Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke

BACKGROUND: Hyperglycemia at the time of acute ischemic stroke has been linked to worse outcome in both human and animal studies. OBJECTIVE: To describe the prevalence and severity of hyperglycemia on hospital admission among acute ischemic stroke patients, to examine the independent relationship of admission hyperglycemia to all-cause mortality, and to document the inpatient management of hyperglycemia. METHODS: Patients hospitalized with acute ischemic stroke at one hospital from July 1993 to June 1998 (n = 656) were identified. Demographic data, diagnoses, and blood glucose (BG) values were retrieved from the electronic medical record system. Admission stroke severity, fingerstick BG results, and new diabetes diagnoses were obtained by chart review. Hyperglycemia was defined as admitting random serum BG > or = 130 mg/dL. Hazard ratios (HR) for 30-day, 1-year, and 6-year mortality were calculated using multivariable Cox regression models. RESULTS: Hyperglycemia at admission to hospital was present in 40% of patients with acute stroke. Patients with hyperglycemia were more often women and more likely to have prior diagnoses of diabetes and heart failure. Almost all of these patients remained hyperglycemic during their hospital stay (mean BG = 206 mg/dL), and 43% received no inpatient hypoglycemic drugs. Hyperglycemic patients had longer hospital stay (7 vs 6 days, p = 0.015) and higher inpatient hospital charges ($6,611 vs $5,262, p < 0.001). Hyperglycemia independently increased the risk for death at 30 days (HR 1.87, p < or = 0.01), 1 year (HR 1.75, p < or = 0.01), and 6 years after stroke (HR 1.41, p 相似文献   

急性缺血性脑卒中患者认知损害的危险因素分析

目的探讨急性缺血性脑卒中患者出现认知损害的危险因素,为预防脑卒中后认知损害提供依据。方法回顾性分析2015年1月至2018年9月住院的103例急性缺血性脑卒中患者的临床资料,所有入组病例均在入院第2天空腹采集肘静脉血测定血脂、同型半胱氨酸、空腹血糖及糖化血红蛋白。参照2019年美国糖尿病学会发布的"糖尿病医学诊疗标准"制定血糖控制标准(空腹血糖4.4~7.2mmol·L-1,糖化血红蛋白<6.5%)。发病第10~14天(病情稳定排除谵妄等情况)进行北京版蒙特利尔认知评估(MoCA)量表测评,将MoCA评分<26分为认知损害组(64例)和MoCA≥26分为无认知损害组(39例),通过统计学分析探讨急性缺血性脑卒中出现认知损害的危险因素。结果与无认知损害组比较,认知损害患者年龄偏大(P=0.013)、美国国立卫生研究院卒中量表(NIHSS)评分较高(P=0.016);认知损害组空腹血糖、糖化血红蛋白水平高于无认知损害组,且血糖控制达标情况较无认知损害组差(分别P=0.001,P=0.045,P=0.006,P=0.001)。结论高龄、NIHSS评分高、空腹血糖升高及血糖水平控制达标差是急性缺血性脑卒中患者出现认知损害的危险因素之一,血糖作为可控因素,严格控制血糖可能有助于预防急性缺血性脑卒中后认知损害的发生。     

急性脑梗死患者入院时糖代谢水平与病情演变及预后的关系

目的探讨糖代谢水平与急性脑梗死患者病情和预后的关系。方法将171例在我院住院治疗的急性脑梗死患者,根据次日凌晨空腹血糖和糖化血红蛋白水平分为糖尿病和葡萄糖调节受损组、应激性高血糖组、正常血糖组,分析不同血糖水平对急性脑梗死患者入院时神经功能缺损评分、病灶大小和预后的影响。结果正常血糖组神经功能缺损评分低于糖尿病组和应激性高血糖组,梗死灶也较其他2组小,经治疗后总有效率较糖尿病及应激性高血糖组高,差异有统计学意义(P<0.05)。结论急性脑梗死患者入院时空腹血糖水平的测定可作为判定病情、估计预后的指标之一。     

Effects of neuroserpin on clinical outcomes and inflammatory markers in Chinese patients with acute ischemic stroke

Objective: Neuroserpin (NSP) is known for its neuroprotective effects. The aim of this study was to investigate the relationship between NSP level and clinical outcomes and inflammatory markers in Chinese patients with acute ischemic stroke.

Methods: A total of 133 patients with acute cerebral infarction (ischemia group) and 44 controls were recruited. The modified Rankin Scale (mRS) was used to determine the functional outcome three months after onset. We investigated the relationship between serum NSP levels [on admission and a decrease in NSP levels (10 days after admission versus on admission)] and serum levels of several inflammatory markers.

Results: We confirmed that NSP levels on admission in the ischemia group were significantly higher than those in the control group. NSP levels in patients with good outcomes were significantly higher than those in patients with poor outcomes. NSP levels on admission were associated with having a good outcome in these patients. We found that a larger decrease in NSP levels (on admission vs. 10 days after admission) was correlated with lower serum levels of IL-6, IL-1β, and ICAM-1 10 days after admission.

Conclusions: A larger decrease in NSP levels related to lower levels of inflammatory marker, while higher NSP levels were associated with lower inflammatory markers and better functional outcomes. Decreasing the infarct size may play a role in this process. These results provide more evidence of the neuroprotective effect of NSP in cerebral ischemic patients. Decrease in the Serum NSP level and NSP level at admission may be considered as potential predictive factors for outcome of acute ischemic stroke.     

TOAST分型的急性缺血性脑卒中患者血糖变异性及其和预后的关系研究

目的 研究TOAST分型的急性缺血性脑卒中患者血糖变异性及其和预后的关系。方法 选取本院2014年2月～2015年2月接诊的112例急性缺血性脑卒中患者作为研究对象,据血糖监测将其分为血糖变异组和非血糖变异组,对所有患者的TOAST分型各亚型血糖变异性、TOAST分型各亚型血糖变异性两两比较情况、NIHSS评分以及Barthel指数、患者预后的多因素进行分析。结果 2组患者的年龄、糖尿病史以及NIHSS评分患者例数具有明显差异(P<0.05)。血糖变异组患者的LAA患者例数明显多于非血糖变异组(P<0.05),LAA组血糖变异性与SAO组和CE组比较有明显差异(P<0.05),而SAO组和CE组的血糖变异性没有明显差异(P>0.05)。入院半个月后血糖变异组患者的NIHSS评分以及Barthel指数没有明显差异(P>0.05),而非血糖变异组患者的NIHSS评分以及Barthel指数均有明显的变化,且2组患者在入院半个月后的NIHSS评分以及Barthel指数有明显差异(P<0.05)。年龄、NIHSS评分以及血糖变异等因素与急性缺血性脑卒中患者预后有关。结论 年龄、糖尿病史、LAA患者等均是影响患者血糖变异性的相关因素,且血糖变异性对急性缺血性脑卒中患者的预后具有一定的影响,是其独立的危险因素,即血糖变异性异常的急性缺血性脑卒中患者的恢复较缓慢,预后情况不良。     

Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial

BACKGROUND: Hyperglycemia during acute ischemic stroke may augment brain injury, predispose to intracerebral hemorrhage (ICH), or both. METHOD: To analyze the relationship between admission glucose level and clinical outcomes from acute ischemic stroke, the authors performed multivariate regression analysis with the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator (rt-PA) Stroke Trial data. Neurologic improvement was defined as improvement on the NIH Stroke Scale by 4 or more points from baseline to 3 months, or a final score of zero. Favorable outcome was defined as both Glasgow Outcome score of 1 and Barthel Index 95 to 100 at 3 months. Symptomatic ICH was defined as CT-documented hemorrhage temporally related to clinical deterioration within 36 hours of treatment. Potential confounding factors were controlled, including acute treatment (rt-PA or placebo), age, baseline NIH Stroke Scale score, history of diabetes mellitus, stroke subtype, and admission blood pressure. RESULTS: There were 624 patients enrolled within 3 hours after stroke onset. As admission glucose increased, the odds for neurologic improvement decreased (odds ratio [OR] = 0.76 per 100 mg/dL increase in admission glucose, 95% CI 0.61 to 0.95, p = 0.01). The relation between admission glucose and favorable outcome depended on admission mean blood pressure (MBP): as admission MBP increased, the odds for favorable outcome related to increasing admission glucose levels progressively decreased (p = 0.02). As admission glucose increased, the odds for symptomatic ICH also increased (OR = 1.75 per 100 mg/dL increase in admission glucose, 95% CI 1.11 to 2.78, p = 0.02). Admission glucose level was not associated with altered effectiveness of rt-PA. CONCLUSIONS: In patients with acute ischemic stroke, higher admission glucose levels are associated with significantly lower odds for desirable clinical outcomes and significantly higher odds for symptomatic ICH, regardless of rt-PA treatment. Whether this represents a cause and effect relationship remains to be determined.     

Serum alpha-1 antitrypsin in acute ischemic stroke: A prospective pilot study

BackgroundAlpha-1 antitrypsin (AAT) is a potent anti-protease enzyme which may play a role in arterial wall stability. A variant of its encoding gene has been recently linked to ischemic stroke due to large artery atherosclerosis (LAA). We sought to explore potential relationships between ischemic stroke mechanisms, atherosclerosis burden and serum AAT levels.MethodsWe performed a prospective observational study of consecutive patients with acute ischemic stroke who were admitted to an academic comprehensive stroke center over a three-month period. Blood samples were collected within 24 h of hospital admission, and stroke subtype classification was determined based on modified TOAST criteria. Modified Woodcock scoring system was used to quantify calcification of major cervico-cranial arteries as a surrogate for atherosclerosis burden. Linear regression analysis was used to assess the association between serum AAT levels and calcification scores, both as continuous variables.ResultsAmong eighteen patients met our inclusion criteria and were enrolled in our study, 10 patients (56%) were men; mean age was 66 (SD 12.5); median NIH stroke scale was 4 (IQR 9.5); 8 patients (44%) had stroke due to LAA. The median serum level of AAT was 140 mg/dl (IQR 41.7) for patients with LAA-related stroke, and 148.5 mg/dl (IQR 37.7) for patients with other stroke mechanisms (p = 0.26). Higher serum AAT levels was associated with lower modified Woodcock calcification scores. (p-value = 0.038)ConclusionsMeasurement of AAT levels in patients with acute stroke is feasible, and there may be associations between AAT levels and stroke mechanism that warrant further study in larger samples.     

Human urinary kallidinogenase in treating acute ischemic stroke patients: analyses of pooled data from a randomized double-blind placebo-controlled phase IIb and phase III clinical trial

ABSTRACT

Objectives: Intravenous thrombolysis and thrombectomy are recommended for patients whose stroke onsets are within first 6 h, and very few options are available for patients whose stroke onset is more than 6 h, which includes most ischemic stroke patients. Human urinary kallidinogenase (HUK) showed potential clinical benefits in acute ischemic stroke patients. This study aims to investigate the safety and clinical benefits of HUK in ischemic stroke patients.

Patients and methods: Patients were recruited for a multicenter double-blind, placebo-controlled phase II b and phase III trial. Neurophysiological outcomes were assessed by the European Stroke Scale (ESS) and the functional outcomes were assessed by the activity of daily living scale (ADL). Safety was monitored by recording adverse events.

Results: The improvements in ESS scores and ADL scores in the HUK group were significantly greater than that in patients receiving placebo. Furthermore, HUK treatment was also associated with a lower rate of disable, according to ADL. HUK-related adverse events occurred at a low rate, in 1.73% of HUK-treated patients.

Conclusion: HUK is safe and provides potential clinical benefits as a treatment for acute ischemic stroke. Further large post-marketing observational studies are needed.     

Relationship of Malnutrition During Hospitalization With Functional Recovery and Postdischarge Destination in Elderly Stroke Patients

AimMalnutrition during hospitalization affects the functional recovery and postdischarge destinations of elderly stroke patients. However, insufficient studies exist about nutritional status during hospitalization in the acute stroke phase in this population. This study determined factors of nutritional status changes during hospitalization in elderly patients in the acute phase of stroke, and investigated the relationship between nutritional status changes and improved activities of daily living and postdischarge destination.MethodsThis retrospective observational study included 205 acute-phase stroke patients admitted to Shinshu University Hospital from 2010-2016. Multiple regression analysis was conducted to determine relationships between nutritional status changes, patient characteristics, and improved activities of daily living. Binomial logistic regression analysis was used to determine the relationship between the postdischarge destination and nutritional status changes.ResultsPrevalence of malnutrition was 42% at admission and 76% at discharge. Factors affecting nutritional status changes at admission included Geriatric Nutritional Risk Index (β = ?0.35, P < .001) and Barthel Index/feeding (β = 0.22, P = .002), and factors during hospitalization included age (β = ?0.21, P < .001), ischemic stroke (β = 0.16, P = .008), and National Institute of Health Stroke Scale score (β = ?0.29, P < .001). Significant associations of changes in geriatric nutritional risk index occurred with improved activities of daily living during hospitalization (β = 0.26, P < .001) and discharge to home (odds ratio = 1.11, 95% confidence interval: 1.03-1.19, P = .008).ConclusionMany elderly patients in the acute phase of stroke with malnutrition exhibited worsening conditions during hospitalization, which was negatively associated with their activities of daily living abilities and postdischarge destinations. Nutritional status changes and associated factors must be evaluated during hospitalization in this patient population.     

Fasting Hyperglycemia and Long-term Outcome in Patients with Acute Ischemic Stroke Treated with Mechanical Thrombectomy

BackgroundLittle is known about the prognostic role of fasting glucose after mechanical thrombectomy (MT).AimsWe investigated whether fasting glucose on the next day after MT was associated with long-term outcome in acute ischemic stroke patients according to diabetes.MethodsWe retrospectively analyzed 181 consecutive patients with acute anterior circulation ischemic stroke who underwent MT in 2 comprehensive stroke centers in Poland. Glucose levels were evaluated on admission and on the next day after MT. Fasting hyperglycemia (FHG) was defined as the glucose level above 5.5 mmol/L. Unfavorable outcome was defined as modified Rankin scale (mRS) of 3-6 at day 90 from stroke onset.ResultsPatients with FHG had higher mRS at 3-month follow-up compared with those without FHG (3.71 ± 2.56 versus 1.87 ± 2.22, P < .001). In the subgroup analyses, FHG was associated with poor neurological outcome in the group without diabetes (3.74 ± 2.52 versus 1.81 ± 3.74, P < .001) but not with diabetes (3.64 ± 2.67 versus 2.30 ± 3.74, P= .11). Patients without diabetes who had FHG were older, had higher glucose on admission, higher prevalence of atrial fibrillation, cardioembolic stroke etiology and bleeding brain complications compared with the group with normal fasting glucose. After adjustment for potential confounders, fasting glucose (odds ratio [OR] 1.46; 95% CI 1.19-1.79, P < .001), age (OR 1.06; 95% CI 1.02-1.10, P = .001), successful reperfusion (OR 0.09; 95% CI 0.04-0.22, P < .001) and baseline NIHSS score (OR 1.18; 95% CI 1.08-1.29, P < .001) were predictors of mRS 3-6 at 3-month follow-up in the whole group. In the subgroup without diabetes, fasting glucose (OR 1.57; 95% CI 1.17-2.11, P = .002), age (OR 1.05; 95% CI 1.01-1.08, P = .008), successful reperfusion (OR 0.11; 95% CI 0.04-0.30, P < .001) and baseline NIHSS score (OR 1.14; 95% CI 1.04-1.26, P = .011) were independent predictors of unfavorable 3-month outcome.ConclusionsFasting glucose on the next day after MT in patients with acute ischemic stroke is an independent risk factor for worse 3-month outcome.     

Combination oral antiplatelet therapy may increase the risk of hemorrhagic complications in patients with acute ischemic stroke caused by large artery disease

Introduction

The association between the frequency or severity of bleeding complications and combination antiplatelet therapy for acute stroke treatment is not understood in detail. This retrospective study investigated whether combination oral antiplatelet therapy for cases with acute ischemic stroke due to large artery disease increased the incidence of hemorrhagic complications.

Materials and Methods

We reviewed 1335 consecutive patients who were admitted to our department within 7 days of the onset of an ischemic stroke or transient ischemic attack between April 2005 and November 2009. We enrolled 167 patients with > 50% stenosis or occlusion in culprit major vessels and who were administered oral antiplatelet agents within 48 hours of admission. Hemorrhagic complications were classified according to the bleeding severity index. We studied the association between the incidence and severity of hemorrhagic complications during hospitalization and the clinical characteristics, including antiplatelet therapy.

Results

Fifty-nine and 108 patients were treated with only 1 antiplatelet agent and combination antiplatelet agents, respectively. Fourteen patients developed bleeds (3 major and 11 minor), and all of the major bleeds occurred in those given combination agents. The proportion of patients receiving combination agents was significantly higher in those with significant bleeds. Multivariate logistic regression analysis revealed that being older and receiving combination agents were independent predictors for significant bleeds during hospitalization.

Conclusions

Despite the retrospective nature of this study, our findings suggest that the incidence of hemorrhagic complications increases in patients with acute ischemic stroke treated with combination antiplatelet agents.     

脑卒中急性期血压监测及其与预后关系的临床研究

目的：探讨急性脑卒中中后动态血压变化及其与预后的关系。方法：由专人（同一人）负责对55例急性脑卒中患者进行了第1及第7天动态血压的监测，同时评定第1、第7天及第30天神经功能评分及病残程度分级。结果：脑卒中后增高的血压在7天后，在无特殊降压措施条件下，无论是随测血压，还是动态血压均自发下降，生活基本自理组（0－Ⅲ）和生活依赖组（Ⅳ－Ⅶ）脑卒中后增高的血压无明显差异性，结论：脑卒中急性期血压存在自发下降趋势，脑卒中急性期血压的治疗需采取慎重，合理，个体化治疗。     

脑卒中患者急性期血糖水平与病情严重程度的关系

目的探讨脑卒中患者急性期血糖水平与病情严重程度的关系。方法采用前瞻性队列研究的方法检测2005-02～2008-02所有入院病程<24h的340例脑卒中患者(其中出血性卒中153例,缺血性卒中187例)的空腹血糖水平。采用斯勘的纳维亚卒中评分(SSS)量表评价患者入院时神经功能缺损程度。按卒中类型和空腹血糖水平分组,比较各组间指标差异。结果出血性卒中组空腹血糖水平及SSS评分高于缺血性卒中组(P<0.05);血糖升高组SSS评分高于正常血糖组(P<0.01)。结论急性脑卒中患者血糖越高,病情越重,其中出血性卒中更显著。对急性脑卒中患者检测血糖有利于病情的判断。     

Effects of major adipokines and the −420 C > G resistin gene polymorphism on the long-term outcome of patients with acute ischemic stroke

Abstract

Aim: The association between adiponectin, leptin, and resistin and the long-term outcome of ischemic stroke are controversial. We aimed to evaluate this relationship.

Methods: We prospectively studied 83 patients consecutively hospitalized for acute ischemic stroke (38.6% males, age 79.7?±?6.3?years). Serum adiponectin, leptin, and resistin levels and the ?420C?>?G polymorphism of the resistin gene were determined at admission. Stroke severity at admission was evaluated with the National Institutes of Health Stroke Scale (NIHSS). One year after discharge, functional status, incidence of cardiovascular events and all-cause mortality were recorded. Functional status was evaluated with the modified Rankin scale (mRS).

Results: Patients with the G allele had lower mRS (p?<?.05) and patients with adverse outcome had higher serum resistin levels (p?<?.05). The only independent predictor of adverse outcome was mRS at discharge (risk ratio (RR) 2.78, 95% confidence interval (CI) 1.54–5.00; p?<?.001). Higher adiponectin levels were an independent predictor of cardiovascular morbidity (RR 1.07, 95% CI 1.01–1.14; p?<?.05). Patients who died had higher serum adiponectin levels than those who survived (p?<?.05). The only independent predictor of all-cause mortality was NIHSS at admission (RR 1.19, 95% CI 1.04–1.35; p?<?.01).

Conclusions: In patients with acute ischemic stroke, the G allele of the ?420C?>?G polymorphism of the resistin gene promoter is more frequent in those with a more favorable functional outcome at one year after discharge. Patients with higher serum resistin levels appear to have worse long-term functional outcome, while higher serum adiponectin levels are associated with higher incidence of cardiovascular events.     

Expression of stromal‐cell‐derived factor‐1 (SDF‐1): a predictor of ischaemic stroke?

Background and purpose: Platelet stromal‐cell‐derived factor‐1 (SDF‐1) plays a pivotal role in angiogenesis and the regeneration of ischaemic tissue through the regulation of haematopoietic progenitor cells and is upregulated at the sites of vascular injury and platelet activation. Thus, SDF‐1 has recently been discussed as a predictor in ischaemic diseases such as acute myocardial infarction. However, no clinical data pertinent to the investigation of the platelet SDF‐1 expression in patients with stroke are available. Methods: We consecutively evaluated 196 patients who were admitted to the stroke unit with symptoms suspected for stroke. Surface expression of the platelet activation markers (P‐selectin and GPIb) and the expression of platelet‐bound SDF‐1 were determined by two‐colour whole blood flow cytometry. Results: Patients with transient ischaemic attack (TIA) as well as with ischaemic stroke showed similar levels of SDF‐1 expression on hospital admission compared with patients with non‐ischaemic (NI) events and with 30 healthy controls (TIA (mean fluorescence intensity ± SD): 31.5 ± 18.2 vs. NI: 26.4 ± 15.7; P = 0.361; stroke: 28.7 ± 19.8 vs. NI; P = 0.943; control: 26.1 ± 11.3; P > 0.05 compared with all). Platelet SDF‐1 expression showed a trend with the severity of stroke according to National Institute of Health Stroke Scale score (r = 0.125; P = 0.085), but significantly correlated with the peak levels of C‐reactive protein (r = 0.218; P = 0.002) and with the levels of platelet activation (P‐selectin: r = 0.389; P = 0.001). Multifactorial analysis of covariance revealed a significant influence on platelet SDF‐1 expression by smoking (P = 0.019). Conclusions: Platelet SDF‐1 surface expression did not show any significant difference in patients with TIA and ischaemic stroke compared with patients with NI events. Thus, single biomarker evaluation of platelet SDF‐1 surface expression is not helpful to predict ischaemic stroke.     

Coagulation factor XIII activation peptide and subunit levels in patients with acute ischaemic stroke: A pilot study

Introduction

We have recently shown that FXIII activation peptide (AP-FXIII) can be measured in plasma. The objective of this pilot study was to investigate for the first time if AP-FXIII can be detected in plasma from patients with acute ischaemic stroke.

Materials and methods

We included 66 patients with acute ischaemic stroke admitted between 1 and 7 hours after the onset of clinical symptoms. We collected plasma samples upon admission and on the two following days and measured AP-FXIII and subunit levels by ELISA. Clinical stroke severity was assessed by NIHSS stroke score.

Results

AP-FXIII could be detected in 34 patients upon admission (range 0.2-26.3 ng/ml), on day 1 in 15 patients (0.2-10.4 ng/ml), and on day 2 in 11 patients (0.1-15.1 ng/ml. AP-FXIII was higher in patients with severe stroke. Lower AP-FXIII levels upon admission were associated with clinical improvement. FXIII-A and FXIII-B subunit levels decreased significantly from day 0 to day 1.

Conclusions

For the first time, we detected AP-FXIII in patients upon an acute thrombotic event. The decrease in FXIII subunit levels during acute ischaemic stroke is evidence for ongoing coagulation activity and FXIII consumption. Our results suggest that FXIII activation and concomitant AP-FXIII release might be associated with an unfavourable short-term clinical outcome. Larger studies are needed to further investigate whether AP-FXIII might serve as a diagnostic and/or prognostic marker for acute thrombotic diseases.     

Family history of stroke and death or vascular events within one year after ischemic stroke

ABSTRACT

Background and aims: The association between family history of stroke and clinical outcomes after ischemic stroke remains unclear.

Methods: A total of 3878 acute ischemic stroke patients from CATIS were included. The participants with ischemic stroke were divided into groups according to types of family history of stroke, stroke onset age and stroke subtypes. The primary outcome was a composite outcome of death and vascular events within 1 year after stroke. Multivariable Cox proportional hazard models were used to analyze the association between family history of stroke and other variables and clinical outcomes.

Results: Among 3878 ischemic stroke patients, 708 (18.26%) had a history of stroke in their first-degree relatives and 399 experienced a composite outcome (172 patients died and 227 experienced vascular events) within 1 year after stroke. Overall family history was not associated with the primary outcome (HR, 1.08; 95% CI, 0.37–3.19). However, the patients with maternal stroke history (HR, 1.87; 95% CI, 1.31–2.97), stroke onset age<55 years with family history (HR, 2.02; 95% CI, 1.08–3.80) and thrombotic stroke in the patients with family history (HR, 1.46; 95% CI, 1.00–2.12) were associated with primary outcome, death and vascular events, respectively.

Conclusion: This study suggests that maternal stroke history, age<55 years at stroke onset and thrombotic stroke in the patients with a family history are associated with poor outcomes after stroke. Further studies from other samples are needed to replicate our findings due to a reason for excluding some severe stroke patients in this study.     

Stroke Mimics: An Important Source of Bias in Acute Ischemic Stroke Research

Study Objective: Stroke mimics may be difficult distinguish from acute ischemic strokes and are often treated with alteplase though not by intent. We report the characteristics, frequency, and outcomes of stroke mimics treated at our institution. Using our data, we then explore how the inclusion of stroke mimics in stroke outcomes research may be an important source of bias. Methods: We retrospectively identified all patients treated with alteplase in our emergency department from August 2013 to December 2017 for suspected acute ischemic stroke. We collected the following variables: gender, age, risk factors (hypertension, diabetes, and atrial fibrillation), admission glucose, admission National Institute of Health Stroke Scale, admission mean arterial pressure, onset-to-treatment time, adverse events, discharge diagnosis, length of stay, discharge NIHSS, discharge destination, and 3 month modified Rankin score. Results: One hundred and eighteen patients were treated with alteplase for suspected acute ischemic stroke of which 33 (27.9%) were stroke mimics. Compared to ischemic strokes, stroke mimics were younger (median age 53 versus 69; P < .0003); were less likely to have vascular risk factors (hypertension [51.5% versus 78.8%; P < .005] diabetes (9.1% versus 32.9%; P < .007), and atrial fibrillation (3.0% versus 23.5%; P < .006). The most common stroke mimic was transient ischemic attack (33.3%). Stroke mimics were significantly more likely to be discharged home (75.8% versus 41.2%; P < .002). Outcomes unadjusted for stroke mimics led to artificial inflation of a favorable discharge destination. Conclusions: Inclusion of stroke mimics led to an artificial inflation of a favorable discharge destination for our entire cohort. Our study highlights the potential for bias in reporting favorable outcomes if appropriate adjustment accounting for stroke mimics does not occur.     

Temporal changes of adiponectin plasma levels in patients with acute ischemic stroke

Abstract

Adiponectin, an adipocyte-derived hormone, possesses anti-inflammatory properties. Its decreased levels were noted in patients with ischemic stroke (IS). Animal studies suggest that the decline of adiponectin levels in the acute IS phase is a dynamic process. The aim of the present study was to analyze the temporal expression of the adiponectin plasma levels in patients with acute IS. Thirty-one consecutive patients with first-ever IS (mean age±SD: 69·5±12·5 years; 12 women) and 26 control subjects (CS; 72·2±7·6 years; 18 women) were included into the study. Plasma adiponectin levels were measured at three time points: within first 24 hours, on Days 2–4, and on Days 5–10 days after the onset of IS. Adiponectin levels were significantly lower in IS patients on admission comparing with CS (medians: 6·0 μg/ml vs. 11·3 μg/ml, respectively; P < 0·05) and continued to decline at later time points (P < 0·001).