroke patients in China are unknown. Objective: We investigated the stroke risk factors of stroke patients in China. Design: We examined stroke risk factors in 6580 stroke patients aged 18 years or older in the China National Chronic Diseases and Nutrition Surveillance of Adults (2015–2017). With regard to the basic characteristics of the study participants, categorical variables were described as frequency (percent). The chi-square test was used to analyze the difference between men and women. The multivariate logistic regression model was used in the multivariate analysis. Results: Among the 6580 stroke patients, hypertension was the most common stroke risk factor identified in most cases (78.51%), followed by overweight or obesity (61.58%), dyslipidemia (54.38%), smoking (24.04%), diabetes (21.75%), family history of stroke (17.43%), lack of exercise (16.35%), and atrial fibrillation (4.47%). Drinking stroke patients had a lower rate of hypertension, diabetes, and dyslipidemia. Patients with hyperuricemia had a higher rate of hypertension and dyslipidemia than no-hyperuricemia patients. The hypertension awareness, treatment, and control rates among hypertension stroke patients were 73.62%, 70.19%, and 17.79%, respectively. The diabetes awareness, treatment, and control rates among diabetes patients were 69.74%, 65.83%, and 34.59%, respectively. The dyslipidemia awareness, treatment, and control rates among dyslipidemia patients were 42.37%, 29.4%, and 20.07%, respectively. Among treated hypertension patients, the rates of taking medicine as medically advised, controlled diet, increased exercise, and blood pressure monitoring were 91.31%, 58.88%, 45.78%, and 73.99%, respectively. Among treated diabetes patients, the rates of oral antidiabetic medications, insulin injection, diet control, and blood glucose monitoring were 78.24%, 34.71%, 85.77%, and 78.24%, respectively. Among treated dyslipidemic patients, the rate of taking medicine as medical advice, controlled diet, increased exercise, and regular blood lipid monitoring was 80.61%, 77.57%, 56.46%, and 40.3%, respectively. Conclusions: The most common risk factors for community stroke patients in China are hypertension, dyslipidemia, and overweight or obesity. The stroke community patients’ suboptimal awareness and treatment of hypertension, and suboptimal awareness, treatment, and control of diabetes, and dyslipidemia are significant problems in China.
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Affiliation(s)
- Jingyi Chen
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
| | - Qianrang Zhu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
| | - Lianlong Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Shandong Center for Disease Control and Prevention, Ji’nan 250000, China
| | - Yuqian Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Key Laboratory of Trace Element Nutrition of National Health Commission (NHC), Beijing 100050, China
| | - Shanshan Jia
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Key Laboratory of Trace Element Nutrition of National Health Commission (NHC), Beijing 100050, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Correspondence: ; Tel.: +86-010-6623-7147
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