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Xue W, Li Y, Xia H, Yu T, Sun S, Zhang M. Influence of neutrophil-to-lymphocyte ratio and mean platelet volume on severity and short-term prognosis of acute ischemic stroke. Am J Transl Res 2022; 14:4066-4073. [PMID: 35836843 PMCID: PMC9274605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the influence of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) on the severity and short-term prognosis of acute ischemic stroke (AIS). METHODS A retrospective analysis was made on 188 AIS patients treated in our hospital from June 2019 to June 2021. They were divided into mild stroke group and severe stroke group based on NIHSS score. In view of the modified Rankin score (mRS) on 14th day after stroke, patients were divided into good prognosis group and bad prognosis group. The clinical data, NLR and MPV data of each group were compared, and the independent risk factors of short-term poor prognosis of AIS patients were analyzed by multivariate Logistic regression. RESULTS NLR and MPV in patients with mild stroke were lower than those with severe stroke (P<0.05). In addition, NLR and MPV of patients with good prognosis were lower than those with poor prognosis (P<0.05). Regression analysis revealed that high NLR and MPV were independent predictors of short-term poor prognosis of AIS patients. The AUC of NLR in predicting the poor prognosis of patients after 14 days of stroke was 0.904, and the specificity and sensitivity were 70.55% and 97.62%. A. AUC of MPV was 0.904, and the specificity and sensitivity were 92.47% and 85.71%. B. Pearson correlation analysis revealed that NLR was positively correlated with MPV (r=0.452, P<0.001). CONCLUSION The elevation of NLR and MPV may be independent risk factors of AIS, but it is related to the severity of stroke and short-term prognosis.
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Affiliation(s)
- Weimin Xue
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan No. 203, Huaibin Road, Tianjia'an District, Huainan 232007, Anhui Province, China
| | - Yaqiang Li
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan No. 203, Huaibin Road, Tianjia'an District, Huainan 232007, Anhui Province, China
| | - Henglei Xia
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan No. 203, Huaibin Road, Tianjia'an District, Huainan 232007, Anhui Province, China
| | - Tingting Yu
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan No. 203, Huaibin Road, Tianjia'an District, Huainan 232007, Anhui Province, China
| | - Shiyu Sun
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan No. 203, Huaibin Road, Tianjia'an District, Huainan 232007, Anhui Province, China
| | - Mei Zhang
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan No. 203, Huaibin Road, Tianjia'an District, Huainan 232007, Anhui Province, China
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Masiliūnas R, Vilionskis A, Bornstein NM, Rastenytė D, Jatužis D. The impact of a comprehensive national policy on improving acute stroke patient care in Lithuania. Eur Stroke J 2022; 7:134-142. [PMID: 35647307 PMCID: PMC9134776 DOI: 10.1177/23969873221089158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/05/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction: Reperfusion therapy (RT) is a mainstay treatment for acute ischemic stroke (AIS). We aimed to evaluate the impact of a comprehensive national policy (CNP) to improve access to RT for AIS patients across Lithuania. Patients and methods: Aggregated anonymized data on AIS cases treated in Lithuanian hospitals between 2006 and 2019 were retrospectively obtained from the Institute of Hygiene and the Stroke Integrated Care Management Committee. Through an interrupted time series analysis, we examined the trends in AIS hospital admissions, RT, and in-hospital case fatality rates prior to the enactment of CNP in 2014, changes immediately after the intervention, and differences in trends between the pre- and post-intervention periods. Mean yearly door-to-needle times were calculated post-intervention. Results: 114,436 cases were treated for AIS in Lithuanian hospitals before, and 65,084 after the government intervention. We observed a significant decreasing post-intervention trend change in AIS hospital admission rate per 100,000 population (regression coefficient ± standard error: β = –16.47 ± 3.95, p = 0.002) and an increasing trend change in the proportion of AIS patients who received reperfusion treatment: intravenous thrombolysis (β = 1.42 ± 0.96, p < 0.001) and endovascular therapy (β = 0.85 ± 0.05, p < 0.001). The proportion of patients treated in stroke centers increased immediately after the intervention (β = 4.95 ± 1.14, p = 0.001), but the long-term post-intervention trend did not change. In addition, there was a significant decreasing trend in all cause in-hospital case fatality rate within primary and comprehensive stroke centers after the intervention (β = –0.60 ± 0.18, p = 0.008) despite its prompt initial immediate increase (β = 1.68 ± 0.73, p = 0.043). The mean countrywide door-to-needle time decreased from 68 min in 2014 to 43 min in 2019. Conclusion: The comprehensive national stroke patient care policy could be associated with an immediate increase in stroke center treatment rate, increased access to RT, and improved stroke care performance measures.
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Affiliation(s)
| | - Aleksandras Vilionskis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Natan M Bornstein
- Neurological Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Daiva Rastenytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalius Jatužis
- Center of Neurology, Vilnius University, Vilnius, Lithuania
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Miękisiak G, Pettersson SD, Szarek D, Morasiewicz P, Fercho J, Adamski S, Kipiński L, Szmuda T. Acute Stroke Care during COVID-19: National Data. Infect Dis Rep 2022; 14:198-204. [PMID: 35314654 PMCID: PMC8938781 DOI: 10.3390/idr14020024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The pandemic of COVID-19 and subsequent lockdown strategies had a profound impact on many aspects of everyday life. During this time the world faced the unprecedented crisis of healthcare disrupting timely care delivery. This study was designed to evaluate the impact of the pandemic on the acute treatment of stroke in Poland. (2) Methods: The national data on hospitalizations with stroke as a primary diagnosis were obtained from the National Health Fund of Poland. Poisson regression was used to determine the significance of the change in hospital admissions. The differences between proportions were analyzed using the “N-1” Chi-squared test. (3) Results: During the COVID-19 period, the number of hospitalizations dropped by 8.28% with a monthly nadir of 22.02 in April. On a monthly scale during 2020, the greatest decrease was 22.02%. The thrombolysis ratio was also affected, with the highest monthly drop of 15.51% in November. The overall number of in-hospital deaths did not change. (4) Conclusions: The pandemic caused a serious disruption of the acute care of stroke. There is no evidence that the quality of care was seriously compromised.
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Affiliation(s)
- Grzegorz Miękisiak
- Institute of Medicine, University of Opole, 45-040 Opole, Poland;
- Correspondence: ; Tel.: +48-71-306-4607
| | - Samuel D. Pettersson
- Department of Neurosurgery, Medical University of Gdansk, 80-210 Gdansk, Poland; (S.D.P.); (J.F.); (T.S.)
| | - Dariusz Szarek
- Department of Neurosurgery, Marciniak’s Hospital, 54-049 Wrocław, Poland;
| | | | - Justyna Fercho
- Department of Neurosurgery, Medical University of Gdansk, 80-210 Gdansk, Poland; (S.D.P.); (J.F.); (T.S.)
| | - Stanisław Adamski
- Neurosurgery Department, Copernicus Hospital, 80-152 Gdansk, Poland;
| | - Lech Kipiński
- Department of Pathophysiology, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Tomasz Szmuda
- Department of Neurosurgery, Medical University of Gdansk, 80-210 Gdansk, Poland; (S.D.P.); (J.F.); (T.S.)
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4
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Bryndziar T, Matyskova D, Sedova P, Belaskova S, Zvolsky M, Bednarik J, Brown RD, Mikulik R. Predictors of Short- and Long-Term Mortality in Ischemic Stroke: A Community-Based Study in Brno, Czech Republic. Cerebrovasc Dis 2021; 51:296-303. [PMID: 34788769 DOI: 10.1159/000519937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Short- and long-term mortality following ischemic stroke (IS) and their predictors have not been defined in the Czech population, and studies on long-term mortality are largely missing for the populations of Central Europe. METHODS Using the National Register of Hospitalized Patients and the Czech National Mortality Registry, we analyzed data on 1-month, 1-year, and 3-year all-cause mortality for patients admitted with IS to any of the 4 hospitals with a certified stroke unit in Brno, Czech Republic, in 2011. We reviewed discharge summaries and recorded potential factors impacting mortality after the index stroke event. Using univariate and multivariable analyses, we identified predictors of mortality at all 3 time points. RESULTS In our multivariable model, statin use (odds ratio [OR] 0.095, p < 0.0001), age at stroke (OR 1.03, p = 0.0445), and admission National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, p < 0.0001) predicted 1-month mortality, while statin use (OR 0.43, p = 0.0004), history of cardiac failure (OR 2.17, p = 0.0137), age at stroke (OR 1.07, p < 0.0001), and admission NIHSS score (OR 1.14, p < 0.0001) predicted 1-year mortality. Statin use (OR 0.54, p = 0.0051), history of cardiac failure (OR 2.13, p = 0.0206), age at stroke (OR 1.07, p < 0.0001), and admission NIHSS score (OR 1.11, p < 0.0001) also predicted 3-year mortality. CONCLUSIONS Our study is the first to report data on short- and long-term mortality rates and their predictors in patients hospitalized with IS in the Czech population. Our results indicate that mortality rates and predictors of mortality are consistent with those reported in studies from other populations throughout the world.
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Affiliation(s)
- Tomas Bryndziar
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, St. Anne's University Hospital, Brno, Czechia
| | - Dominika Matyskova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petra Sedova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, St. Anne's University Hospital, Brno, Czechia.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czechia
| | - Silvie Belaskova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia.,Institute of Mathematics and Statistics, Masaryk University, Brno, Czechia
| | - Miroslav Zvolsky
- Institute for Health Information and Statistics of the Czech Republic, Prague, Czechia
| | - Josef Bednarik
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, St. Anne's University Hospital, Brno, Czechia
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Zaprutko T, Florczak-Wyspiańska J, Kopciuch D, Paczkowska A, Ratajczak P, Dorszewska J, Nowakowska E, Kus K. Costs of Stroke and Incidence of First Diagnosis of Atrial Fibrillation at Time of Stroke. Neurology Ward Hospital Poznań, Poland 2018. Healthcare (Basel) 2021; 9:healthcare9080999. [PMID: 34442136 PMCID: PMC8394020 DOI: 10.3390/healthcare9080999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke is a major cause of morbidity in industrialized countries, representing 8% of total deaths across Europe in 2017. It is also a very costly disorder, frequently caused by atrial fibrillation. We aimed to calculate the cost of stroke hospitalization in 2018 in Poznań (Poland). We also intended to present patients with the first AF diagnosis at the time of stroke. The study was conducted from January 2019 to July 2020. Data were obtained from hospital records and from the hospital accounting department. Out of 164 patients included in the study, 41 had AF and in 18 cases AF was first diagnosed at the time of stroke. The cost of hospitalization in Poznań was EUR 139,257.21 (x¯= EUR 849.13). Among those with concomitant AF, the general cost of inpatient care was EUR 33,859.18 (x¯= EUR 825.83). Considering those who had AF first diagnosed during hospitalization the cost was EUR 16,248.97 (x¯= EUR 906.24). Stroke is associated with high costs of inpatient care, which turned out to be higher among those with AF first diagnosed at the time of stroke. The number of patients who used oral anticoagulants at the time of admission was relatively low. The most frequently used NOAC was dabigatran.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
- Correspondence: ; Tel./Fax: +48-61-845-26-84
| | - Jolanta Florczak-Wyspiańska
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland; (J.F.-W.); (J.D.)
| | - Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
| | - Anna Paczkowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
| | - Jolanta Dorszewska
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland; (J.F.-W.); (J.D.)
| | - Elżbieta Nowakowska
- Department of Toxicology and Pharmacology, University of Zielona Góra, 28 Zyty St, 65-046 Zielona Góra, Poland;
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznan, Poland; (D.K.); (A.P.); (P.R.); (K.K.)
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Liu S, Liu P, Wang P, Zhang F, Wang L, Wang Y, Lu H, Ma X. Argatroban Increased the Basal Vein Drainage and Improved Outcomes in Acute Paraventricular Ischemic Stroke Patients. Med Sci Monit 2020; 26:e924593. [PMID: 32667287 PMCID: PMC7382300 DOI: 10.12659/msm.924593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Since venous drainage in acute arterial ischemic stroke has not been thoroughly researched, we evaluate the effect of argatroban, a selective direct thrombin inhibitor, as a therapy to increase the rate of basal vein Rosenthal (BVR) drainage and improve patients’ post-stroke outcomes. Material/Methods In this multicenter clinical trial, 60 eligible patients at 4.5 to 48 hours after the stroke onset were recruited. After being randomly allocated into 2 groups, they were treated with standard therapy either alone or with argatroban. Results Compared to the contralateral brain hemisphere, the mean flow velocity (MFV) in BVR drainage was significantly reduced in the stroke-afflicted ipsilateral hemisphere. After treatment with argatroban for 7 days, the MFV from BVR of the ipsilateral hemisphere in the argatroban treated group was significantly increased when compared to the control group. At 90 days after the onset of stroke, the MFV of BVR in the ipsilateral hemisphere was similar in both groups. Compared with controls, the argatroban-treated patients had smaller lesions from baseline to 7 days. Argatroban also improved National Institutes of Health Stroke Scale (NIHSS) scores on day 7 after the onset of stroke. Furthermore, the argatroban group’s neurological functions were superior to those of their untreated counterparts after 90 days. No difference was found in the incidence of adverse reactions between the 2 groups. Conclusions These observations indicate that vein drainage change may contribute to the acute phase of brain edema and the outcomes of ischemic stroke patients. Clinical Trial Registration URL-http://www.chictr.org Unique identifier: ChiCTR-IPR-16008663
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Affiliation(s)
- Shoufeng Liu
- The Graduate School, Tianjin Medical University, Tianjin, China (mainland).,Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Peipei Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Po Wang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China (mainland)
| | - Fang Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Lijun Wang
- Department of Neurology, Tianjin Fourth Central Hospital, Tianjin, China (mainland)
| | - Yu Wang
- Department of Ultrasonography, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Hao Lu
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Xiaofeng Ma
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China (mainland)
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Marko M, Posekany A, Szabo S, Scharer S, Kiechl S, Knoflach M, Serles W, Ferrari J, Lang W, Sommer P, Greisenegger S. Trends of r-tPA (Recombinant Tissue-Type Plasminogen Activator) Treatment and Treatment-Influencing Factors in Acute Ischemic Stroke. Stroke 2020; 51:1240-1247. [PMID: 32114931 DOI: 10.1161/strokeaha.119.027921] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and Purpose- Frequencies of treatment with r-tPA (recombinant tissue-type plasminogen activator) are increasing over the past 15 years. However, published data on the influence of various demographic and clinical factors on r-tPA treatment as well as estimates of future trajectories are limited. We evaluated time trends and future trajectories of r-tPA treatment in patients with acute stroke and the influence of various factors on r-tPA treatment by analyzing data of 103 970 patients enrolled in the Austrian Stroke Unit Registry from 2006 to 2018, of which 18 953 were treated with r-tPA. Methods- Time trends of r-tPA-treatment were investigated in predefined subgroups (minor/major stroke, age, anterior/posterior circulation stroke); limited exponential time series models were calculated to estimate future trends of r-tPA-treatment. Logistic regression models were calculated to estimate the influence of clinical variables on r-tPA-treatment. Results- Overall, r-tPA treatment frequencies increased from 9.9% in 2006 to 21.8% in 2018. We observed a particular increase in patients >80 years, patients presenting with a National Institutes of Health Stroke Scale Score of 2 to 3, patients with posterior circulation stroke, patients with wake-up stroke, and patients without atrial fibrillation. Forecast of overall r-tPA frequencies predicted a further but flattened increase up to 24% by 2025. Logistic regression of time-dependent associations of clinical variables with r-tPA-treatment revealed increasing odds of r-tPA-treatment in patients with a posterior circulation stroke and decreasing odds of r-tPA-treatment in patients with atrial fibrillation. Conclusions- We observed a positive development of r-tPA-treatment frequencies mirroring increasing confidence with intravenous thrombolysis in clinical practice; however, decreasing odds of r-tPA-treatment over time in patients with atrial fibrillation deserve particular attention.
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Affiliation(s)
- Martha Marko
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Alexandra Posekany
- Institute of Statistics and Mathematical Methods in Economics, Vienna University of Technology, Austria (A.P.)
| | - Simon Szabo
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Sebastian Scharer
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Austria (S.K., M.K.)
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Austria (S.K., M.K.)
| | - Wolfgang Serles
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Julia Ferrari
- Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (J.F., W.L.)
| | - Wilfried Lang
- Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (J.F., W.L.)
| | - Peter Sommer
- Department of Neurology, Krankenanstalt Rudolfstiftung Vienna, Austria (P.S.)
| | - Stefan Greisenegger
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
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Wang Y, Zhang Y, Ma Q, Wang C, Xu Y, Sun H, Ma Y. Determination of Clinical Cut-Off Values for Serum Cystatin C Levels to Predict Ischemic Stroke Risk. J Stroke Cerebrovasc Dis 2019; 28:104345. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/29/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022] Open
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