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1.
Low-molecular-weight heparins and heparinoids in acute ischemic stroke : a meta-analysis of randomized controlled trials 总被引:24,自引:0,他引:24
BACKGROUND AND PURPOSE: Low-molecular-weight heparins and heparinoids (LMWHs) are superior to unfractionated heparin in the prevention and treatment of venous thromboembolism and acute coronary syndromes. We performed a systematic review of randomized controlled trials (RCTs) to examine the safety and efficacy of LMWH in acute ischemic stroke. METHODS: Randomized, controlled, and nonconfounded trials of LMWH in acute ischemic stroke were identified from the Cochrane Library (version 2, 1999), previous systematic reviews, and a review of publication quality relating to acute stroke trials. The authors each independently extracted data by treatment group and assessed trial quality using Cochrane Collaboration criteria. RESULTS: Eleven completed RCTs involving 3048 patients were identified; data were available from 10 of these. Four trials explicitly excluded patients with presumed cardioembolic stroke. Treatment with LMWH was associated with significant reductions in prospectively identified deep vein thrombosis (OR 0.27, 95% CI 0.08 to 0.96) and symptomatic pulmonary embolism (OR 0.34, 95% CI 0.17 to 0.69) and with increased major extracranial hemorrhage (OR 2.17, 95% 1.10 to 4.28). Nonsignificant increases in end-of-treatment (OR 1.20, 95% CI 0.86 to 1.69) and end-of-trial (OR 1.05, 95% CI 0.83 to 1.32) case fatality and symptomatic intracranial hemorrhage (OR 1.77, 95% CI 0. 95 to 3.31) were observed. End-of-trial death and disability was nonsignificantly reduced (OR 0.87, 95% CI 0.72 to 1.06). CONCLUSIONS: ++LMWHs reduce venous thromboembolic events in patients with acute ischemic stroke and increase the risk of extracranial bleeding. A nonsignificant reduction in combined death and disability and nonsignificant increases in case fatality and symptomatic intracranial hemorrhage were also observed. On the basis of the current evidence, LMWH should not be used in the routine management of patients with ischemic stroke. 相似文献
2.
Thrombolysis increases case fatality but reduces the proportion of disabled survivors in recent trials in acute ischaemic
stroke, although some trials show much higher mortality rates than others. One possible explanation for the different outcomes
between trials is that the treatment effect with thrombolysis varies with baseline prognostic factors such as stroke severity.
We examined the interaction between baseline risk and thrombolysis on outcome using individual patient data from the Multicentre
Acute Stroke Trial–Italy (MAST-I). A multiple logistic regression of the MAST-I data was performed to identify which factors,
identifiable at randomisation, most strongly predict a poor functional outcome. We then stratified the patients into those
with severe strokes and those with mild strokes and examined the effect of thrombolysis on (a) case fatality and (b) dependency
at 6 months after the stroke in the 157 patients who received streptokinase alone and the 156 controls. Streptokinase was
found to cause an absolute increase of about 3% in case fatality in both “severe” and “mild” strokes; however, there was a
12% reduction in the number of dead or dependent “mild” strokes but a 6% increase in “severe” strokes. The number of patients
was small, and therefore neither finding was statistically significant. In this exploratory analysis, the hazard with streptokinase
appears similar in “severe” and “mild” strokes, but the benefit may be greater in “mild” strokes. Thrombolysis may be more
effective in patients with “mild” strokes, but more information is required to confirm this hypothesis.
Received: 29 January 1999 Received in revised form: 13 April 1999 Accepted: 5 May 1999 相似文献
3.
Silent infarcts in stroke patients: patient characteristics and effect on 2-year outcome 总被引:2,自引:0,他引:2
Corea F Hénon H Pasquier F Leys D;Lille Stroke/Dementia Study Group 《Journal of neurology》2001,248(4):271-278
Although silent infarcts (SIs) are frequent in stroke patients, their clinical significance remains controversial, and their
effect on stroke outcome remains unclear. This study evaluated the prevalence of SI on computed tomography, associated factors,
and the effect on outcome in stroke patients. We studied 202 consecutive patients admitted for acute ischaemic or haemorrhagic
stroke with clinical deficits lasting more than 24 h. Survivors were followed up for 24 months; no patient was lost to follow-up.
Patients with Rankin scores of 2 or lower were considered separately. New vascular events were also recorded. Computed tomography
showed that one-fourth of patients (52/202) had at least one SI; these were located in deep hemispheric areas in 46 patients,
superficial hemispheric areas in 5, and the posterior fossa in 7. Logistic regression analysis showed the factors independently
associated with SI to be severe leukoaraiosis (OR 1.71, 95 % CI 1.26–2.31) and small-vessel occlusion as presumed cause of
the index stroke (OR 2.66, 95 % CI 1.22–5.79). SI did not affect vital or functional outcome or the occurrence of new vascular
events within 2 years after stroke. Whether they affect cognitive outcome remains under evaluation over a longer follow-up
period.
Received in revised form: 10 August 2000, Accepted: 22 August 2000 相似文献
4.
Glycerol for acute stroke: a Cochrane systematic review 总被引:3,自引:0,他引:3
Righetti E Celani MG Cantisani TA Sterzi R Boysen G Ricci S 《Journal of neurology》2002,249(4):445-451
Brain oedema is a major cause of early death after stroke. Glycerol is a hyperosmolar agent that is claimed to reduce brain
oedema. We sought to determine whether I. V. glycerol treatment in acute stroke, either ischaemic or haemorrhagic, influences
death rates and functional outcome in the short or long term and whether the treatment is safe. The Cochrane Stroke Group
Trials Register was searched, conference proceedings were screened and some trialists were personally contacted. We considered
all completed, controlled, published and unpublished comparisons, evaluating clinical outcome, in which intravenous glycerol
treatment was initiated within the first days after stroke onset. Death from all causes, functional outcome and adverse effects
were analysed. Analysis of short term death for acute ischaemic and/or haemorrhagic stroke was possible in ten trials where
482 glycerol treated patients were compared with 463 control patients. Glycerol was associated with a non-significant reduction
in the odds of death within the scheduled treatment period (OR 0.78, 95 % Confidence Intervals 0.58–1.06). Among patients
with definite or probable ischaemic stroke, glycerol was associated with a significant reduction in the odds of death during
the scheduled treatment period (odds ratio 0.65, 95 % CI 0.44–0.97). However, at the end of the scheduled follow up period
there was no significant difference in the odds of death (odds ratio 0.98, 95 % CI 0.73–1.31). Functional outcome was reported
in only two studies and there was a non-significant positive effect on outcome at the end of scheduled follow up (odds ratio
0.73, 95 % CI 0.37–1.42). Haemolysis seems to be the only relevant adverse effect of glycerol treatment. This systematic review
suggests a favourable effect of glycerol treatment on short term survival in probable or definite ischaemic stroke, but the
magnitude of the treatment effect may be minimal (as low as a 3 % reduction in odds). Because of the relatively small number
of patients and because the trials have been performed in the pre-CT era, the results must be interpreted cautiously. The
lack of evidence of benefit in long term survival does not support the routine or selective use of glycerol treatment in patients
with acute stroke.
Received: 17 May 2001, Received in revised form: 5 August 2001, Accepted: 27 August 2001 相似文献
5.
Serum neurofilaments are markers of axonal injury. We investigated whether serum neurofilament light (sNfL) is a potential prognostic marker of functional outcome in Chinese patients with acute ischemic stroke (AIS). From May 2015 to December 2018, consecutive patients with AIS from the Department of Neurology of the Second Hospital of Jilin University were included. sNfL concentration was tested at baseline, and stroke severity was analyzed at admission using the NIHSS score. Functional outcome was assessed at discharge by the modified Rankin scale (mRS). The sNfL concentration was tested in 343 patients with a median value of 17.8 (IQR, 13.4–25.2) pg/ml. sNfL concentration paralleled lesion size (P = 0.035). At admission, 174 patients were defined as moderate-to-high stroke (NIHSS ≥ 5); the sNfL concentration in those patients were higher than that observed in patients with minor clinical severity [21.2 (IQR, 15.1–31.7) vs. 14.9 (11.8–19.4) pg/ml, P < 0.001]. For each 1 quartile increase of sNfL concentration, the unadjusted and adjusted risk of moderate-to-high stroke increased by 202% (with the OR of 3.04 (95% CI 2.15–4.32), P < 0.001) and 102% [2.02 (1.10–3.16), P = 0.001), respectively. At discharge, 85 patients (24.8%) had poor functional outcome (mRS, 3–6); the sNfL concentration in those patients were higher than that observed in patients with good outcome [24.1 (IQR, 18.8–33.9) vs. 15.7 (11.9–21.8) pg/ml, P < 0.001]. For each 1 quartile increase of sNfL concentration, the unadjusted and adjusted risk of poor outcome increased by 236% [with the OR of 3.36 (95% CI 2.23–5.06), P < 0.001] and 102% [2.29 (1.37–3.82), P < 0.001], respectively. The results show sNfL is meaningful blood biomarker to monitor stroke severity and functional outcome in ischemic stroke, suggesting that sNfL may play a role in stroke progression. 相似文献
6.
《Journal of stroke and cerebrovascular diseases》2002,11(2):55-62
Aspirin is the standard treatment for acute ischemic stroke, although heparins are widely prescribed. We performed a systematic review of randomized controlled trials to compare the safety and efficacy of low molecular weight heparins (LMWH) with aspirin in acute ischemic stroke. Two completed randomized controlled trials involving 1,933 patients were identified; 1 trial only included patients with presumed cardioembolic stroke. As compared with aspirin, treatment with heparin was associated with a significant reduction in symptomatic venous thromboembolism (odds ratio [OR] - 0.29, 95% confidence interval [CI] - 0.12-0.66) and an increase in major extracranial hemorrhage (OR - 2.57, 95% CI - 1.01-6.52). Nonsignificant increases in end-of-treatment case fatality (OR - 1.35, 95% CI - 0.87-2.08) and symptomatic intracranial haemorrhage (OR - 1.82, 95% CI - 0.68-4.87) were seen; symptomatic intracranial haemorrhage was significantly raised (OR - 4.26, 95% CI - 1.04-17.4) with heparin in patients treated within 24 hours of stroke onset. Stroke recurrence (OR - 1.24, 95% CI - 0.79-1.94) and deterioration (OR - 1.13, 95% CI - 0.85-1.50) during treatment and end-of-trial death (OR - 1.00, 95% CI - 0.77-1.30) or dependency and case fatality (OR - 1.03, 95% CI - 0.85-1.25) did not differ between the 2 treatments. No benefit of LMWH over aspirin was seen in patients with presumed cardioembolic stroke. Low molecular weight heparin should not replace aspirin in the routine management of patients with ischemic stroke, including those with presumed cardioembolic stroke. Copyright © 2002 by National Stroke Association 相似文献
7.
Elisabetta Groppo Riccardo De Gennaro Gino Granieri Patrik Fazio Edward Cesnik Enrico Granieri Ilaria Casetta 《Neurological sciences》2012,33(1):53-58
The reported annual incidence of juvenile stroke ranges from 9 to 47 cases per 100,000 inhabitants. We sought to estimate
the incidence of first-ever stroke in young adults through a population-based stroke registry in a well-defined and stable
population. We planned to collect all cases of new stroke in people aged 15–44 years in Ferrara, Italy, over the period 2002–2007.
During the surveillance period, a first-ever stroke was diagnosed in 39 patients, giving a mean annual crude incidence rate
of 12.1 cases per 100,000 person-years (95% CI 8.6–16.5), 9.1 when adjusted to the European population. The overall 30-day
case fatality rate was 7.7, 21.4% for hemorrhagic stroke. The incidence rate was in the range of estimates detected in western
countries. The case-fatality rate was lower than that reported in less recent studies. The stroke subtype predicted the probability
of death and the outcome. 相似文献
8.
Causes of early and delayed death after stroke differ. It has been suggested that delayed mortality rate was increased in
patients with post-stroke dementia. Prestroke dementia is frequent: its influence on survival in stroke patients has never
been evaluated. The aim of this study was to evaluate the influence of prestroke dementia on early and delayed mortality rate
after stroke. In a cohort of 202 consecutive stroke patients aged ≥ 40 years admitted between November 1995 and May 1996 in
a primary care center, the prevalence of prestroke dementia was determined using the Informant Questionnaire on Cognitive
Decline in the Elderly (IQCODE) with a cut-off of 104. Patients were followed-up for 3 years. Statistics were performed using
life-table methods.
Of 202 patients, 33 had prestroke dementia. Of 142 survivors at month–6, 44 were demented, of them 15 having prestroke and
29 new-onset post-stroke dementia. No patient was lost to follow-up. The risk of death at month–6 was higher in patients with
prestroke dementia (RR 2.7; 95 % CI: 1.6–4.8). However, independent predictors of early death were age, severity of the deficit
at admission, type and etiology of stroke. The risk of delayed death was higher in patients with prestroke dementia (RR 4.97;
95 % CI: 1.76–13.98) as in patients with new-onset post-stroke dementia (RR 6.24; 95 % CI: 2.67–14.57), compared with non-demented
patients. The mortality rate did not differ between patients with prestroke and new-onset post-stroke dementia. Dementia at
month–6 was an independent predictor of delayed death (RR 5.7; 95 % CI: 2.4–13.4), with age and stroke recurrence. Causes
of death did not differ between demented and non-demented patients. Dementia adversely influences vital outcome in stroke
patients, perhaps partly because the therapeutic approach differs between demented and non-demented patients.
Received: 5 September 2001, Received in revised form: 20 June 2002, Accepted: 26 June 2002
Correspondence to Hilde Hénon, MD, PhD 相似文献
9.
G. D'Alessandro E. Bottacchi M. Di Giovanni C. Martinazzo L. Sironi C. Lia L. Carenini G. Corso V. Gerbaz C. Polillo M. Pesenti Compagnoni 《Neurological sciences》2000,21(1):13-18
The objective of this study was to evaluate temporal changes of stroke in an Italian community by comparing the present incidence
rates with those reported in the same area for 1989. The two studies were conducted by the same research group and met almost
all the criteria proposed for an “ideal” stroke incidence study. The annual incidence rate per 1000 inhabitants increased
(p < 0.01) by 29% from 2.23 (95% CL, 1.96–2.50) in 1989 to 2.89 (95% CL, 2.58–3.20) in 1997. No statistically significant change
was found when these rates were adjusted to the 1991 Italian population. The overall incidence rate was 2.40 (95% CL, 2.14–2.66)
in 1989 and 2.65 (95% CL, 2.39–2.91) in 1997. The thirty-day case fatality rate declined dramatically (p < 0.001) from 31% (95% CL, 26– 36) to 20% (95% CL, 16–24) between 1989 and 1997. Ageing of the population and better identification
of cases could explain the high incidence rate, whereas the decrease of fatality rate may be due to a general improvement
in acute care and inclusion of milder cases.
Received: 24 August 1999 / Accepted in revised form: 2 December 1999 相似文献
10.
Smith WS Tsao JW Billings ME Johnston SC Hemphill JC Bonovich DC Dillon WP 《Neurocritical care》2006,4(1):14-17
Introduction Independent predictors of outcome for ischemic stroke include age and initial stroke severity. Intracranial large-vessel occlusion
would be expected to predict poor outcome. Because large-vessel occlusion and stroke severity are likely correlated, it is
unclear if largevessel occlusion independently predicts outcome or is simply a marker for stroke severity.
Methods A consecutive series of patients with suspected stroke or transient ischemic attack were imaged acutely with computed tomography
angiography (CTA). CTAs were reviewed for intracranial large-vessel occlusion as the cause of the stroke. Baseline National
Institutes of Health Stroke Scale (NIHSS) score, discharge modified Rankin score, and patient demographics were abstracted
from hospital records. Poor neurological outcome was defined as modified Rankin score exceeding 2.
Results Seventy-two consecutive patients with acute ischemic stroke were imaged with CTA. The median (range) time from stroke symptom
onset to CT imaging was 183 minutes (25 minutes to 4 days). Median NIHSS score was 6 (1–32) and intracranial large-vessel
occlusion was found in 28 (38.9%) patients. Fifty-six percent of patients had a good neurological outcome. In multivariate
logistic regression analysis, two variables predicted poor neurological outcome: baseline NIHSS score (OR 1.21,95% CI[1.07–1.37])
and presence of intracranial large-vessel occlusion (OR 4.48, 95% CI[1.19–16.9]). The predictive value of large-vessel occlusion,
on outcome was similar to an 8-point increase in NIHSS score.
Conclusion In patients presenting with acute brain ischemia, intracranial large-vessel occlusion independently predicts poor neurological
outcome at hospital discharge, as does the presence of a high NIHSS score. Performing routine intracranial vascular imaging
on acute stroke patients may allow for more accurate determination of prognosis and may also guide therapy. 相似文献
11.
Szolnoki Z Maasz A Magyari L Horvatovich K Farago B Somogyvari F Kondacs A Szabo M Fodor L Bodor A Hadarits F Melegh B 《Neuromolecular medicine》2006,8(3):353-360
The renin-angiotensin system plays an important role in the maintenance of blood pressure homeostasis. The angiotensin-converting
enzyme (ACE) converts angiotensin I into angiotensin II. Angiotensin II, which binds the angiotensin II type-1 receptor (AT1R),
is a potent vasoconstrictor. On a pathophysiological basis, both ACE I/D and AT1R A1166C polymorphism lead to an enhanced
activity of the angiotensin II-AT1R axis, thereby possibly contributing to circulatory disturbances. A mutually facilitatory
effect may be presumed between the two polymorphisms. We examined whether this synergistic effect is involved in the evolution
of different types of ischemic stroke. Genetic and clinical data on 308 consecutive patients with acutely developing ischemic
stroke were analyzed. A total of 272 stroke and neuroimaging alteration-free subjects served as a control group. Univariate
and logistic regression statistical approaches were used. The ACE D allele combined with the AT1R 1166C allele did not yield
a risk of ischemic stroke. However, the co-occurrence of the homozygous ACE D/D and at least one AT1R 1166C allele was more
frequent in the ischemic stroke group than in the control group (22.4 vs 11%, p<0.005, OR, 2.33; 95% CI, 1.46–3.7). After specific subgroup analysis, this synergistic association was even stronger for
small-vessel ischemic stroke (OR, 3.44; 95% CI, 1.9–6.24; p<0.0005). Multivariate logistic regression analysis of the data confirmed this association (adjusted OR, 3.54, 95% CI, 1.88–7.16;
p<0.0005). Our results demonstrate that ACE D/D and AT1R 1166C polymorphism were associated with the development of small-vessel
ischemic stroke through a mutually facilitatory interplay between them. Genetic interactions might contribute to the altered
functional network in renin-angiotensin system in vascular disorders. 相似文献
12.
H. M. den Hertog J. A. van Rossum H. B. van der Worp H. M. A. van Gemert R. de Jonge P. J. Koudstaal D. W. J. Dippel the PAIS investigators 《Journal of neurology》2009,256(12):2003-2008
Acute ischemic stroke may trigger an inflammatory response that leads to increased levels of C-reactive protein (CRP). High
levels of CRP may be associated with poor outcome because they reflect either an inflammatory reaction or tissue damage. We
evaluated the prognostic value of CRP within 12 h of onset of ischemic stroke. Levels of CRP were routinely obtained within
12 h of symptom onset in 561 patients with ischemic stroke. CRP values were dichotomized as <7 or ≥7 mg/L. The full range
of CRP values was used to detect a possible level-risk relationship. We studied the relation between CRP values and poor outcome
(modified Rankin Scale score >2) or death at 3 months. A multiple logistic regression model was applied to adjust for age,
sex, NIHSS score, current cigarette smoking, diabetes mellitus, hypertension, statin use, and stroke subtype. After adjustment
for potential confounders, patients with CRP levels ≥7 mg/L had a significantly increased risk of poor outcome (adjusted OR
1.6, 95% CI 1.1–2.4) or death (adjusted OR 1.7, 95% CI 1.0–2.9) at 3 months. In addition, the risk of poor outcome or death
at 3 months increased with higher levels of CRP. CRP within 12 h of ischemic stroke is an independent prognostic factor of
poor outcome at 3 months. 相似文献
13.
Objective To examine
whether intravenous recombinant
tissue plasminogen activator (rt–PA) treatment given in the acute
phase of ischaemic stroke has a
favourable effect on cognitive and
functional outcome at six months
post–stroke.
Methods The present
study included 92 patients with a
first–ever symptomatic infarct, of
whom 25 (27%) were subjected to
rt–PA treatment in the first three
hours post–stroke. Multivariate
logistic regression analyses adjusted
for stroke severity, education,
age, and sex were performed
to examine whether rt–PA treatment
influenced cognitive outcome
(assessed with a neuropsychological
examination covering 7 cognitive
domains), basic ADL independence
(modified Barthel Index
≥ 19), and instrumental ADL independence
(Frenchay Activities
Index ≥ 15) after six months.
Results The adjusted odds ratio for
intact cognition was 1.0 (95% CI
0.2 to 4.3), that for basic ADL outcome
13.5 (95 % CI 1.4 to 129.4)
and for instrumental ADL 7.1
(95 % CI 1.2 to 42.2).
Conclusion Our findings suggest that rt–PA
treatment is associated with a
favourable basic and instrumental
ADL outcome, but not with a beneficial
cognitive outcome after 6
months. 相似文献
14.
den Hertog HM van der Worp HB van Gemert HM Algra A Kappelle LJ van Gijn J Koudstaal PJ Dippel DW 《Journal of neurology》2011,258(2):302-307
Subfebrile temperature or fever is present in about a third of patients on the first day after stroke onset and is associated
with poor outcome. However, the temporal profile of this association is not well established. We aimed to assess the relationship
between body temperature on admission as well as the change in body temperature from admission to 24 h thereafter and functional
outcome and death. We analyzed data of 1,332 patients admitted within 12 h of stroke onset. The relation between body temperature
on admission or the change in body temperature from admission to 24 h thereafter (adjusted for body temperature on admission)
on the one hand and unfavorable outcome (death, or a modified Rankin Scale score >2) at 3 months on the other were expressed
as odds ratio per 1.0°C increase in body temperature. Adjustments for potential confounders were made with a multiple logistic
regression model. No relation was found between admission body temperature and poor outcome (aOR 1.06; 95% CI 0.85–1.32) and
death (aOR 1.23; 95% CI 0.95–1.60). In contrast, increased body temperature in the first 24 h after stroke onset was associated
with poor outcome (aOR 1.30; 95% CI 1.05–1.63) and death (aOR 1.51; 95% CI 1.15–1.98). An early rise in body temperature rather
than high body temperature on admission is a risk factor for unfavorable outcome in patients with acute stroke. 相似文献
15.
I. Kane P. J. Hand C. Rivers P. Armitage M. E. Bastin R. Lindley M. Dennis J. M. Wardlaw 《Journal of neurology》2009,256(11):1832-1838
MR diffusion/perfusion mismatch may help identify patients for acute stroke treatment, but mixed results from clinical trials
suggest that further evaluation of the mismatch concept is required. To work effectively, mismatch should predict prognosis
on arrival at hospital. We assessed mismatch duration and associations with functional outcome in acute stroke. We recruited
consecutive patients with acute stroke, recorded baseline clinical variables, performed MR diffusion and perfusion imaging
and assessed 3-month functional outcome. We assessed practicalities, agreement between mismatch on mean transit time (MTT)
or cerebral blood flow (CBF) maps, visually and with lesion volume, and the relationship of each to functional outcome. Of
82 patients starting imaging, 14 (17%) failed perfusion imaging. Overall, 42% had mismatch (56% at <6 h; 41% at 12–24 h; 23%
at 24–48 h). Agreement for mismatch by visual versus volume assessment was fair using MTT (kappa 0.59, 95% CI 0.34–0.84) but
poor using CBF (kappa 0.24, 95% CI 0.01–0.48). Mismatch by either definition was not associated with functional outcome, even
when the analysis was restricted to just those with mismatch. Visual estimation is a reasonable proxy for mismatch volume
on MTT but not CBF. Perfusion is more difficult for acute stroke patients than diffusion imaging. Mismatch is present in many
patients beyond 12 h after stroke. Mismatch alone does not distinguish patients with good and poor prognosis; both can do
well or poorly. Other factors, e.g. reperfusion, may influence outcome more strongly, even in patients without mismatch. 相似文献
16.
《Journal of stroke and cerebrovascular diseases》2020,29(4):104659
Background: Many studies have evaluated the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and its prognostic value in ischemic stroke. However, a widespread consensus has not been reached. Therefore, we completed a meta-analysis to evaluate the prognostic significance of NT-proBNP for mortality and functional outcome in patients with ischemic stroke. Methods: We performed a systematic search and review using the PubMed and EMBASE databases to identify literature that reported a correlation between NT-proBNP and mortality and functional outcome in ischemic stroke patients. Results: Eleven studies inclusive of 10,498 patients met the inclusion criteria. Elevated plasma NT-proBNP levels were associated with increased risk of mortality in ischemic stroke patients (all-cause mortality: odds ratio [OR] = 2.43, 95% confidence interval [CI] 1.62-3.64, P < .001, I2=74.3%; cardiovascular mortality: OR = 2.01, 95% CI 1.55-2.61, P < .001, I2 = 42.6%). In addition, unfavorable functional outcomes were observed in patients with higher levels of NT-proBNP (OR = 1.68, 95% CI 1.13-2.50, P = .01, I2 = 90.8%) after ischemic stroke. Conclusions: This meta-analysis demonstrates that NT-proBNP could be a predictor of mortality and functional outcome in ischemic stroke patients. 相似文献
17.
Rosalba Patella Alessandra Spalloni Marco Ferrari Sara La Starza Alessandro Bozzao Maurizia Rasura 《Neurological sciences》2011,32(3):427-432
Ischemic stroke in young patients is a relatively rare event. Few studies have examined the long-term prognosis. The aim of
this study was to evaluate the long-term outcome to identify clinical, laboratory and radiologic patterns as possible predictors
for mortality, recurrence and functional recovery. We prospectively evaluated 94 patients (42 males and 52 females, aged 14–45 years,
mean age 35.5 years, SD 8.4) admitted to our Neurological Department, for first acute ischemic stroke. A 48-month follow-up
was performed. The patients were classified according to TOAST and Baltimore classification and Bamford criteria. The severity
of the neurological deficit on admission was assessed using the NIHSS. The follow-up included a clinical visit, the modified
Ranking scale (mRs) score, Barthel index (BI), and magnetic resonance imaging and intra-extracranial vessel Angio MRI. A good
functional outcome (mRS 0–1) was found in 74 patients and unfavourable outcome (mRS 2–6) in 20 patients. 16 patients had a
recurrent cerebral ischemic event: 5 patients had stroke and 11 patients had TIA. The average incidence annual rate of recurrence
was 4.5% and a mortality rate was of 1.06%. Our study does not demonstrate any predictive factor related to clinical outcome.
The relevant data of neuroradiological follow-up is the presence of clinically silent lesions in nine patients, considered
as a recurrent stroke. To attribute a prognostic role to these lesions, clinical and neuroradiological follow-up needs to
be continued. 相似文献
18.
Pezzini A Grassi M Del Zotto E Volonghi I Giossi A Costa P Cappellari M Magoni M Padovani A 《Journal of neurology》2011,258(4):634-640
The optimal management of blood pressure (BP) during acute stroke is controversial. We aimed to investigate whether (1) acute
BP has differential impact on clinical outcome of ischemic stroke (IS) and spontaneous intracerebral hemorrhage (ICH), and
(2) the magnitude of such an effect varies from the very acute phase to the postacute phase of the two diseases. BP values
were automatically recorded at 15-min intervals within the first 48 h in consecutive patients with stroke onset less than
24 h before Stroke Unit admission. Growth mixture models were applied to evaluate the association between binary outcome measures
[(1) early neurological deterioration (defined as a ≥4-point increase in 48-h National Institutes of Health Stroke Scale [NIHSS]
score), (2) 90-day unfavorable functional status (modified Rankin Scale [mRS] 3–6), and (3) 90-day mortality] and the latent
heterogeneity of maximum BP trajectories over time, expressed by two (high/low) BP latent classes within stroke groups. After
exclusions, 264 patients (198 IS, 66 ICH) were included. High systolic BP (sBP) class was associated with (1) a direct ~15%
increased risk of early neurological deterioration [risk difference (RD), +0.151; 95% confidence interval (CI) +0.039 to +0.263]
and ~4% worse 48-h outcome for ICH with respect to IS (RD, +0.038; 95% CI +0.005 to +0.071), (2) a ~28% increased risk of
90-day unfavorable outcome in the group of patients with ICH with respect to IS [IRD = RD(ICH) – RD(IS), +0.289; 95% CI +0.010
to +0.571], and (3) no significant effect on 90-day mortality. The influence of acute BP values on mid-term stroke outcome
varies depending on the stroke subtype. 相似文献
19.
Kleindorfer D Khoury J Kissela B Alwell K Woo D Miller R Schneider A Moomaw C Broderick JP 《Journal of child neurology》2006,21(5):415-418
A recent study reported that mortality from stroke in children and adolescents decreased by 58% from 1979 to 1998, although it wasn't clear if the case fatality or the incidence of stroke in this age group is decreasing. We report trends of stroke incidence and case fatality in children and adolescents within a large biracial population. The study involved collection of all strokes in the study population between January 1, 1988 and December 31, 1989, July 1, 1993 and June 30, 1994, and January 1, 1999 and December 31, 1999, at all of the regional hospitals serving the Greater Cincinnati/Northern Kentucky population (only the children's hospital in 1988). Study nurses reviewed the medical records of all inpatients with stroke-related discharge diagnoses and abstracted relevant data. A study physician reviewed each abstract to determine whether a stroke or transient ischemic attack had occurred. A total of 54 strokes occurred in children or adolescents younger than 20 years during the three study periods (30% African American, 70% Caucasian, and 56% female). The overall incidence rate of all strokes in children younger than 15 years was 6.4/100,000 in 1999, a nonsignificant increase when compared to 1988. The 30-day case-fatality rates were 18% in 1988-1989, 9% in 1993-1994, and 9% in 1999. We found that the incidence of strokes in children has been stable over the past 10 years. The previously reported nationwide decrease in overall stroke mortality in children might be due to decreasing case fatality after stroke and not decreasing stroke incidence. Based on our data, we conservatively estimated that approximately 3000 children less than 20 years old would have a stroke in the United States in 2004. 相似文献
20.
OBJECTIVES: To identify the clinical factors which predicted the outcome of ischemic stroke patients in northwest China. PATIENTS AND METHODS: We retrospectively reviewed 489 consecutive patients with ischemic stroke admitted to the Neurology Department of Xijing Hospital. Demographic, clinical and laboratory data were recorded. Follow-up assessments were performed by telephone interviews or letters. The clinical outcome was assessed by using the modified Rankin Scale (mRS) and categorized as good (score 0-2) or poor (score 3-6) outcomes. Univariate and multivariate logistic regression analyses were performed to explore predictors of ischemic stroke. RESULTS: The follow-up period was up to 47 months (mean, 28.3 months). Fifty-five patients (11.2%) were lost. Among these 434 patients, 244 (56.2%) patients had good outcome and 190 (43.8%) had poor outcome. The poor outcome was associated with old age (OR: 3.505; CI 95%: 2.100-5.849), lower educational level (OR: 0.686; CI 95%: 0.570-0.825), having stroke history (OR: 2.481; CI 95%: 1.442-4.268), and higher NIHSS total score (OR: 2.619; CI 95%: 1.584-4.330). CONCLUSION: The results suggest that age, the educational level, stroke history, and NIHSS score are useful in the prediction of functional outcome of ischemic stroke in Chinese northwest area. 相似文献