BackgroundHypertension is the prime risk factor for stroke, and primary aldosteronism (PA) is the most common cause of secondary hypertension. The prevalence of PA in stroke patients has never been reported. The aim of this study was to elucidate the prevalence of PA.MethodsA total of 427 consecutive patients with acute stroke were prospectively enrolled for this study. The screening tests were performed at the initial visit and a week after admission by measuring plasma aldosterone concentration and plasma renin activity. The rapid adrenocorticotropic hormone (ACTH) test was performed as the confirmatory test when both screening tests were positive. The primary endpoint was a final diagnosis of PA.ResultsThe sensitivity of the dual screening system for the diagnosis of PA was 88.2 %, and PA was finally diagnosed in 4.0 % of acute stroke patients and in 4.9 % of stroke patients with a history of hypertension. Patients with PA were less likely to be male and have diabetes, and they had higher blood pressure at the initial visit, lower potassium concentration, and more intracerebral hemorrhage. The rapid ACTH test was performed safely even in acute stroke patients.ConclusionsThe prevalence of PA is not low among acute stroke patients. Efficient screening of PA should be performed particularly for patients with risk factors.Trial registrationUMIN-CTR; UMIN000011021. Trial registration date: June 23, 2013 (retrospectively registered).
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Acute lung injury (ALI) associated with systemic inflammatory response syndrome (SIRS) is a systemic complication following subarachnoid hemorrhage (SAH), but the incidence and influence on prognosis are unclear. The incidences of SIRS and ALI were surveyed in a prospective multicenter study of 96 patients admitted for SAH between December 2004 and June 2007. Hunt and Hess grade and Glasgow Outcome Scale score were also investigated. Forty-eight patients were diagnosed with SIRS, and 26 developed ALI within 4 weeks of admission. Nineteen of the 26 patients with ALI were complicated by SIRS, and 7 developed only ALI. Thirteen of the 19 patients complicated by SIRS and ALI died, and this mortality was higher than for patients with only SIRS (3/29) and only ALI (1/7). Multivariate analysis of the development of SIRS and/or ALI and Hunt and Hess grade as risk factors associated with aggravation of the outcome showed that complication with SIRS and ALI had the highest risk. Half of the patients admitted for SAH developed SIRS, and more than 25% developed ALI. The prognosis for patients complicated by SIRS and ALI was poor, which indicates that prevention and active treatment of these two pathologies are important.
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