Background: There is scant information on characteristics, treatment, functional outcome and case fatality of ischemic stroke with atrial fibrillation (AF) in China. Methods: For this study, first-ever ischemic stroke patients who were admitted within 1 month of stroke onset during the period of March 2002 through December 2008 were included. Data on ischemic stroke patients were collected which included: demographics, risk factors, treatment administered, stroke-related complications and 3-month, 6-month and 1-year death and disability. Multivariate regression models were used to analyze predictors for death and disability. Results: Of the 2,683 patients included in this study, 366 (13.6%) had AF. In this group, valvular AF was observed in 153 (41.8%) patients. Compared to patients without AF, patients with AF were older (66.1 vs. 63.6, p = 0.001) and had a higher NIHSS score on admission (median 10 vs. 4, p < 0.001) and more frequently suffered from hemorrhagic transformation (7.3 vs. 2.8%, p < 0.001), pulmonary infection (27 vs. 10.6%, p < 0.001), urinary tract infection (8.5 vs. 3.0%, p < 0.001), acute gastrointestinal tract hemorrhage (4.1 vs. 1.9%, p = 0.008), electrolyte disturbance (5.2 vs. 1.8%, p < 0.001), acute renal failure (1.1 vs. 0.5%, p = 0.005) and urinary incontinence (3.8 vs. 0.6%, p < 0.001) during hospitalization. The percentages of patients with AF who received oral anticoagulants were 3.3% before stroke onset and 14.2% at discharge. Moreover, patients with AF had a higher proportion of disability (determined as modified Rankin Scale score 3–5) in 3-month, 6-month and 1-year follow-ups (46.6, 41.9 and 37.6 vs. 29.1, 24.0 and 19.3%, respectively, p < 0.001) and higher case fatality in hospitalization, 3-month, 6-month and 1-year follow-ups (10.1, 25.5, 29.1 and 34.0 vs. 2.0, 7.4, 8.8 and 11.6%, respectively, p < 0.001). Multivariate logistic regression determined that AF, age and NIHSS score were the independent predictors for the 3-month, 6-month and 1-year death. Conclusions: Ischemic stroke patients with AF have a poorer outcome, a higher frequency of stroke-related complications and a higher case fatality than patients without AF. Oral anticoagulants were underused in AF patients.

Background and Purpose: Data on the association between renal dysfunction and outcome in patients with stroke are controversial and scarce. We investigated the predictors of renal dysfunction upon admission and the association between renal dysfunction and clinical outcome in patients with acute stroke in a hospitalized Chinese population. Methods: 1,758 acute stroke patients were consecutively enrolled into the study. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease equation. Reduced estimate of the glomerular filtration rate was defined as eGFR <60 ml/min/1.73 m². Multivariate logistical regression was used to evaluate the predictors of renal dysfunction upon admission and to examine the association between renal dysfunction and outcomes. The main outcome measures were death and death/disability (disability defined as modified Rankin Scale score >2) at 12 months after stroke. Results: Of the included 1,758 cases (ischemic stroke: n = 1,192; hemorrhagic stroke: n = 566), 463 cases had reduced eGFR, which accounted for 26.3% of the total number. The distribution of eGFR upon admission was normal and the mean was 75.87 ± 38.31 ml/min/1.73 m² (ischemic stroke: 75.07 ± 29.89 ml/min/1.73 m²; hemorrhagic stroke: 77.57 ± 51.73 ml/min/1.73 m²). There was no significant difference between the two groups (p = 0.285). The independent predictors of eGFR upon admission were age (OR = 1.039, 95% CI = 1.028–1.050), male gender (OR = 0.658, 95% CI = 0.504–0.859), hematocrit on admission (OR = 1.008, 95% CI = 1.003–1.013), history of hypertension (OR = 1.307, 95% CI = 1.034–1.653), history of diabetes (OR = 1.411, 95% CI = 1.012–1.967) and NIHSS scores upon admission (OR = 1.497, 95% CI = 1.286–1.743). After adjustment for confounders, the patients with renal dysfunction had a significantly higher risk of death/disability (OR = 1.864, 95% CI = 1.170–2.970) compared with patients whose eGFR was more than 90 ml/min/1.73 m² at the end of the 12th month. Further analysis on type of stroke showed that reduced eGFR was an independent predictor of death/disability at the end of the 12th month in patients with hemorrhagic stroke (OR = 2.353, 95% CI = 1.063–5.209), but not for ischemic stroke (OR = 1.625, 95% CI = 0.881–2.999). Conclusions: Our study indicated that more than 1/4 of all patients with acute stroke presented with renal dysfunction. Reduced eGFR on admission is a strong predictor of poor outcome for hemorrhagic stroke but not for ischemic stroke.

Background and Purpose: Women have a worse functional outcome after stroke, but the specific factors associated with a poor outcome in women are rarely reported. This study was designed to investigate the clinical predictors of 1-year disability and death in women after ischemic stroke. Methods: Patients with ischemic stroke consecutively registered from March 2002 to July 2007 were followed prospectively for 1 year. Multivariate regression models were employed to analyze predictors of disability (defined as modified Rankin scale score, mRS, 3–5 ) and death. Results: A total of 2,774 ischemic stroke patients were included with 1,119 (40.3%) females (mean age 65 ± 13.5 years). Among female patients, disability (mRS 3–5) is 1.68-fold higher and case fatality is 1.23-fold higher than in men at the 1-year follow-up. Diabetes is an independent predictor of 1-year disability among women (odds ratio, 1.56; 95% confidence interval, CI, 1.01–2.39). In-hospital acute renal failure (hazard ratio, HR, 7.26; 95% CI, 3.47–5.19), suboptimal antiplatelets (HR, 0.55; 95% CI, 0.37–0.83) and antihypertensive therapy (HR, 0.61; 95% CI, 0.42–0.90) are associated with death at 1 year after stroke among women. Conclusions: The present study indicates that diabetes, in-hospital acute renal failure, suboptimal antiplatelets and antihypertensive therapy are the possible explanations for the poor 1-year outcome of women hospitalized with ischemic stroke.

Background and purpose An estimated 2.5–3.1% of people with episodic migraine develop chronic migraine in a year. Several risk factors are associated with an increased risk for this transformation. We conducted a systematic review and meta-analysis to provide quantitative and qualitative data on predictors of this transformation. Methods An electronic search was conducted for published, prospective, cohort studies that reported risk factors for chronic migraine among people with episodic migraine. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Effect estimates were retrieved and summarized using risk ratios. Results Of 5695 identified publications, 11 were eligible for inclusion. The pooled analysis (GRADE system) found “high” evidence for monthly headache day frequency ≥ 10 (risk ratio = 5.95), “moderate” evidence for depression (risk ratio = 1.58), monthly headache day frequency ≥ 5 (risk ratio = 3.18), and annual household income ≥ $50,000 (risk ratio = 0.65) and “very low” evidence for allodynia (risk ratio = 1.40) and medication overuse (risk ratio = 8.82) in predicting progression to chronic migraine. Conclusions High frequency episodic migraine and depression have high quality evidence as predictors of the transformation from episodic migraine to chronic migraine, while annual household income over $50,000 may be protective.

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