Abstract T MP65: Rate of Peri-Hematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sebastian Urday ◽  
Lauren A Beslow ◽  
David Goldstein ◽  
Feng Dai ◽  
Fan Zhang ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Intraventricular Hemorrhage ◽  
Strong Association ◽  
Expansion Rate ◽  
Multivariable Model ◽  
Hematoma Volume ◽  
Poor Functional Outcome ◽  
The Relationship

Background and Purpose: There have been conflicting reports regarding the association between peri-hematomal edema (PHE) in spontaneous intracerebral hemorrhage (ICH) and outcome. We hypothesized that PHE expansion rate from baseline to 24 hours predicts mortality and poor functional outcome after ICH. Methods: ICH, PHE and intraventricular hemorrhage volumes were measured for 139 subjects who presented with primary ICH and received head computed tomography scans at baseline and 24-hours post-ICH. Subjects were retrospectively identified from a prospective cohort study of ICH. Inclusion criteria were age over 18 years with primary spontaneous supratentorial ICH. Exclusion criteria were infratentorial hemorrhage, primary intraventricular hemorrhage, or any suspected cause of secondary ICH. Logistic regression was performed to evaluate the relationship between PHE expansion rate and 90-day mortality and functional outcome. Poor functional outcome was defined as a modified Rankin Scale (mRS) score > 2. Results: There was a strong association between PHE expansion rate and mortality (OR 1.42, p = 0.0025) and a trend in the correlation between PHE expansion rate and poor outcome (OR 1.50, p = 0.07). In a multivariable model accounting for hematoma volume and time from symptom onset to 24 hour scan, PHE expansion rate was a significant predictor of mortality (OR 1.07, p = 0.032). In a multivariable model accounting for hematoma volume, age, Glasgow Coma Scale score, presence of intraventricular hemorrhage and time from symptom onset to 24 hour scan, PHE expansion rate predicted poor functional outcome (OR 2.58, p = 0.05). Conclusions: PHE expansion rate predicts outcome in ICH and may represent a novel therapeutic target.

Abstract W P225: The Relationship between Leukocytosis and Time to Neurodeterioration

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Amelia K Boehme ◽  
James E Siegler ◽  
Karen C Albright ◽  
Alexander J George ◽  
Dominique Monlezun ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Poor Functional Outcome ◽  
Improve Outcome ◽  
Future Studies ◽  
Point Increase ◽  
Stroke Center ◽  
The Relationship

Background: Previous research has illustrated how leukocytosis after acute ischemic stoke (AIS) is related to poor functional outcome. A main predictor of poor functional outcome is neurodeterioration (ND). We sought to explore the relationship between leukocytosis and time to ND to identify a risk factor for a process that predicts poor functional outcome. Methods: Patients admitted to our stroke center (07/08-06/12) were retrospectively assessed. Leukocytosis was defined as WBC >11,000, ND was characterized as ≥ 2 point increase in NIHSS scale and poor functional outcome was classified as modified Rankin Scale (mRS) of 3-6. Patients were grouped into 2 categories: (1) the leukocytosis group- those who developed leukocytosis ≥24 hours after admission and those who presented with leukocytosis and remained at 24 hours and, (2) the non-leukocytosis group- those that did not have leukocytosis and those where the leukocytosis resolved within 24 hours of admission. Results: A cohort of AIS patients (N=476) with median age 64 years, 43% female and 69% Black were assessed. Of the patients with ND (27%), median time to ND was 43 hours. In the leukocytosis group (N=84), 42 (50.6%) of them developed ND. In the non-leukocytosis group (N=312), 75 (24.5%) developed ND. Leukocytosis within 24 hours of admission is predictive of earlier time to ND (p<0.0001; Figure 1). Adjusting for age, stroke severity, glucose, tPA and infection, the leukocytosis group had a 2 times greater risk for developing ND (HR 2.49, 95%CI 1.61-3.84, p<0.0001). Conclusion: Having leukocytosis persist from admission to 24 hours or developing leukocytosis within 24 hours of admission is a significant predictor of early ND, which often results in poor functional outcome. Identifying such a predictor can enable physicians to identify those at risk for ND and subsequent poor functional outcomes. Future studies are needed to identify if interventions targeting leukocytosis may improve outcome after stroke.

The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

2016 ◽  
Vol 42 (5-6) ◽  
pp. 485-492 ◽  
Author(s):  
Paola Forti ◽  
Fabiola Maioli ◽  
Michele Domenico Spampinato ◽  
Carlotta Barbara ◽  
Valeria Nativio ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Symptom Onset ◽  
Oldest Old ◽  
Hematoma Expansion ◽  
Elderly Subjects ◽  
Supporting Evidence ◽  
Hematoma Volume ◽  
Young Old

Background: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years). However, supporting evidence from cohort studies is limited. We investigated ICH characteristics of oldest-old subjects compared to young (<65 years), young-old (65-74 years) and old-old (75-84 years) subjects. We also investigated whether age is an independent mortality predictor in elderly (age ≥65 years) subjects with acute ICH. Methods: We retrospectively collected clinical and neuroimaging data of 383 subjects (age 34-104 years) with acute supratentorial primary ICH who were admitted to an Italian Stroke Unit (SU) between October 2007 and December 2014. Measured ICH characteristics included hematoma location, volume and intraventricular extension of hemorrhage on admission CT scan; admission Glasgow Coma Scale ≤8 and hematoma expansion (HE) measured on follow-up CT-scans obtained after 24 h. General linear models and logistic models were used to investigate the association of age with ICH characteristics. These models were adjusted for pre-admission characteristics, hematoma location and time from symptom onset to admission CT scan. Limited to elderly subjects, Cox models were used to investigate the association of age with in-SU and 1-year mortality: the model for in-SU mortality adjusted for pre-admission and ICH admission characteristics and the model for 1-year mortality additionally adjusted for functional status and disposition at SU discharge. Results: Independent of pre-admission characteristics, hematoma location and time from symptom onset to admission CT-scan, oldest-old subjects had the highest admission hematoma volume (p < 0.01). Age was unrelated to all other ICH characteristics including HE. In elderly patients, multivariable adjusted risk of in-SU and 1-year mortality did not vary across age categories. Conclusions: Oldest-old subjects with acute supratentorial ICH have higher admission hematoma volume than young and young-old subjects but do not differ for other ICH characteristics. When taking into account confounding from ICH characteristics, risk of in-SU and 1-year mortality in elderly subjects with acute supratentorial ICH does not differ across age categories. Our findings question use of age as an independent criterion for stratification of mortality risk in elderly subjects with acute ICH.

scholarly journals The relationship between modified Graeb score and intraventricular hematoma volume with Glasgow outcome scale and modified Rankin scale in intraventricular hemorrhage of brain: a comparative study

2021 ◽  
Author(s):  
Mohammad H. Rashid ◽  
Mohammad N. Hossain ◽  
Muhammad S. Hossain ◽  
Israt Z. Eva ◽  
Rumana Habib ◽  
...  
Keyword(s):  
Glasgow Outcome Scale ◽  
Intraventricular Hemorrhage ◽  
External Ventricular Drainage ◽  
Modified Rankin Scale ◽  
Hematoma Volume ◽  
College Hospital ◽  
Presenting Symptoms ◽  
Quasi Experimental ◽  
Gcs Score ◽  
The Relationship

Background: Intraventricular hemorrhage (IVH) is an acute neurosurgical condition. The aim of this study was to identify the relationship between modified Graeb score (mGS) and intraventricular hematoma volume with Glasgow outcome scale (GOS) and modified Rankin scale (mRS).Methods: This is a Quasi-experimental study conducted in the department of neurosurgery, Chittagong Medical College Hospital, Chittagong, Bangladesh during the period from 24 July 2018 to 23 July 2019. After a detailed history and clinical examination, 150 patients were selected for this study. The study participants were divided into two major groups- external ventricular drainage (EVD) and conservative; both groups consisted of 44 patients. Written informed consent were taken from the participants. Data were analyzed using statistical package for the social sciences (SPSS) software.Results: Overall mean age was around 60 years with an age range from 15-85 years. More than three fourth of the patients in both groups were from the age group of >50 years (73.83%). There were no differences between EVD and conservative groups regarding medical comorbidities. Most prevalent comorbidity among the patients of both groups’ hypertension, followed by diabetes and previous ischemic stroke. Overall the most frequent symptoms in the studied patients were vomiting, followed by loss of consciousness, headache and convulsion. There were no significant differences between the two groups regarding presenting symptoms. The mean Glasgow coma scale (GCS) score level was significantly lower in the patients with EVD than their counterpart from 1st post-operative day to 8th post-operative day. However, within-group comparison shows that the GCS score was significantly increased from 1st day to 8th day in both groups of patients.Conclusions: These findings can be used to identify patients in whom an EVD may provide measurable outcomes benefit with respect to patient mortality and help guide neurosurgical decision-making in particular patient subgroups with acute IVH.

scholarly journals Glycated Hemoglobin as a Marker for Predicting Outcomes of Patients With Stroke (Ischemic and Hemorrhagic): A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yaya Bao ◽  
Dadong Gu
Keyword(s):  
Functional Outcome ◽  
Hemorrhagic Stroke ◽  
Glycated Hemoglobin ◽  
Meta Analysis ◽  
Poor Functional Outcome ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Unit Increase ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Relationship

Background: Glycated hemoglobin (HbA1c) has emerged as a useful biochemical marker reflecting the average glycemic control over the last 3 months, and the values are not affected by short-term transient changes in blood glucose levels. However, its prognostic value in the acute neurological conditions such as stroke is still not well-established. The present meta-analysis was conducted to assess the relationship of HbA1c with outcomes such as mortality, early neurological complications, and functional dependence in stroke patients.Methods: A systematic search was conducted for the PubMed, Scopus, and Google Scholar databases. Studies, either retrospective or prospective in design that examined the relationship between HbA1c with outcomes of interest and presented the strength of association in the form of adjusted odds ratio/hazard ratios were included in the review. Statistical analysis was done using STATA version 13.0.Results: A total of 22 studies (15 studies on acute ischemic stroke and seven studies on hemorrhagic stroke) were included in the meta-analysis. For patients with acute ischemic stroke, each unit increase in HbA1c was found to be associated with an increased risk of mortality within 1 year, increased risk of poor functional outcome at 3 months, and an increased risk of symptomatic intracranial hemorrhage (sICH) within 24 h of admission. In those with HbA1c ≥ 6.5%, there was an increased risk of mortality within 1 year of admission, increased risk of poor functional outcomes at 3 and 12 months as well as an increased risk of symptomatic intracranial hemorrhage (sICH) within 24 h of admission. In patients with hemorrhagic stroke, each unit increase in HbA1c was found to be associated with increased risk of poor functional outcome within the first 3 months from the time of admission for stroke. In those with HbA1c ≥ 6.5%, there was an increased risk of poor functional outcome at 12 months.Conclusions: The findings indicate that glycated hemoglobin (HbA1c) could serve as a useful marker to predict the outcomes in patients with stroke and aid in the implementation of adequate preventive management strategies at the earliest.

scholarly journals Prediabetes is associated with poor functional outcome in patients with intracerebral hemorrhage

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Qiongzhang Wang ◽  
Guiqian Huang ◽  
Fei Chen ◽  
Pinglang Hu ◽  
Wenwei Ren ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Poor Functional Outcome

Prognostic Significance of Serum Magnesium in Acute Intracerebral Hemorrhage Patients

2019 ◽  
Vol 16 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Xianjun Han ◽  
Shoujiang You ◽  
Zhichao Huang ◽  
Qiao Han ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Serum Magnesium ◽  
Prognostic Significance ◽  
Stroke Severity ◽  
Linear Regression Models ◽  
Poor Functional Outcome ◽  
All Cause Mortality ◽  
Acute Intracerebral Hemorrhage

Background: Experimental animal model studies have shown neuroprotective properties of magnesium. We assessed the relationship between admission magnesium and admission stroke severity and 3-month clinical outcomes in patients with acute intracerebral hemorrhage (ICH). Methods: The present study included 323 patients with acute ICH who were prospectively identified. Demographic characteristics, lifestyle risk factors, National Institute of Health Stroke Scale (NIHSS) score, hematoma volumes, and other clinical features were recorded at baseline for all participants. Patients were divided into three groups based on the admission magnesium levels (T1: <0.84; T2: 0.84-0.91; T3: =0.91 mmol/L). Clinical outcomes were death, poor functional outcome (defined by modified rankin ccale [mRS] scores 3-6) at 3 months. Results: After 3-month follow-up, 40 (12.4%) all-cause mortality and 132 (40.9%) poor functional outcome were documented. Median NIHSS scores for each tertile (T1 to T3) were 8.0, 5.5, and 6.0, and median hematoma volumes were 10.0, 8.05, and 12.4 ml, respectively. There was no significant association between baseline NIHSS scores (P=0.176) and hematoma volumes (P=0.442) in T3 and T1 in multivariable linear regression models. Compared with the patients in T1, those in T3 were associated with less frequency of all-cause mortality [adjusted odds ratio (OR), 0.10; 95% confidence interval (CI), 0.02-0.54; P-trend=0.010] but not poor functional outcome (adjusted OR, 1.80; 95%CI, 0.71-4.56; P-trend=0.227) after adjustment for potential confounders. Conclusion: Elevated admission serum magnesium level is associated with lower odds of mortality but not poor functional outcome at 3 months in patients with acute ICH.

Abstract P440: Inpatient Blood Pressure Variability is Associated With Mortality and Poor Functional Outcome in Patients With Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Evangelos Pavlos Myserlis ◽  
Jessica R Abramson ◽  
Haitham Alabsi ◽  
Christopher D Anderson ◽  
Alessandro Biffi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Poor Functional Outcome ◽  
Logistic Regression Models ◽  
Established Risk Factor ◽  
The Impact

Introduction: Although elevated blood pressure (BP) is an established risk factor for intracerebral hemorrhage (ICH), the impact of acute BP fluctuations on ICH outcomes remains unclear. In this study, we sought to investigate the effect of acute BP variability (BPV) on mortality and functional outcome in ICH survivors. Methods: Subjects were consecutive ICH patients ≥ 18 years with available inpatient BP data, who survived hospitalization. Four measures of systolic BPV were calculated: standard deviation (SD), coefficient of variation (CoV), average real variability (ARV), and successive variation (SV). Our outcomes were (1) death and (2) poor functional outcome, defined as a modified Rankin Score (mRS) of 3-6 in a period between 60-120 days after discharge. We assessed the effect of hyperacute (ICH event-72 hours) and acute/subacute (72 hours-discharge) BPV on outcomes. We constructed Cox proportional hazards and logistic regression models to investigate the associations of BPV (per 10 mmHg increase) with mortality and poor functional outcome, respectively, after adjustment for potential confounders. Results: We included 345 patients, 120 of whom had available mRS data. 151 (43.8%) patients were female and 280 (81.2%) were white; mean age was 71 (±13) years. SBP ARV and SBP SV were the strongest predictors of mortality (HR 2.53-2.91 per 10 mmHg increase), while SBP SD, CoV, and SV were the strongest predictors of poor functional outcome (OR 2.89-5.14 per 10 mmHg increase) (Table) . These associations remained significant when analyzing both hyperacute as well as acute/subacute BPV. Compared to hyperacute BPV, acute/subacute BPV was more strongly associated with both mortality and poor functional outcome. Conclusion: Inpatient blood pressure variability is an important determinant of mortality and poor functional outcome in ICH survivors. Further studies are needed to investigate the role of addressing BPV as a potential target for intervention.

Abstract TP459: Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Cerebral Venous Thrombosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kai Liu ◽  
Shen Li ◽  
Bo Song ◽  
Yu Xu
Keyword(s):  
Multivariate Analysis ◽  
Regression Analysis ◽  
Venous Thrombosis ◽  
Functional Outcome ◽  
Cerebral Venous Thrombosis ◽  
Cox Regression ◽  
Poor Functional Outcome ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
The Relationship

Background: Increasing evidences suggest that neutrophil-to- lymphocyte ratio (NLR) is an independent predictor of poor prognosis in patients with cardiovascular disease. However, it is not clear about the relationship between NLR and prognosis in patients with cerebral venous thrombosis (CVT). Methods: Consecutive CVT patients from November 2011, through January 2017 were retrospectively identified. Unfavorable outcome was defined as modified Rankin Scale (mRS) of 3-6. Multivariate analysis and Cox regression analysis were conducted to evaluate the predictive value of NLR for unfavorable prognosis. Results: A total of 223 CVT patients were included. Multivariate analysis suggested that elevated NLR value, as a continuous variable, was significantly associated with a high risk of poor outcome (adjusted odds ratio [OR]=1.106, 95% confidence intervals [CI] 1.012-1.207, P = 0.025) and mortality (adjusted OR = 1.118; 95% CI, 1.017-1.230; P = 0.021).Receiver operating curve (ROC) analysis showed that the area under the ROC curves for NLR was 0.753 and the optimal cut-off value was 4.8 (sensitivity 81.1%, specificity 62.4%).Multivariate Cox regression analysis demonstrated that NLR>4.8 increased the risk of mortality (adjusted hazard ratio[HR]=6.111, 95% CI 1.680-22.232, P =0.006) and multivariate analysis further showed that NLR>4.8 was a significant predictor of poor functional outcome (adjusted OR=3.607, 95% CI 1.307-9.957, P =0.013). Conclusions: Elevated NLR value is associated with the long-term poor functional outcome and mortality. Future well-designed studies and experiments are needed to confirm the relationship and explore the potential mechanisms. Table 1 Results of multivariate logistic regression analysis ofpredictors for poor clinical outcome in CVTpatients. WBC,white blood cell; ANC, absolute neutrophil count; ALC, absolute lymphocyte count; *The multivariate model is adjusted for age, sex, coma, intracerebral hemorrhage, and straight sinus and/or deep CVT Figure 1. Kaplan-Meier curves of patients stratified according to the NLR value. The Kaplan-Meier curves showed a significant difference between the NLR>4.8 and NLR≤4.8 categories.

Abstract WP289: The Impact of Infection on Neurological Deterioration and Outcome in Acute Ischemic Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Amelia K Boehme ◽  
Andre D Kumar ◽  
Adrianne M Dorsey ◽  
James E Siegler ◽  
Michael J Lyerly ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Acute Hospitalization ◽  
Stroke Center ◽  
The Impact

Introduction: To date, few studies have assessed the influence of infection on neurological deterioration (ND) and other outcome measures in acute ischemic stroke. Methods: Patients admitted to our stroke center (07/08-12/10) were retrospectively assessed. Patients were excluded if they had an in-hospital stroke, unknown time of symptom onset, or delay from symptom onset to hospital arrival >48 hours. Positive blood or urine culture, or chest x-ray consistent with pneumonia were classified as infection and stratified according to whether the infection was diagnosed within the first 24 hours of admission or after 24 hours. ND was defined as an increase ≥2 points on the NIHSS score within a 24hr period. Poor functional outcome was defined as a mRS score of 3-6 on discharge. Results: Of the 334 patients included in this study, 78 had an infection (19 on admission). The majority of infections were found in the urinary tract (64%), while pneumonia (37%) and bacteremia (24%) were also common. Infection on admission was predictive of ND (Table 1; OR=2.79, 95% CI 1.18-6.64, p=0.0211) and poor functional outcome (OR=3.0, 95% CI 1.1-7.9, p=0.0182). Developing an infection during acute hospitalization was an even stronger predictor of ND (OR=11.9, 95% CI 5.8-24.5, p<0.0001) and poor functional outcome (OR=56.4, 95% CI 7.7-414, p<0.0001). After adjusting for age, NIHSS at baseline and glucose on admission, the development of an infection during acute hospitalization remained a significant predictor of ND (OR=8.9, 95% CI 4.2-18.6, p<0.0001) and poor functional outcome (OR=41.7, 95% CI 5.2-337.9, p=0.005) while an infection on admission was no longer predictive of ND (OR=1.5, 95%CI 0.59-3.99, p=0.3738) or poor functional outcome (OR=1.09, 95%CI 0.3-3.9, p=0.8984). Conclusion: Our data suggest that ischemic stroke patients who develop an infection during their acute hospitalization are at increased odds of experiencing ND and of being discharged with significant disability.

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