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Zhou D, Qin H, Miao L, Xu Y, Yu L, Wang J. Predictive value of glycoprotein DKK3 for early neurological deterioration after ischemic stroke. Clinics (Sao Paulo) 2024; 79:100360. [PMID: 38678874 PMCID: PMC11066595 DOI: 10.1016/j.clinsp.2024.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/05/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE To explore the value of serum Dickkopf-3 (sDKK3) in predicting Early Neurological Deterioration (END) and in-hospital adverse outcomes in acute ischemic stroke (AIS) patients. METHODS AIS patients (n = 200) were included and assessed by the National Institutes of Health Stroke Rating Scale. Serum Dkk3 levels were assessed by ELISA. END was defined as an increase of ≥ 4 points in NIHSS score within 72h. The biological threshold of sDKK3 level and END occurrence were predicted based on X-tile software. Primary outcomes were END and all-cause death, and the secondary outcome was ICU admission during hospitalization. The logistic regression model and Cox risk regression model were applied to evaluate the relationship between DKK3 level and END incidence, all-cause in-hospital mortality, and in-hospital adverse outcomes (ICU admission). RESULTS During hospitalization, the incidence of END in patients with AIS was 13.0 %, and the mortality rate within 7 days after END was 11.54 % (3/26). In patients below the serum DKK3 cutoff (93.0 pg/mL), the incidence of END was 43.5 % (20/48). Patients with lower sDKK3 levels were associated with a 1.188-fold increased risk of developing END (OR = 1.188, 95 % CI 1.055‒1.369, p < 0.0001). However, there was no significant association with admission to the ICU. sDKK3 below the threshold (93.0 pg/mL) was a risk factor for death. CONCLUSION Predictive threshold levels of serum DKK3 based on X-tile software may be a potential predictive biomarker of in-hospital END in patients with AIS, and low levels of DKK3 are independently associated with increased in-hospital mortality.
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Affiliation(s)
- DongLiang Zhou
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - HongWei Qin
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - Lei Miao
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - Ying Xu
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - Lan Yu
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - JianMin Wang
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
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Zou K, Wei C, Huang Q, Xu Z, Mao X, Zhang H, Zeng C, Zhang L, Lin J, Yi Y, Zhang J. Glycated serum protein is independently associated with progressive infarction in patients with acute ischemic stroke. J Int Med Res 2024; 52:3000605241245299. [PMID: 38613248 PMCID: PMC11016233 DOI: 10.1177/03000605241245299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE This study investigated the relationship between glycated serum protein (GSP) and progressive infarction (PI). METHODS From April 2017 to December 2020, we recruited 477 patients within 48 hours after the onset of acute ischemic stroke into this case-control study. Demographic characteristics, clinical information, and laboratory and neuroimaging data were recorded after admission. RESULTS PI occurred in 144 (30.8%) patients. Patients with PI had higher initial National Institute of Health Stroke Scale (NIHSS) scores, higher discharge NIHSS scores, higher modified Rankin scale scores at 3 months after onset, higher GSP levels, lower prothrombin times, and lower creatinine levels than patients without PI. The likelihood of PI increased with increases in the GSP quartile. Multiple regression analysis revealed that high GSP levels (>2.14 mmol/L) were independently associated with PI. Subgroup analyses identified high GSP levels as an independent predictor of PI in patients with large artery atherosclerosis (third quartile: odds ratio [OR] = 3.793; 95% confidence interval [CI] = 1.555-9.250; fourth quartile: OR = 2.675; 95% CI = 1.056-6.776) and anterior circulation small vessel occlusion (fourth quartile: OR = 13.859; 95% CI = 2.024-94.885). CONCLUSIONS GSP might be an independent predictor for PI in certain patients with acute ischemic stroke.
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Affiliation(s)
| | | | - Qin Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zubing Xu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaocheng Mao
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hudie Zhang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chenying Zeng
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lanjiao Zhang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jing Lin
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Jinchong Zhang
- Jinchong Zhang, First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Road, Nanchang, Jiangxi 330000, China.
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Yi L, Li Z, Jiang Y, Jiang Y, Meng X, Li H, Zhao X, Wang Y, Liu L, Wang Y, Gu H. Inflammatory marker profiles and in-hospital neurological deterioration in patients with acute minor ischemic stroke. CNS Neurosci Ther 2024; 30:e14648. [PMID: 38432871 PMCID: PMC10909616 DOI: 10.1111/cns.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/10/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024] Open
Abstract
AIM The aim of the study was to analyze the association between inflammatory marker profiles and in-hospital neurological deterioration (ND) in acute ischemic stroke (AIS) patients. METHODS Data from patients with minor AIS from the Third China National Stroke Registry were analyzed. Inflammatory cytokine levels within 24 h of admission were measured. The primary outcome was in-hospital ND (an increase in National Institutes of Health Stroke Scale score ≥4 from admission to discharge). Associations were evaluated using odds ratios (ORs) and 95% confidence intervals (CIs) derived from logistic regression models. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate incremental predictive values. RESULTS A total of 4031 patients (1246 women, 30.9%) with a median age of 62 years were included. In-hospital ND occurred in 121 patients (3%). Each standard-deviation increase in interleukin (IL)-6 (OR, 1.17 [95% CI, 1.06-1.31]) and high-sensitivity C-reactive protein (hsCRP) (OR, 1.43 [95% CI, 1.24-1.66]) levels was associated with increased in-hospital ND risk. Incremental predictive values for adding IL-6 (IDI, 0.012; NRI, 0.329) but not hsCRP levels to the conventional risk factors were found. CONCLUSION In minor AIS, hsCRP and IL-6 levels were associated with in-hospital ND, including IL-6 levels in prognostic models improved risk classification.
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Affiliation(s)
- Luo Yi
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zi‐Xiao Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Ying‐Yu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xia Meng
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xing‐Quan Zhao
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yi‐Long Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Li‐Ping Liu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yong‐Jun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Hong‐Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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Yu W, Ma J, Guo W, Xu J, Xu J, Li S, Ren C, Wu L, Wu C, Li C, Chen J, Duan J, Ma Q, Song H, Zhao W, Ji X. Night shift work was associated with functional outcomes in acute ischemic stroke patients treated with endovascular thrombectomy. Heliyon 2024; 10:e25916. [PMID: 38390161 PMCID: PMC10881325 DOI: 10.1016/j.heliyon.2024.e25916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Objective This study aimed to explore the impact of late night shift work on the functional outcomes of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). Methods Consecutive AIS patients who underwent EVT between June 2019 and June 2021 were enrolled and divided into non-night shift work and night shift work groups based on their occupational histories. The primary outcome was the modified Rankin Scale score defined 3-month functional outcome. The secondary outcomes were 3-month mortality, symptomatic intracerebral hemorrhage (sICH), ICH and early recanalization. Results A total of 285 patients were enrolled, 35 patients (12.3%) were night shift workers, who were younger (P < 0.001) and had a significantly higher prevalence of smoking (P < 0.001), hyperlipidemia (P = 0.002), coronary heart disease (P = 0.031), and atrial fibrillation (P < 0.001). The 3-month favorable outcomes were achieved in 44.8% and 25.7% of patients in the non-night shift work and night shift work groups, respectively (adjusted odds ratio [OR]: 0.24, 95% CI: 0.10-0.57; adjusted P = 0.001). No difference was found in 3-month mortality (adjusted OR: 0.43; 95% CI: 0.14-1.25, adjusted P = 0.121), rates of ICH (adjusted OR: 0.73; 95% CI: 0.33-1.60; adjusted P = 0.430), sICH (adjusted OR: 0.75; 95% CI: 0.34-1.67; adjusted P = 0.487), or early successful recanalization (adjusted OR: 0.42; 95% CI: 0.12-1.56; adjusted P = 0.197). These results were consistent after PSM analysis. Conclusion Our findings suggest that late night shift work is significantly associated with unfavorable outcomes in patients with AIS after EVT.
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Affiliation(s)
- Wantong Yu
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
- Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Jin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Wenting Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Jiali Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Jun Xu
- Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Sijie Li
- Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University Beijing, China
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Longfei Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Chuanhui Li
- Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
- Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China
- Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital, Capital Medical University Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorder, Capital Medical University, Beijing, China
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Li H, Zhang JT, Zheng Y, Zhang DD, Cui XY, Zhao X, Zhang GW, Yang F, Fu Y, Fan XT, Jiang H, Shi JM, Wang B, Zhang R. Risk factors and prognosis of early neurological deterioration in patients with posterior circulation cerebral infarction. Clin Neurol Neurosurg 2023; 228:107673. [PMID: 36958072 DOI: 10.1016/j.clineuro.2023.107673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/11/2023] [Accepted: 03/12/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The incidence, risk factors, and pathogenesis of early neurological deterioration (END) in posterior circulation stroke are still unclear. In this study, we aimed to determine the risk factors and prognosis of END in patients with acute posterior circulation cerebral infarction. METHODS Acute posterior circulation ischemic stroke patients who had completed neuroimaging within 72 h of onset were selected from a prospective registry study Demographic characteristics, physiological data, medical history, laboratory data, in-hospital evaluation, neurological severity and TOAST classification, treatment, and the modified Rankin Scale (mRS) score of patients were assessed. Early neurological deterioration was defined as an increase of 2 points in the National Institutes of Health Stroke Scale score between the baseline and 72 h evaluation. Favorable and poor outcomes were defined as mRSs of 02 and≥ 3, respectively, at 3 months. The incidence and risk factors were evaluated by univariate and multivariate regression analysis (step-back method). RESULTS The analysis included 455 subjects with an acute posterior circulation non-cardiac ischemic stroke, 330 (72.53 %) of them male, with an average age of 63.12 ( ± 10.14) years and with 47 (10.33 %) having END. The results of univariate and multivariate logistic regression analysis showed that BATMAN scores ≥ 5 (OR: 0.1, 95 % CI: 0.02-0.53, P < 0.01), large artery atherosclerosis (OR: 11.55, 95 % CI: 4.18-31.93, P < 0.01), vascular stenosis > 50 % (OR: 2.44, 95 % CI: 1.1-5.42, P = 0.029), reperfusion therapy (OR: 4.21, 95 % CI: 1.66-10.64, P < 0.01), and the distribution of pontine lesions (OR: 5.66, 95 % CI: 2.39-13.44, P < 0.01) were significantly associated with END. Patients with END had a lower rate of favorable outcomes at discharge and long-term follow-up (P < 0.001), regardless of whether they received reperfusion therapy. CONCLUSION The lesion distribution of the pons, the progression of temporo-occipital lobe lesions, and large arterial atherosclerosis are independent risk factors of END that might predict a poor short- and long-term prognosis.
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Affiliation(s)
- Hui Li
- Chengde Medical University, Chengde, Hebei 067000, China; Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Jiang-Tao Zhang
- Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Yi Zheng
- Image center, Chengde Central Hospital, Chengde, China
| | - Ding-Ding Zhang
- Central laboratory, Peking Union Medical College Hospital, Beijing, China
| | - Xiu-Ying Cui
- Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Xin Zhao
- Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Guan-Wen Zhang
- Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Fei Yang
- Chengde Medical University, Chengde, Hebei 067000, China; Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Yu Fu
- Chengde Medical University, Chengde, Hebei 067000, China; Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Xiao-Tian Fan
- Chengde Medical University, Chengde, Hebei 067000, China; Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China
| | - Hao Jiang
- Clinical blood laboratory, Chengde Central Hospital, Chengde, China
| | - Jian-Ming Shi
- Information center, Chengde Central Hospital, Chengde, China
| | - Bo Wang
- Department of Neurology, Bijie People's Hospital, Guizhou, China
| | - Ran Zhang
- Department of Neurology, Chengde Central Hospital, Chengde, Hebei 067000, China.
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Ji X, Tian L, Yao S, Han F, Niu S, Qu C. A Systematic Review of Body Fluids Biomarkers Associated With Early Neurological Deterioration Following Acute Ischemic Stroke. Front Aging Neurosci 2022; 14:918473. [PMID: 35711907 PMCID: PMC9196239 DOI: 10.3389/fnagi.2022.918473] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
Biomarkers are objectively measured biological properties of normal and pathological processes. Early neurological deterioration (END) refers to the deterioration of neurological function in a short time after the onset of acute ischemic stroke (AIS) and is associated with adverse outcomes. Although multiple biomarkers have been found to predict END, there are currently no suitable biomarkers to be applied in routine stroke care. According to the Preferred Reporting Items for Systematic Review standards, we present a systematic review, concentrating on body fluids biomarkers that have shown potential to be transferred into clinical practice. We also describe newly reported body fluids biomarkers that can supply different insights into the mechanism of END. In our review, 40 scientific papers were included. Depending on the various mechanisms, sources or physicochemical characteristics of body fluids biomarkers, we classified related biomarkers as inflammation, protease, coagulation, metabolism, oxidative stress, and excitatory neurotoxicity. The body fluids biomarkers whose related articles are limited or mechanisms are unknown are categorized as other biomarkers. The inflammation-related biomarkers, such as neutrophil-to-lymphocyte ratio and hypersensitive C-reactive protein, play a crucial role among the mentioned biomarkers. Considering the vast heterogeneity of stroke progression, using a single body fluids biomarker may not accurately predict the risk of stroke progression, and it is necessary to combine multiple biomarkers (panels, scores, or indices) to improve their capacity to estimate END.
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Affiliation(s)
- Xiaotan Ji
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Neurology, Jining No. 1 People’s Hospital, Jining, China
| | - Long Tian
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shumei Yao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Fengyue Han
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Shenna Niu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chuanqiang Qu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Chuanqiang Qu,
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Sabir Rashid A, Huang-Link Y, Johnsson M, Wetterhäll S, Gauffin H. Predictors of Early Neurological Deterioration and Functional Outcome in Acute Ischemic Stroke: The Importance of Large Artery Disease, Hyperglycemia and Inflammatory Blood Biomarkers. Neuropsychiatr Dis Treat 2022; 18:1993-2002. [PMID: 36097537 PMCID: PMC9464020 DOI: 10.2147/ndt.s365758] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early neurological deterioration (END) in acute ischemic stroke (AIS) can be associated with poor outcome. The aim of this study was to investigate the association between infarction subtypes, biomarkers and END, and to identify patients with risk of unfavorable functional outcome. MATERIALS AND METHODS This prospective study enrolled 101 patients with AIS. Neurological status was evaluated according to NIHSS at acute onset, on days 2, 3, and 90. END was defined as ≥2-point increase of NIHSS within 72 hours. Functional outcome was assessed using NIHSS and the modified Rankin Scale (mRS) at day 90. RESULTS END was observed in 20, 8%. Patients with large artery disease had higher risk of developing END compared with patients with cardioembolism or small vessel disease (p <0.01). Significant higher blood glucose level and leukocytes were observed in the END group. Patients with END had higher scores of mRS at day 90 (p <0.01). Levels of NSE, IL-6, hsCRP and NT-proBNP were higher in the patients with unfavorable compared with favorable functional outcome. CONCLUSION Large artery disease, high blood glucose and leukocytes levels are associated with END. Elevated levels of blood markers NSE, IL-6, HsCRP and NT-proBNP indicate poor functional outcome at 90 days after AIS. These patients must be identified and be offered treatment immediately in order to improve the functional outcome after AIS.
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Affiliation(s)
- Avan Sabir Rashid
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Yumin Huang-Link
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Marcus Johnsson
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Simon Wetterhäll
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
| | - Helena Gauffin
- Department of Biomedical and Clinical Sciences (BKV), Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Neurology, Linköping University Hospital, Region Östergötland, Linköping, Sweden
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8
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Luo X, Li D. Effects of epidural block anesthesia combined with general anesthesia on inflammatory factors, cognitive function and postoperative pain in patients with lung cancer after thoracoscopic surgery. Am J Transl Res 2021; 13:13024-13033. [PMID: 34956520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the effects of epidural block anesthesia combined with general anesthesia on inflammatory factors, cognitive function and postoperative pain in patients with lung cancer after thoracoscopic surgery. METHODS A total of 144 lung cancer patients admitted to the Department of Cardiothoracic Surgery of Ganzi Tibetan Autonomous Prefecture People's Hospital from October 2017 to October 2019 were included in this retrospective cohort study. The patients were divided into an observation group and a control group, with 72 cases in each group. Observation group was treated with epidural block anesthesia plus general anesthesia under thoracoscopic surgery, while control group was treated with general anesthesia alone. General information of both groups was compared. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured by enzyme-linked immunosorbent assay before anesthesia (T0), before the end of operation (T1), 12 h after operation (T2) and 24 h after operation (T3). Calcium-binding protein (S-100β) content, mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) at T0, T3, the 3rd day after operation (T4), and the 5th day after operation (T5) were measured. And postoperative pain was recorded. RESULTS There were no significant differences in TNF-α, IL-6, MMSE and MoCA between the two groups at T0, and no significant differences were seen in S-100β between the two groups at T0 and T1 (all P>0.05). Compared with control group, observation group had lower TNF-α and IL-6 at T1, T2, T3, T4 and T5, and lower S-100β at T3, T4 and T5 (all P<0.001). Lower pain scores and higher MMSE and MoCA were found in the observation group at T3, T4 and T5 (all P<0.05). CONCLUSION Epidural block anesthesia combined with general anesthesia can effectively reduce levels of inflammatory factors, cognitive disorder and postoperative pain in patients with lung cancer after thoracoscopic surgery.
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Affiliation(s)
- Xiaoqin Luo
- Department of Anesthesiology, Ganzi Tibetan Autonomous Prefecture People's Hospital Kangding 626000, Sichuan Province, China
| | - Dong Li
- Department of Anesthesiology, Ganzi Tibetan Autonomous Prefecture People's Hospital Kangding 626000, Sichuan Province, China
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Yang Y, Xie D, Zhang Y. Increased Platelet-to-Lymphocyte Ratio is an Independent Predictor of Hemorrhagic Transformation and In-Hospital Mortality Among Acute Ischemic Stroke with Large-Artery Atherosclerosis Patients. Int J Gen Med 2021; 14:7545-7555. [PMID: 34754227 PMCID: PMC8570380 DOI: 10.2147/ijgm.s329398] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/01/2021] [Indexed: 12/28/2022] Open
Abstract
Background The platelet-to-lymphocyte ratio (PLR) is an inflammation marker of acute ischemic stroke, but its significance in patients with hemorrhage transformation (HT) after acute ischemic stroke with large-artery atherosclerosis (AIS-LAA) is unclear, and we also identified the relationship between PLR and in-hospital mortality of HT after AIS-LAA. Methods This was a retrospective analysis of patients with AIS-LAA. The PLR was calculated according to platelet and lymphocyte counts on admission. HT was defined on follow-up magnetic resonance imaging or computed tomography when neurologic deterioration worsened during hospitalization. The univariate analysis and multivariate logistic regression were performed to assess the association of PLR, HT and in-hospital mortality of HT after AIS-LAA. Results We included 328 Chinese AIS-LAA patients (mean age 67.2±11.1 years; 70.4% male). HT occurred in 38 patients (11.6%). After multivariate regression analyses, NRL (odds ratio [OR] 1.354, 95% confidence interval [CI] 1.176–1.559, P<0.001) and PLR (odds ratio [OR] 3.869, 95% confidence interval [CI] 2.233–5.702, P<0.001) were independently associated with HT after AIS-LAA. The area under the ROC curve (AUC) value of PLR (0.72, 95% CI (0.64–0.80), P<0.001) tested a greater discriminatory ability compared with neutrophil-lymphocyte ratio (NLR) (0.67, 95% CI (0.58–0.76), P<0.001). Meanwhile, PLR was found to be significantly related to HT after AIS-LAA, including in subtypes of artery-to-artery embolization (aOR 1.699, 95% CI 1.298–3.215, P<0.001), in-situ thrombosis (aOR4.499, 95% CI 1.344–9.054, P<0.001) and branch atheromatous disease (aOR3.239, 95% CI 1.098–8.354, P<0.001). Increased PLR predicts high in-hospital mortality of HT after AIS-LAA (OR 1.041, 95% CI (1.006–1.077), P=0.020; aOR 1.053, 95% CI (1.004–1.104), P=0.034). Conclusion High PLR is associated with greater risk of HT in AIS-LAA patients, including in artery-to-artery embolization, in-situ thrombosis and branch atheromatous disease. Meanwhile, increased PLR predicts high in-hospital mortality of HT after AIS-LAA.
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Affiliation(s)
- Yi Yang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dan Xie
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongbo Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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10
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Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke. Sci Rep 2021; 11:20610. [PMID: 34663874 PMCID: PMC8523653 DOI: 10.1038/s41598-021-99920-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022] Open
Abstract
We aimed to develop a novel prediction model for early neurological deterioration (END) based on an interpretable machine learning (ML) algorithm for atrial fibrillation (AF)-related stroke and to evaluate the prediction accuracy and feature importance of ML models. Data from multicenter prospective stroke registries in South Korea were collected. After stepwise data preprocessing, we utilized logistic regression, support vector machine, extreme gradient boosting, light gradient boosting machine (LightGBM), and multilayer perceptron models. We used the Shapley additive explanation (SHAP) method to evaluate feature importance. Of the 3,213 stroke patients, the 2,363 who had arrived at the hospital within 24 h of symptom onset and had available information regarding END were included. Of these, 318 (13.5%) had END. The LightGBM model showed the highest area under the receiver operating characteristic curve (0.772; 95% confidence interval, 0.715–0.829). The feature importance analysis revealed that fasting glucose level and the National Institute of Health Stroke Scale score were the most influential factors. Among ML algorithms, the LightGBM model was particularly useful for predicting END, as it revealed new and diverse predictors. Additionally, the effects of the features on the predictive power of the model were individualized using the SHAP method.
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11
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Ryu WS, Yoon HS, Jeong SW, Kim DE. Hyperintense Vessel Sign in Large-Vessel Occlusion Stroke of Mild-to-Moderate Severity Ineligible for Recanalization. J Clin Neurol 2021; 17:516-523. [PMID: 34595859 PMCID: PMC8490907 DOI: 10.3988/jcn.2021.17.4.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The impact of fluid-attenuated inversion recovery hyperintense vessels (FHVs) on outcomes in patients ineligible for recanalization therapy with large-vessel occlusion (LVO) is unclear. We investigated the impact of FHVs determined using the FHV–Alberta Stroke Program Early CT Score (ASPECTS) on clinical outcomes in patients with LVO stroke of mild-to-moderate severity ineligible for recanalization therapy. Methods Sixty-eight consecutive patients with M1-middle cerebral artery occlusion who underwent magnetic resonance imaging within 24 hours of symptom onset and were ineligible for recanalization were included. Patients were dichotomized into a severe-FHV group (FHV-ASPECTS ≤4; n=33) and a mild-FHV group (FHV-ASPECTS >4; n=35), and multiple logistic regression analysis was used to examine the relationships of FHV scores with early neurological deterioration (END) and an unfavorable 3-month outcome (modified Rankin Scale score ≥3). Results Mean age was 66.2±13.5 years (mean±SD), and 30 (44%) were female. The severe-FHV group had a larger infarct volume (median, 5.5 mL vs. 3 mL) and more frequently exhibited the susceptibility vessel sign (30% vs. 3%) than the mild-FHV group. Ipsilateral old nonlacunar infarct was more frequent in the mild-FHV group than in the severe-FHV group (37% vs. 15%). The severe-FHV group had a fivefold higher risk of END (odds ratio [OR] 5.02, 95% confidence interval [CI] 1.36–18.45) and unfavorable outcome (OR 5.97, 95% CI 1.18–33.31, p=0.03) compared with the mild-FHV group. Conclusions Greater FHV extent was associated with higher risk of END and unfavorable outcome in patients with LVO stroke of mild-to-moderate severity.
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Affiliation(s)
- Wi Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Ho Sang Yoon
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Wuk Jeong
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dong Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
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Yang Y, Han Y, Sun W, Zhang Y. Increased systemic immune-inflammation index predicts hemorrhagic transformation in anterior circulation acute ischemic stroke due to large-artery atherosclerotic. Int J Neurosci 2021; 133:629-635. [PMID: 34233123 DOI: 10.1080/00207454.2021.1953021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Inflammation and immune response play an important role in hemorrhage transformation after acute ischemic stroke. According to previous studies, systemic immune-inflammation index is associated with severity of stroke. We aimed to evaluate the association between systemic immune-inflammation index and hemorrhage transformation in anterior circulation acute ischemic stroke due to large-artery atherosclerosis. METHODS This was a retrospective analysis of patients with anterior circulation acute ischemic stroke due to large-artery atherosclerosis. The laboratory data were collected within 24 h after admission. Hemorrhage transformation was defined on follow-up magnetic resonance imaging or Computed Tomography. The univariate analysis and multivariate logistic regression were performed to assess the association of systemic immune-inflammation index with hemorrhage transformation. Then the relationship between systemic immune-inflammation index and hemorrhage transformation in different stroke subtypes was further studied. RESULTS We included 310 Chinese anterior circulation acute ischemic stroke patients due to large-artery atherosclerosis (mean age 65 ± 11.4 years; 72.6% male). Hemorrhage transformation occurred in 41 patients (13.2%). After multivariate regression analyses, systemic immune-inflammation index (odds ratio [OR] 1.109, 95% Confidence Interval [CI] 1.054-1.167, p<0.001) was independently associated with hemorrhage transformation. Systemic immune-inflammation index was found to be significantly related to hemorrhagic transformation in artery-to-artery embolization (OR 1.111, 95% CI 1.029-1.210, p<0.001) and in-situ thrombosis (OR 1.059, 95% CI 1.011-1.194, p = 0.045). CONCLUSIONS Higher systemic immune-inflammation index is associated with greater risk of hemorrhagic transformation in patients with anterior circulation acute ischemic stroke due to large-artery atherosclerosis, especially in artery-to-artery embolization and in-situ thrombosis.
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Affiliation(s)
- Yi Yang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanfei Han
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Weidong Sun
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yongbo Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Nam KW, Kim CK, Yu S, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Oh K, Seo WK. Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening. Cerebrovasc Dis 2021; 50:288-295. [PMID: 33588410 DOI: 10.1159/000513396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. OBJECTIVE The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. METHODS We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. RESULTS A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04-1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04-1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01-1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. CONCLUSIONS High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Kim
- Department of Neurology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, Dae-gu, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, .,Department of Digital Health, SHAIST, Sungkyunkwan University, Seoul, Republic of Korea,
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Chen S, Cai D, Huang P, Liu J, Lai Y, He J, Zhou L, Sun H. Early and long-term outcomes of argatroban use in patients with acute noncardioembolic stroke. Clin Neurol Neurosurg 2020; 198:106233. [DOI: 10.1016/j.clineuro.2020.106233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/28/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
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Uehara T, Yoshida K, Terasawa H, Shimizu H, Kita Y. Increased serum alkaline phosphatase and early neurological deterioration in patients with atherothrombotic brain infarction attributable to intracranial atherosclerosis. eNeurologicalSci 2020; 20:100253. [PMID: 32695891 PMCID: PMC7364112 DOI: 10.1016/j.ensci.2020.100253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/21/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The purpose of this study was to determine whether increased alkaline phosphatase (ALP) was associated with early neurological deterioration (END) in patients with atherothrombotic brain infarction (ATBI) attributable to intracranial atherosclerosis (ICAS) or not. Methods We analyzed data derived from 70 patients (47 men; mean age, 72.4 ± 12.8 years) with symptomatic ICAS who were admitted within 3 days of ATBI onset between April 2013 and December 2018. We defined END as an increase of ≥2 in the National Institutes of Health Stroke Scale scores during the first 72 h of hospitalization. Results Eleven (15.7%) patients had END. Serum ALP levels on admission were significantly higher among patients with, than without END (median [interquartile range], 296 [233-338] vs. 216 [187-262] U/L, p = .0081). Conclusion Increased serum ALP levels on admission may be able to predict developing END in patients with symptomatic ICAS.
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Affiliation(s)
- Toshiyuki Uehara
- Corresponding author at: Departments of Neurology, Hyogo Brain and Heart Center at Himeji, 520 Saisho-ko, Himeji, Hyogo 670-0981, Japan.
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Chen HX, Wang LJ, Yang Y, Yue FX, Chen LM, Xing YQ. The prevalence of intracranial stenosis in patients at low and moderate risk of stroke. Ther Adv Neurol Disord 2019; 12:1756286419869532. [PMID: 31447935 PMCID: PMC6693021 DOI: 10.1177/1756286419869532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/22/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Previous studies assessing the risk of stroke in the general population
performed screening with Doppler ultrasonography only for high-risk patients
and neglected low- and moderate-risk patients. The aims of this study were
to explore the current prevalence of intracranial arterial stenosis (ICAS)
and analyze its association with different levels of stroke risk and risk
factors based on the risk assessment scale for stroke used in China. Methods: A total of 3654 participants who underwent transcranial Doppler ultrasound
(TCD) were eligible for inclusion. Information regarding demographic
characteristics and risk factors such as alcohol consumption and
hypertension was collected through interviews and questionnaires and used to
analyze the association of ICAS with different levels of stroke risk and
risk factors. Results: The mean age of 501 subjects diagnosed with at least one ICAS was higher than
that of participants without ICAS (57.13 ± 9.56 years and
55.52 ± 9.35 years, respectively). After adjusting for confounding factors,
gender, education, residence, hypertension and personal history of stroke
were associated with ICAS. The odds ratios for ICAS in patients with
hypertension and a personal history of stroke were 1.655 [95% confidence
interval (CI): 1.341–2.043] and 1.854 (95% CI: 1.371–2.508), respectively.
In addition, participants in the low- and moderate-risk stroke groups
accounted for an unexpectedly high proportion of individuals with ICAS (up
to 38.3%). Results from multivariate analyses indicated that the adjusted
odds ratios for ICAS in patients with moderate and high stroke risks
versus those with a low stroke risk were 1.603 (95% CI:
1.171–2.195) and 1.612 (95% CI: 1.272–2.042), respectively. Conclusion: The prevalence of ICAS is high in northeast China and increases with the
level of stroke risk. However, the proportion of patients with ICAS among
those with low and moderate stroke risks should also be noted.
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Affiliation(s)
- Hong-Xiu Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Fei-Xue Yue
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Min Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ying-Qi Xing
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China
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Nam KW, Kim TJ, Lee JS, Park SH, Jeong HB, Yoon BW, Ko SB. Neutrophil-to-lymphocyte ratio predicts early worsening in stroke due to large vessel disease. PLoS One 2019; 14:e0221597. [PMID: 31449547 PMCID: PMC6709913 DOI: 10.1371/journal.pone.0221597] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background Inflammation plays an important role in atherosclerosis and its complications. Since a dysregulated inflammatory response is associated with early neurological deterioration (END), serum neutrophil-to-lymphocyte ratio (NLR) could be a marker of END as well. Aim In this study, we evaluated the relationship between the serum NLR and END in patients with ischemic stroke due to large-artery atherosclerosis (LAA). Methods We evaluated consecutive patients with ischemic stroke due to LAA between January 2010 and December 2015. END was defined as an increase ≥ 2 on the total NIHSS score or ≥ 1 on the motor NIHSS score within the first 72 hours of admission. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Results Of the 349 included patients, 18.1% (n = 63) had END events. In multivariate analysis, serum NLR was independently associated with END (adjusted odds ratio, 1.08; 95% confidence interval [1.00–1.16], P = 0.043). Time to admission, and in-situ thrombosis and artery-to-artery embolization mechanisms were also significantly associated with END events. In an analysis of the relationship between serum NLR and vascular lesion burden, serum NLR was positively correlated with both the degree of stenotic lesions (P for trend = 0.006) and the number of vessel stenosis (P for trend = 0.038) in a dose-response manner. We also compared serum NLR by the stroke mechanisms: patients with hypoperfusion or in-situ thrombosis had the highest levels of NLR: however, only those with in-situ thrombosis had significantly higher NLR in the END group compared to the non-END group (P = 0.005). Conclusions Serum NLR levels were associated with END events in patients with ischemic stroke due to LAA. Since NLR was also closely correlated with the underlying vascular lesions, our results indicated clues for mechanisms of END events.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Tae Jung Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Soo-Hyun Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Hae-Bong Jeong
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- * E-mail:
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Kim HJ, Lee SJ, Jung KO. Association of Concomitant Intracranial Atherosclerotic Stenosis with Collateral Status in Patients with Emergent Large Vessel Occlusion. World Neurosurg 2019; 128:e1102-e1108. [PMID: 31103756 DOI: 10.1016/j.wneu.2019.05.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Concomitant atherosclerotic stenoses are commonly encountered in emergent large vessel occlusion. This study attempted to prove whether or not the pattern of atherosclerotic stenosis other than symptomatic occlusion is associated with pretreatment collateral status among patients with emergent large vessel occlusion. METHODS The study included 115 patients with middle cerebral artery territory infarct within 6 hours of stroke onset who were considered for endovascular revascularization therapy. All patients underwent pretreatment conventional computed tomography angiography using a 128-detector high-definition computed tomography scanner. Based on maximum intensity projection images, ≤50% filling of the occluded territory was considered to indicate poor collaterals, whereas >50% filling was considered to indicate good collaterals. Finding of >50% stenosis on computed tomography angiography was considered significant, and the stenosis patterns were classified into intracranial atherosclerotic stenosis and extracranial atherosclerotic stenosis according to the location of the stenosis. RESULTS All patients had symptomatic M1 (47.8%), M2 (20.0%), or internal carotid artery (32.2%) occlusion. There were 44 patients with poor collaterals (38.3%) and 71 patients with good collaterals (61.7%). Univariate analysis revealed that poor collateral status was associated with advanced age (≥65 years), hypertension, high National Institutes of Health Stroke Scale score, symptomatic internal carotid artery occlusion, and concomitant atherosclerotic stenosis. Multivariate analysis showed that poor collateral circulation was associated with concomitant intracranial atherosclerotic stenosis and symptomatic internal carotid artery occlusion (vs. a more distal occlusion). CONCLUSIONS Concomitant intracranial atherosclerotic stenosis other than symptomatic occlusion might be a crucial factor associated with pretreatment collateral status among patients with emergent large vessel occlusion.
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Affiliation(s)
- Hyung Jun Kim
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, South Korea
| | - Seung-Jae Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, South Korea.
| | - Kyu-On Jung
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, South Korea
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Computational Fluid Dynamics as an Engineering Tool for the Reconstruction of Hemodynamics after Carotid Artery Stenosis Operation: A Case Study. ACTA ACUST UNITED AC 2018; 54:medicina54030042. [PMID: 30344273 PMCID: PMC6122108 DOI: 10.3390/medicina54030042] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/14/2022]
Abstract
Background and objectives: Brain ischemic stroke is caused by impaired or absolutely blocked blood flow into the brain regions. Despite the large number of possible origins, there is no general strategy for preventive treatment. In this paper, we aimed to predict the hemodynamics in a patient who experienced a critical stenosis operation in the carotid artery. This is a unique study where we used medical data together with the computational fluid (CFD) technique not to plan the surgery, but to predict its outcome. Materials and Methods: AngioCT data and blood perfusion of brain tissue (CT-perfusion) together with CFD technique were applied for stroke formation reconstruction in different clinical conditions. With the use of self-made semiautomatic algorithm for image processing and 3DDoctror software, 3D-vascular geometries before and after surgical intervention were reconstructed. As the paper is focused on the analysis of stroke appearance, apparent stroke was simulated as higher and lower pressure values in the cranial part due to different outcomes of the surgical intervention. This allowed to investigate the influence of spatial configuration and pressure values on blood perfusion in the analyzed circulatory system. Results: Application of CFD simulations for blood flow reconstruction for clinical conditions in the circulatory system accomplished on average 98.5% and 98.7% accuracy for CFD results compared to US-Doppler before and after surgical intervention, respectively. Meanwhile, CFD results compared to CT-perfusion indicated an average 89.7% and 92.8% accuracy before and after surgical intervention, respectively. Thus, the CFD is a reliable approach for predicting the patient hemodynamics, as it was confirmed by postoperative data. Conclusions: Our study indicated that the application of CFD simulations for blood flow reconstruction for clinical conditions in circulatory system reached 98% and 90% accuracy for US-Doppler and CT-perfusion, respectively. Therefore, the proposed method might be used as a tool for reconstruction of specific patients' hemodynamics after operation of critical stenosis in the carotid artery. However, further studies are necessary to confirm its usefulness in clinical practice.
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Chang Y, Kim J, Kim MH, Kim YJ, Song TJ. Interarm Blood Pressure Difference is Associated with Early Neurological Deterioration, Poor Short-Term Functional Outcome, and Mortality in Noncardioembolic Stroke Patients. J Clin Neurol 2018; 14:555-565. [PMID: 30284767 PMCID: PMC6172494 DOI: 10.3988/jcn.2018.14.4.555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background and Purpose Interarm differences in the systolic and diastolic blood pressures (IASBD and IADBD, respectively) are found in various populations, including stroke patients, but their significance for stroke outcomes has rarely been reported. We aimed to determine the associations of IASBD and IADBD with early neurological deterioration (END), functional outcome, and mortality. Methods This study included 1,008 consecutive noncardioembolic cerebral infarction patients who were admitted within 24 hours of onset and had automatic measurements of blood pressures in the bilateral arms. END was assessed within 72 hours of stroke onset according to predefined criteria. A poor functional outcome was defined as a score on the modified Rankin Scale ≥3 at 3 months after the index stroke. All-cause mortality was also investigated during a median follow-up of 24 months. The absolute difference of blood pressure measurements in both arms were used to define IASBD and IADBD. Results END occurred in 15.3% (155/1,008) of the patients. A multivariate analysis including sex, age, and variables for which the p value was <0.1 in a univariate analysis revealed that IASBD ≥10 mm Hg was significantly associated with END [odds ratio (OR)=1.75, 95% CI=1.02–3.01]. IADBD ≥10 mm Hg was also related to END (OR=3.11, 95% CI=1.61–5.99). Moreover, having both IASBD ≥10 mm Hg and IADBD ≥10 mm Hg was related to a poor functional outcome (OR=2.67, 95% CI=1.36–5.35) and mortality (hazard ratio=7.67, 95% CI=3.76–12.83) even after adjusting for END. Conclusions This study suggests that an interarm blood pressure difference of ≥10 mm Hg could be a useful indicator for the risks of END, poor functional outcome, and mortality.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, College of Medicine, Ewha Woman's University, Seoul, Korea.,Department of Neurology, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Min Ho Kim
- Department of Biostatistics, Ewha Institute of Convergency Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, College of Medicine, Ewha Woman's University, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, College of Medicine, Ewha Woman's University, Seoul, Korea.
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