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Qin B, Fu L, Qin H, Liang Y, Qin C, Zhang J, Gao W. Intravenous thrombolysis versus dual antiplatelet therapy for patients with acute minor ischaemic stroke: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1377475. [PMID: 38915465 PMCID: PMC11194400 DOI: 10.3389/fphar.2024.1377475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Background and purpose The efficacy of intravenous thrombolysis (IVT) in patients with acute minor ischaemic stroke (AMIS) remains unclear. We performed a meta-analysis to compare the efficacy and safety of IVT and dual antiplatelet therapy (DAPT) in patients with AMIS. Methods The Embase, Cochrane Library, PubMed, and Web of Science databases were searched up to 10 October, 2023. Prospective and retrospective studies comparing the clinical outcomes of IVT and DAPT were included. Odds ratios (ORs) and 95% confidence intervals (CIs) for early neurological deterioration (END), excellent and favourable functional outcomes, recurrent ischaemic stroke at 3 months, mortality at 3 months, and symptomatic intracranial haemorrhage (ICH) were pooled using a random-effects model. Results Of the five included studies, 6,340 patients were included. In patients with AMIS, IVT was not significantly associated with excellent and favourable functional outcomes, recurrent ischaemic stroke, or all-cause mortality at 3 months compared to early DAPT. However, a higher risk of symptomatic ICH (OR, 9.31; 95% CI, 3.39-25.57) and END (OR, 2.75; 95% CI, 1.76-4.30) were observed with IVT. Conclusion This meta-analysis indicated that IVT was not superior to DAPT in patients with AMIS, especially in those with nondisabling AIS. However, these findings should be interpreted with caution and have some limitations. Further, well-designed randomised controlled trials are warranted.
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Affiliation(s)
- Bin Qin
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lin Fu
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Huixun Qin
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Yuming Liang
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Cheng Qin
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Jiede Zhang
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
| | - Wen Gao
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, Guangxi, China
- Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China
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Chen G, Ding P, Yang L, Liu X, Yu D, Yue W. Left ventricular ejection fraction <60 % is associated with short-term functional disability in patients of acute ischemic stroke. Heliyon 2024; 10:e29352. [PMID: 38644837 PMCID: PMC11031756 DOI: 10.1016/j.heliyon.2024.e29352] [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: 10/06/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objective The association between cardiac dysfunction and functional outcome in acute ischemic stroke (AIS) is not clear. We aimed to investigate the relationship between the routinely assessed left ventricular ejection fraction (LVEF) and functional outcomes in patients with AIS. Methods Data came from a prospective, observational, single-center study (Effect of Cardiac Function on Short-term Functional Prognosis in Patients with Acute Ischemic Stroke, SPARK). The LVEF was assessed with transthoracic echocardiography within 7 days of stroke onset. The primary outcome was functional disability, defined as a modified Rankin Scale score of 3-6 at 90 days (range: 0-6, with higher scores indicating greater disability). We also investigated the association of the LVEF with mortality, early neurological deterioration, hospital stay, and costs. Multivariate logistic regression analysis and 2:1 propensity score matching (PSM) were performed to compare the differences in outcomes. Results A total of 1181 patients were included in this analysis, of which 87 (7.4 %) patients were found to have LVEF of <60 %. In the entire study population, LVEF<60 % was significantly associated with functional disability at 90 days (odds ratio [OR]: 1.85, 95 % confidence intervals (CI): 1.01-3.40) after adjusting for all confounders. After PSM, the association was consistently significant (OR: 5.32, 95 % CI: 3.04-9.30). However, associations of the LVEF with mortality, early neurological deterioration, hospital stay, and costs were not consistently significant across all analyses. In the subgroup analysis, the association of LVEF of <60 % with functional disability was statistically significant in patients with non-cardioembolic stroke, but not in patients with cardioembolic stroke (P for interaction = 0.872). Conclusions An LVEF of <60 % will likely increase the risk of functional disability in patients with AIS. Future strategies to prevent cardiac dysfunction in the acute phase are needed.
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Affiliation(s)
- Guojuan Chen
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| | - Peng Ding
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
| | - Liqin Yang
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
| | - Xueqing Liu
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
| | - Delin Yu
- Department of Ultrasonic, Tianjin Huanhu Hospital, Tianjin, China
| | - Wei Yue
- Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China
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Hojjati SMM, Hasanpour AH, Shirafkan H, Naghshineh H, Alizadeh Khatir A, Saadat P, Sahebian F, Mehraeen R. Factors affecting improvement after intravenous administration of recombinant tissue plasminogen activator (rtPA) among patients with acute ischemic stroke: A historical cohort study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:251-258. [PMID: 38807733 PMCID: PMC11129057 DOI: 10.22088/cjim.15.2.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/28/2023] [Accepted: 06/14/2023] [Indexed: 05/30/2024]
Abstract
Background One of the most effective treatments for patients with acute ischemic stroke (AIS) is intravenous recombinant tissue plasminogen activator (rtPA) which can minimize mortality and morbidities. In this historical cohort study, we investigate the factors affecting clinical outcomes after IV thrombolysis for AIS. Methods We included 87 patients with acute ischemic stroke who were treated with rtPA between 2015 and 2019. Demographic and clinical data were recorded. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the clinical outcomes. Results 36 patients showed lack of improvement at discharge. In unadjusted model, hypercholesterolemia was the only predictor of lack of improvement (P= 0.043; OR=0.304; CI= 0.096-0.963). After adjusting, hypertension (P= 0.018; OR= 0.18; CI= 0.043-0.749) and hypercholesterolemia (P= 0.008; OR= 8.68; CI= 1.773-42.54) were independent determinants of lack of clinical response. To evaluate risk factors in association with the duration of hospitalization, we found variables which lengthened hospitalization span including; age over 60 years (HR= 0.42 P= 0.002), hypercholesterolemia (HR= 2.19 P= 0.031), Angiotensin-converting enzyme (ACE) Inhibitors consumption (HR= 1.87 P= 0.022), and type of infarction (non-lacunar) (HR= 0.51 P= 0.026). Results indicated no considerable relationship between dose of rtPA and the appropriate response to treatment (OR=8.686 P= 0.324). Conclusion The closer dose of rtPA goes up to standard range, the more chance of improvement will gain without increasing the risk of symptomatic intra-cerebral hemorrhage (SICH). Determining factors involved in intravenous reperfusion outcomes help physicians to identify the patients who benefit the most from rtPA.
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Affiliation(s)
| | - Amir Hossein Hasanpour
- Student Research Committee, Babol University of Medical Sciences, Ganjafrooz Street, Babol, Iran
| | - Hoda Shirafkan
- Social Determinants of Health Research c=Center, Health Research Institute, Babol University of Medical Sciences, Ganjafrooz Street, Babol, Iran
| | - Hoda Naghshineh
- Mobility Impairment Research Centre, Health Research Institute Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ali Alizadeh Khatir
- Mobility Impairment Research Centre, Health Research Institute Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Payam Saadat
- Mobility Impairment Research Centre, Health Research Institute Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Sahebian
- Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Ganjafrooz Street, Babol, Iran
| | - Rahele Mehraeen
- Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Ganjafrooz Street, Babol, Iran
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Luo X, Huo T, Cao P, Zhao J, Zhang Y, Tan G. Thrombolysis Versus Nonthrombolyzed in Patients With Mild Strokes and Large Vessel Occlusions: Results of a Multicenter Stroke Registration. Neurologist 2024; 29:31-35. [PMID: 37639543 PMCID: PMC10763712 DOI: 10.1097/nrl.0000000000000516] [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] [Indexed: 08/31/2023]
Abstract
BACKGROUND The safety and efficacy of intravenous thrombolysis (IVT) in acute ischemic stroke patients with large vessel occlusions and mild neurological deficits are controversial. METHODS Data of stroke patients presenting with mild initial stroke, which was defined as the National Institutes of Health Stroke Scale score (NIHSS) ≤5 and large vessel occlusion, were extracted from a large provincewide stroke registry. RESULTS A total of 619 IVT and 2170 non-IVT patients were identified in this study. IVT patients had higher rates of favorable functional outcome Modified Rankin Scale(mRS) ≤1 (74.6% vs. 70.6%; P =0.047), lower mRS scores (1 vs. 1, P =0.001), and higher NIHSS score decreased (1 vs. 0, P <0.001) at discharge compared with the non-IVT patients. The rates were similar in symptomatic intracranial hemorrhage (2.1% vs. 2.0%, P =0.853), severe systemic bleeding (0.8% vs. 0.6%, P =0.474), and mortality at discharge (0.2% vs. 0.2%, P =0.906) between the 2 groups. A multiple Logistic regression model found that age above 80 years [adjusted OR (aOR) 2.056 (95% CI, 1.125 to 3.756)], history of stroke [aOR 1.577 (95% CI, 1.303 to 1.910)], hyperlipidemia [aOR 2.156 (95% CI, 1.059 to 4.388)], high admission NIHSS score [aOR 1.564 (95% CI, 1.473 to 1.611)], and non-IVT [aOR 1.667 (95% CI, 1.337 to 2.077)] were independent risk factors for mRS >1. CONCLUSIONS IVT administration is safe and effective in eligible acute ischemic stroke patients. Age above 80 years, with a history of stroke and hyperlipidemia, high admission NIHSS score, and non-IVT were independent risk factors for mRS >1 at discharge in these patients.
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Affiliation(s)
- Xintong Luo
- Department of Neurology, The Second Hospital of HeBei Medical University, HeBei Medical University
- Department of Neurology, HeBei General Hospital
| | | | - Pengkai Cao
- Department of Vascular Surgery Department, The Third Hospital of HeBei Medical University, HeBei Medical University, HeBei, Shijiazhuang, China
| | - Jingru Zhao
- Department of Neurology, HeBei General Hospital
| | - Yue Zhang
- Department of Neurology, The Second Hospital of HeBei Medical University, HeBei Medical University
| | - Guojun Tan
- Department of Neurology, The Second Hospital of HeBei Medical University, HeBei Medical University
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Zhou Y, Luo Y, Liang H, Zhong P, Wu D. Applicability of the low-grade inflammation score in predicting 90-day functional outcomes after acute ischemic stroke. BMC Neurol 2023; 23:320. [PMID: 37679730 PMCID: PMC10483771 DOI: 10.1186/s12883-023-03365-6] [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: 03/05/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND AND PURPOSE The low-grade inflammation (LGI) score, a novel indicator of chronic LGI, combines C-reactive protein (CRP), leukocyte counts, the neutrophil/lymphocyte ratio (NLR), and the platelet (PLT) count to predict outcomes of patients with various conditions, such as cardiovascular diseases, cancers, and neurodegenerative diseases. However, few studies have examined the role of the LGI score in predicting functional outcomes of patients with ischemic stroke. The present study aimed to evaluate the association between the LGI score and functional outcomes of patients with ischemic stroke. METHODS A total of 1,215 patients were screened in the present study, and 876 patients were finally included in this retrospective observational study based on the inclusion and exclusion criteria. Blood tests were conducted within 24 h of admission. Severity of ischemic stroke was assessed using the NIHSS score with severe stroke denoted by NIHSS > 5. Early neurological deterioration (END) was defined as an increment in the total NIHSS score of ≥ 2 points within 7 days after admission. Patient outcomes were assessed on day 90 after stroke onset using the modified Rankin Scale (mRS). RESULTS The LGI score was positively correlated with baseline and the day 7 NIHSS scores (R2 = 0.119, p < 0.001;R2 = 0.123, p < 0.001). Multivariate regression analysis showed that the LGI score was an independent predictor of stroke severity and END. In the crude model, the LGI score in the fourth quartile was associated with a higher risk of poor outcomes on day 90 compared with the LGI score in the first quartile (OR = 5.02, 95% CI: 3.09-8.14, p for trend < 0.001). After adjusting for potential confounders, the LGI score in the fourth quartile was independently associated with poor outcomes on day 90 (OR = 2.65, 95% CI: 1.47-4.76, p for trend = 0.001). Finally, the ROC curve analysis showed an AUC of 0.682 for poor outcomes on day 90 after stroke onset. CONCLUSION The LGI score is strongly correlated with the severity of acute ischemic stroke and that the LGI score might be a good predictor for poor outcomes on day 90 in patients with acute ischemic stroke.
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Affiliation(s)
- Yang Zhou
- Emergency Department, Shaoxing People's Hospital, Shaoxing, Zhejiang Province, China
| | - Yufan Luo
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Minhang District, Shanghai, 200240, China
| | - Huazheng Liang
- Monash Suzhou Research Institute, Suzhou Industrial Park, Suzhou, Jiangsu Province, China
| | - Ping Zhong
- Department of Neurology, Shanghai Yangpu District Shidong Hospital, 999 Shiguang Road, Yangpu District, Shanghai, 200438, China.
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Minhang District, Shanghai, 200240, China.
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Chen HS, Cui Y, Zhou ZH, Zhang H, Wang LX, Wang WZ, Shen LY, Guo LY, Wang EQ, Wang RX, Han J, Dong YL, Li J, Lin YZ, Yang QC, Zhang L, Li JY, Wang J, Xia L, Ma GB, Lu J, Jiang CH, Huang SM, Wan LS, Piao XY, Li Z, Li YS, Yang KH, Wang DL, Nguyen TN. Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke: The ARAMIS Randomized Clinical Trial. JAMA 2023; 329:2135-2144. [PMID: 37367978 PMCID: PMC10300686 DOI: 10.1001/jama.2023.7827] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/22/2023] [Indexed: 06/28/2023]
Abstract
Importance Intravenous thrombolysis is increasingly used in patients with minor stroke, but its benefit in patients with minor nondisabling stroke is unknown. Objective To investigate whether dual antiplatelet therapy (DAPT) is noninferior to intravenous thrombolysis among patients with minor nondisabling acute ischemic stroke. Design, Setting, and Participants This multicenter, open-label, blinded end point, noninferiority randomized clinical trial included 760 patients with acute minor nondisabling stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤5, with ≤1 point on the NIHSS in several key single-item scores; scale range, 0-42). The trial was conducted at 38 hospitals in China from October 2018 through April 2022. The final follow-up was on July 18, 2022. Interventions Eligible patients were randomized within 4.5 hours of symptom onset to the DAPT group (n = 393), who received 300 mg of clopidogrel on the first day followed by 75 mg daily for 12 (±2) days, 100 mg of aspirin on the first day followed by 100 mg daily for 12 (±2) days, and guideline-based antiplatelet treatment until 90 days, or the alteplase group (n = 367), who received intravenous alteplase (0.9 mg/kg; maximum dose, 90 mg) followed by guideline-based antiplatelet treatment beginning 24 hours after receipt of alteplase. Main Outcomes and Measures The primary end point was excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 (range, 0-6), at 90 days. The noninferiority of DAPT to alteplase was defined on the basis of a lower boundary of the 1-sided 97.5% CI of the risk difference greater than or equal to -4.5% (noninferiority margin) based on a full analysis set, which included all randomized participants with at least 1 efficacy evaluation, regardless of treatment group. The 90-day end points were assessed in a blinded manner. A safety end point was symptomatic intracerebral hemorrhage up to 90 days. Results Among 760 eligible randomized patients (median [IQR] age, 64 [57-71] years; 223 [31.0%] women; median [IQR] NIHSS score, 2 [1-3]), 719 (94.6%) completed the trial. At 90 days, 93.8% of patients (346/369) in the DAPT group and 91.4% (320/350) in the alteplase group had an excellent functional outcome (risk difference, 2.3% [95% CI, -1.5% to 6.2%]; crude relative risk, 1.38 [95% CI, 0.81-2.32]). The unadjusted lower limit of the 1-sided 97.5% CI was -1.5%, which is larger than the -4.5% noninferiority margin (P for noninferiority <.001). Symptomatic intracerebral hemorrhage at 90 days occurred in 1 of 371 participants (0.3%) in the DAPT group and 3 of 351 (0.9%) in the alteplase group. Conclusions and Relevance Among patients with minor nondisabling acute ischemic stroke presenting within 4.5 hours of symptom onset, DAPT was noninferior to intravenous alteplase with regard to excellent functional outcome at 90 days. Trial Registration ClinicalTrials.gov Identifier: NCT03661411.
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Affiliation(s)
- Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Zhong-He Zhou
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Hong Zhang
- Department of Neurology, Liaoning Health Industry Group Fukuang General Hospital, Fushun, China
| | - Li-Xia Wang
- Department of Neurology, Tieling Central Hospital, Tieling, China
| | - Wei-Zhong Wang
- Department of Neurology, Dandong Central Hospital, Dandong, China
| | - Li-Ying Shen
- Department of Neurology, Tieling County Central Hospital, Tieling, China
| | - Li-Yan Guo
- Department of Neurology, Fushun Second Hospital, Fushun, China
| | - Er-Qiang Wang
- Department of Neurology, The Fuqing Affiliated Hospital of Fujian Medical University, Fuqing, China
| | - Rui-Xian Wang
- Department of Neurology, The Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin, China
| | - Jing Han
- Department of Neurology, Panjin Central Hospital, Panjin, China
| | - Yu-Ling Dong
- Department of Neurology, Chaoyang Second Hospital, Chaoyang, China
| | - Jing Li
- Department of Neurology, Donggang Central Hospital, Donggang, China
| | - Yong-Zhong Lin
- Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing-Cheng Yang
- Department of Neurology, Anyang People‘s Hospital, Anyang, China
| | - Li Zhang
- Department of Neurology, Suizhong Central Hospital, Suizhong, China
| | - Jing-Yu Li
- Department of Neurology, Chinese People’s Liberation Army 967 Hospital, Dalian, China
| | - Jin Wang
- Department of Neurology, Huludao Central Hospital, Huludao, China
| | - Lei Xia
- Department of Neurology, Zhoukou Central Hospital, Zhoukou, China
| | - Guang-Bin Ma
- Department of Neurology, Haicheng Traditional Chinese Medicine Hospital, Haicheng, China
| | - Jiang Lu
- Department of Neurology, The Dalinghe Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Chang-Hao Jiang
- Department of Neurology, Lvshunkou Traditional Chinese Medicine Hospital, Lvshunkou, China
| | - Shu-Man Huang
- Department of Neurology, Dawa District People‘s Hospital, Panjin, China
| | - Li-Shu Wan
- Department of Neurology, Dandong First Hospital, Dandong, China
| | - Xiang-Yu Piao
- Department of Neurology, The Zhongshan Affiliated Hospital of Dalian University, Dalian, China
| | - Zhuo Li
- Department of Neurology, Panjin Central Hospital, Panjin, China
| | - Yan-Song Li
- Department of Neurology, Army Hospital of Northern Theatre Command, Shenyang, China
| | - Kui-Hua Yang
- Department of Neurology, Liaoyang Second People’s Hospital, Liaoyang, China
| | - Duo-Lao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Thanh N. Nguyen
- Neurology, Radiology, Boston Medical Center, Boston, Massachusetts
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Chu M, Luo Y, Wang D, Liu Y, Wang D, Wang Y, Zhao J. Systemic inflammation response index predicts 3-month outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis. Front Neurol 2023; 14:1095668. [PMID: 36846118 PMCID: PMC9946296 DOI: 10.3389/fneur.2023.1095668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction A crucial aspect of stroke progression is the inflammatory response. As novel inflammatory and prognostic markers, the systemic immune inflammation index (SII) and the systemic inflammation response index (SIRI) have recently been studied. The objective of our study was to evaluate the prognostic value of SII and SIRI in mild acute ischemic stroke (AIS) patients following intravenous thrombolysis (IVT). Methods Our study screened the clinical data of patients with mild AIS admitted to the Minhang Hospital of Fudan University for retrospective analysis. The SIRI and SII were examined by the emergency laboratory before IVT. Functional outcome was evaluated 3 months after the onset of stroke using the modified Rankin Scale (mRS). mRS ≥ 2 was defined as an unfavorable outcome. The relationship between SIRI and SII and the 3-month prognosis was determined using both univariate and multivariate analysis. Receiver operating characteristic curve was performed to evaluate the predictive value of SIRI for AIS prognosis. Results A total of 240 patients were included in this study. Both SIRI and SII were higher in the unfavorable outcome group than in the favorable outcome group [1.28 (0.70-1.88) vs. 0.79 (0.51-1.08), P < 0.001 and 531.93 (377.55-797.12) vs. 397.23 (263.32-577.65), P < 0.001]. Multivariate logistic regression analyses showed that SIRI was significantly associated with 3-month unfavorable outcome of mild AIS patients [odds ratio (OR) = 2.938, 95% confidence interval (CI) = 1.805-4.782, P < 0.001], conversely, SII had no prognostic value. When SIRI combined with the established clinical factors, the area under the curve (AUC) showed a significant improvement (0.773 vs. 0.683, P for comparison = 0.0017). Conclusions Higher SIRI could be valuable in predicting poor clinical outcomes for patients with mild AIS following IVT.
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Affiliation(s)
- Min Chu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yunhe Luo
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Daosheng Wang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Delong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China,*Correspondence: Jing Zhao ✉
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Yang H, Lv Z, Wang W, Wang Y, Chen J, Wang Z. Machine Learning Models for Predicting Early Neurological Deterioration and Risk Classification of Acute Ischemic Stroke. Clin Appl Thromb Hemost 2023; 29:10760296231221738. [PMID: 38115694 PMCID: PMC10734329 DOI: 10.1177/10760296231221738] [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: 10/11/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
This study aimed to create machine learning models for predicting early neurological deterioration and risk classification in acute ischemic stroke (AIS) before intravenous thrombolysis (IVT). The study included 704 AIS patients categorized into END and non-END groups. The least absolute shrinkage and selection operator (LASSO) regression was employed to select the best predictors from clinical indicators, leading to the creation of Model 1. Univariate and multivariate logistic regression analyses identified independent predictive factors for END from inflammatory cell ratios. These factors were combined with clinical indicators, forming Model 2. Receiver operating characteristic (ROC) curves assessed the models' predictive performance. Key variables for Model 1 included the NIHSS score, systolic blood pressure, and lymphocyte percentage. Neutrophil-to-Lymphocyte ratio, Platelet-to-Neutrophil ratio, and Platelet-to-Lymphocyte ratio independently predicted END. Model 1 exhibited moderate predictive ability (AUC 0.721 in training, AUC 0.635 in test). Model 2, which integrated clinical indicators and inflammatory cell ratios, demonstrated strong performance in both training (AUC 0.862) and test (AUC 0.816). Machine learning models, combining clinical indicators and inflammatory cell ratios before IVT, accurately predict END and associated risk in AIS.
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Affiliation(s)
- Huan Yang
- Department of Emergency, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Zhe Lv
- Department of Emergency, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Wenxi Wang
- Department of Magnetic Resonance Imaging, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Yaohui Wang
- Department of Emergency, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Jie Chen
- Department of Emergency, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Zhanqiu Wang
- Department of Magnetic Resonance Imaging, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
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Zhai M, Yang J, Cao X, Li Y, Xu H, Wang Y. Determinants of 1-Year Unfavorable Outcomes of Intravenous Alteplase Thrombolysis for Acute Ischemic Stroke. Clin Appl Thromb Hemost 2023; 29:10760296231187616. [PMID: 37461226 DOI: 10.1177/10760296231187616] [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] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Intravenous thrombolytic therapy has become the standard of treatment for eligible patients with ischemic stroke. However, outcomes after receiving intravenous thrombolytic therapy vary widely. This study aims to investigate determinants of 1-year clinical outcomes of intravenous thrombolytic therapy for patients with acute ischemic stroke. METHODS In a prospective, observational study, patients with acute ischemic stroke treated with intravenous thrombolysis were consecutively included, and clinical information and laboratory data were collected. The patients were followed up for 12 months after onset, and the 1-year clinical outcome was evaluated using modified Rankin Scale scores. A score ≥ 3 was defined as unfavorable functional outcome. Univariate and multivariate logistic regressions were used to assess the determinants of the 1-year clinical outcomes of intravenous thrombolysis for acute ischemic stroke. RESULTS A total of 222 patients with intravenous thrombolysis were enrolled, and we identified 58 patients (26.1%) had unfavorable functional outcomes. Multivariate logistic regression analysis revealed that mean platelet volume-to-lymphocyte ratio (MPVLR) (odds ratio [OR] = 1.114, 95% confidence interval [CI]: 1.024-1.211, P = .012), atrial fibrillation (OR = 2.553, 95% CI: 1.086-6.002, P = .032), symptomatic stenosis occlusion (OR = 2.547, 95% CI: 1.269-5.110, P = .009), and baseline National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.141, 95% CI: 1.074-1.212, P < .001) were independent predictors of unfavorable functional outcomes at 1 year. CONCLUSIONS In patients receiving intravenous thrombolysis, we found that MPVLR, atrial fibrillation, symptomatic stenosis occlusion, and baseline NIHSS score were significant predictors of unfavorable functional outcomes at 1 year.
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Affiliation(s)
- Mingfeng Zhai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurology, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China
| | - Jinwei Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoyan Cao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui Public Health Clinical Center, Hefei, China
- Anhui Public Health Clinical Center, Hefei, China
| | - Yingying Li
- Department of Neurology, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China
| | - Hui Xu
- Department of Neurology, The Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Huang P, Yi X. Effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving alteplase intravenous thrombolysis. Int J Immunopathol Pharmacol 2023; 37:3946320231204597. [PMID: 37771034 PMCID: PMC10540570 DOI: 10.1177/03946320231204597] [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: 06/25/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
Objective: To investigate the effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving intravenous alteplase thrombolysis. Methods: Patients with acute ischemic stroke who received intravenous alteplase thrombolysis between January 2016 and December 2017 were enrolled. The clinical prognosis was assessed using the modified Rankin Scale (mRs) at 90 days after onset. Univariate and multivariate logistic regression analyses were conducted to investigate whether admission serum glucose was an independent factor in the 90-day prognosis. The predictive value of admission serum glucose for a 90-day poor prognosis was evaluated using receiver operating characteristic (ROC) curves. All patients were divided into two groups based on admission serum glucose levels: high admission serum glucose (above the cut-off value) and low admission serum glucose (below the cut-off value). The 90-day prognosis of patients with different admission serum glucose was analyzed. Results: A total of 138 patients were enrolled, including 79 males (57.24%), with a mean age of (68 ± 12) years and a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 9 (6 to 13.75). There were 74 cases (53.62%) in the good prognosis group and 64 cases (46.37%) in the poor prognosis group. The results of the univariate analysis indicated that admission serum glucose in the good prognosis group was significantly lower than that in the poor prognosis group [(7.45 ± 2.31) versus (8.80 ± 3.65), p < .05]. Logistic regression analysis revealed that the admission serum glucose level was an independent risk factor for clinical prognosis at 90 days after onset (OR = 1.24, 95% CI:1.01-1.52). ROC curve analysis showed that the cutoff value of admission serum glucose for predicting poor prognosis 90 days after intravenous thrombolytic therapy with alteplase was 6.77 mmol/l AUC (area under curve) 0.623, 95%CI: 0.53-0.72, sensitivity 68.80%, specificity 52.70%. When compared with the admission serum glucose ≥6.77 mmol/l group (83 cases), the 90-day mRS scores in the admission serum glucose <6.77 mmol/l group (55 cases) were lower [3 (1 to 5) scores versus 1 (0 to 3) scores, Z = 2.89, p < .05]. Conclusions: In patients with acute ischemic stroke receiving intravenous alteplase thrombolytic therapy, a higher admission serum glucose level is an independent predictor of adverse neurological outcomes at 90 days postoperatively.
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Affiliation(s)
- Pan Huang
- Department of Neurology, People’s Hospital of Deyang City, Deyang, China
| | - Xingyang Yi
- Department of Neurology, People’s Hospital of Deyang City, Deyang, China
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Ping Z, Min L, Qiuyun L, Xu C, Qingke B. Prognostic nomogram for the outcomes in acute stroke patients with intravenous thrombolysis. Front Neurosci 2022; 16:1017883. [PMID: 36340757 PMCID: PMC9627298 DOI: 10.3389/fnins.2022.1017883] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background and purpose The prediction of neurological outcomes in ischemic stroke patients is very useful in treatment choices, as well as in post-stroke management. This study is to develop a convenient nomogram for the bedside evaluation of stroke patients with intravenous thrombolysis. Materials and methods We reviewed all enrolled stroke patients with intravenous thrombolysis retrospectively. Favorable outcome was defined as modified Rankin Score (mRs) less than 2 at 90 days post thrombolysis. We compared the clinical characteristics between patients with favorable outcome and poor outcome. Then, we applied logistic regression models and compared their predictability. Results A total of 918 patients were enrolled in this study, 448 patients from one hospital were included to develop a nomogram, whereas 470 patients from the other hospital were used for the external validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with baseline NIHSS, blood sugar, blood cholesterol level, part-and full anterior circulation infarction (OCSP type). The AUC was 0.767 (95% CI 0.653–0.772) and 0.836 (95% CI 0.697–0.847) in the derivation and external validation cohorts, respectively. The calibration plot for the probability of severe neurological outcome showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts. Conclusion A convenient outcome evaluation nomogram for patients with intravenous thrombolysis was developed, which could be used by physicians in making clinical decisions and predicting patients’ prognosis.
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Affiliation(s)
- Zheng Ping
- Key Laboratory and Neurosurgery, Shanghai Pudong New Area People’s Hospital, Shanghai, China
- *Correspondence: Zheng Ping, ; orcid.org/0000-0002-3928-3875
| | - Li Min
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Lu Qiuyun
- Department of Neurology, Shanghai Eighth People’s Hospital, Shanghai, China
| | - Chen Xu
- Department of Neurology, Shanghai Eighth People’s Hospital, Shanghai, China
| | - Bai Qingke
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, China
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Lu H, Li S, Zhong X, Huang S, Jiao X, He G, Jiang B, Liu Y, Gao Z, Wei J, Lin Y, Chen Z, Li Y. Immediate outcome prognostic value of plasma factors in patients with acute ischemic stroke after intravenous thrombolytic treatment. BMC Neurol 2022; 22:359. [PMID: 36127663 PMCID: PMC9487126 DOI: 10.1186/s12883-022-02898-6] [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: 07/09/2022] [Accepted: 09/09/2022] [Indexed: 12/04/2022] Open
Abstract
In the present study, we explored multiple plasma factors to predict the outcomes of patients with AIS after IVT. Fifty AIS patients who received IVT with alteplase were recruited and divided into two groups according to their NIHSS scores. Serum from all subjects was collected to quantitatively analyze the levels of different plasma factors, IL-6, MMP-9, ADAMTS13, TNC, GSN and TRX, using Luminex assays or ELISA measurements. Compared with the levels assessed at the onset of AIS, the levels of MMP-9 (P < 0.001), ADAMTS13 (P < 0.001), and TRX (P < 0.001) significantly decreased after IVT. The level of IL-6 was significantly increased in the NIHSS > 5 group at admission (P < 0.001) compared to the NIHSS ≤ 5 group. AIS patients with a poor prognosis had lower levels of ADAMTS13 at 72 h post-IVT compared with patients with a good prognosis (P = 0.021). IL-6 also was notably higher in the poor outcome group (P = 0.012). After adjusting for confounders, ADAMTS13 at 72 h post-IVT was an independent protective factor for prognosis in AIS patients with an adjusted OR of 0.07 (P = 0.049), whereas IL-6 was an independent predictor of risk for AIS patients with an adjusted OR of 1.152 (P = 0.028). IVT decreased MMP-9, ADAMTS13, and TRX levels in the plasma of AIS patients. Patients with a NIHSS score of less than 5 exhibited lower IL-6 levels, indicating that increased levels of IL-6 correlated with AIS severity after IVT. Therefore, IL-6 and ADAMTS13 might be useful plasma markers to predict the prognosis in AIS patients at 90-days after IVT.
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Affiliation(s)
- Huanhuan Lu
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Siyi Li
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Xin Zhong
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Shuxuan Huang
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Xue Jiao
- Youjiang Medical University For Nationalities, NO.98 ChengXiang Road, Baise, 533000, China
| | - Guoyong He
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Bingjian Jiang
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yuping Liu
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Zhili Gao
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jinhong Wei
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yushen Lin
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Zhi Chen
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China.
| | - Yanhua Li
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Institute of Brain and Mental Diseases, Guangxi Academy of Medical Sciences, Nanning, China.
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Satumanatpan N, Tonpho W, Thiraratananukulchai N, Chaichanamongkol P, Lekcharoen P, Thiankhaw K. Factors Associated with Unfavorable Functional Outcomes After Intravenous Thrombolysis in Patients with Acute Ischemic Stroke. Int J Gen Med 2022; 15:3363-3373. [PMID: 35368796 PMCID: PMC8964447 DOI: 10.2147/ijgm.s362116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Intravenous thrombolysis (IVT) has become a standard treatment for eligible ischemic stroke patients. However, functional outcomes after receiving IVT varied widely. Hence the primary goal of this study is to identify characteristics related to poor outcomes. Patients and Methods The study enrolled acute ischemic stroke patients aged 18 or older who received IVT within 4.5 hours after onset between January 2018 and December 2020. The data were retrospectively collected from medical records. The patients were classified as having an excellent (0–2) or poor (3–6) outcomes based on the 90-day modified Rankin Scale (mRS). Univariable and multivariable logistic regression analyses were used to evaluate the results. The predictive model was determined and developed the score using regression coefficients. The prediction power was validated using the area under the receiver operating characteristic curve analysis. Results The study included 138 eligible participants. Forty-eight patients had unfavorable functional outcomes. With multivariable logistic regression analysis, factors significantly associated with poor outcomes were age (adjusted odds ratio (AOR), 1.03; 95% confidence interval (CI), 0.99–1.07; P = 0.05), diabetes (3.96; 1.61–9.37; P = 0.003), admission National Institute of Health Stroke Scale (NIHSS) (1.08; 1.01–1.15; P = 0.02) and initial Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (0.56; 0.37–0.86; P = 0.009). The predictive model developed from the findings demonstrated good discrimination power (AuROC 0.803, 95% CI 0.728–0.877). Conclusion The current study found that older age, diabetes, atrial fibrillation, higher admission NIHSS, and lower ASPECTS on the initial NCCT brain were related to unfavorable functional outcomes following IVT and served as good predictors of patient functional outcomes.
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Affiliation(s)
- Nat Satumanatpan
- Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Warinyupa Tonpho
- Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | | | | | | | - Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- The Northern Neuroscience Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Correspondence: Kitti Thiankhaw, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawaroros Road, Sriphum, Chiang Mai, 50200, Thailand, Tel +66 5393 5899, Fax +66 5393 5481, Email ;
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