Early Prediction of One-Year Mortality in Ischemic and Haemorrhagic Stroke

Liljehult, Jacob; Christensen, Thomas Nordahl; Christensen, Karl Bang

doi:10.1016/j.jstrokecerebrovasdis.2020.104667

Cited by 15 publications

(15 citation statements)

References 19 publications

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“…Patients with heart failure had a higher TFA phase compared to AIS, with intact cardiac function and healthy controls, which was associated with increased myocardial injury (higher troponin) at 6 and 24 h post-AIS, normalizing within three months [ 150 ]. These results seem to contradict previous findings of increased stroke risk, severity, and poor outcome in heart failure and AIS [ 148 , 149 ]. The authors postulate that this is due to ischemic preconditioning induced by chronic cerebral hypoperfusion, rendering the brain less susceptible to acute hypoxic events, such as AIS [ 150 ].…”

Section: The Impact Of Comorbidities and Phenotype In Ca And Strokecontrasting

confidence: 98%

“…Heart failure is an important risk factor for AIS [ 147 , 148 , 149 ], and, as with CKD, it increases the severity and odds of a poorer outcome in acute stroke [ 150 ]. Heart failure results in reduced cerebral perfusion due to lower cardiac output, but also as a result of alterations in sympathetic tone from renin-angiotensin-aldosterone system activation [ 150 ].…”

Section: The Impact Of Comorbidities and Phenotype In Ca And Strokementioning

confidence: 99%

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Cerebral Autoregulation in Ischemic Stroke: From Pathophysiology to Clinical Concepts

et al. 2021

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Ischemic stroke (IS) is one of the most impacting diseases in the world. In the last decades, new therapies have been introduced to improve outcomes after IS, most of them aiming for recanalization of the occluded vessel. However, despite this advance, there are still a large number of patients that remain disabled. One interesting possible therapeutic approach would be interventions guided by cerebral hemodynamic parameters such as dynamic cerebral autoregulation (dCA). Supportive hemodynamic therapies aiming to optimize perfusion in the ischemic area could protect the brain and may even extend the therapeutic window for reperfusion therapies. However, the knowledge of how to implement these therapies in the complex pathophysiology of brain ischemia is challenging and still not fully understood. This comprehensive review will focus on the state of the art in this promising area with emphasis on the following aspects: (1) pathophysiology of CA in the ischemic process; (2) methodology used to evaluate CA in IS; (3) CA studies in IS patients; (4) potential non-reperfusion therapies for IS patients based on the CA concept; and (5) the impact of common IS-associated comorbidities and phenotype on CA status. The review also points to the gaps existing in the current research to be further explored in future trials.

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Section: The Impact Of Comorbidities and Phenotype In Ca And Strokecontrasting

confidence: 98%

Section: The Impact Of Comorbidities and Phenotype In Ca And Strokementioning

confidence: 99%

Cerebral Autoregulation in Ischemic Stroke: From Pathophysiology to Clinical Concepts

et al. 2021

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“…See "Results" for hazard ratios at different values of these predictors. Baseline survival was 44% [36,39,40], 2 years [41] and 5 years [42] mortality. The longest term mortality study [43] predicted death at 10 years or more, but this study only included patients with Transient Ischaemic Attacks or minor strokes.…”

Section: Discussionmentioning

confidence: 99%

“…Stroke mortality was a common outcome predicted by previous scores, which included inpatient [ 35 ], 7 days [ 35 ], 1 month [ 36 ], 3 months [ 37 ] 6 months [ 38 ], 1 year [ 36 , 39 , 40 ], 2 years [ 41 ] and 5 years [ 42 ] mortality. The longest term mortality study [ 43 ] predicted death at 10 years or more, but this study only included patients with Transient Ischaemic Attacks or minor strokes.…”

Section: Discussionmentioning

confidence: 99%

Predicting 10-year stroke mortality: development and validation of a nomogram

et al. 2021

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Predicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96–9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62–3.14), eGFR < 15 (1.97, 1.55–2.52), 1-year increment in age (1.04, 1.04–1.05), liver disease (1.50, 1.20–1.87), peripheral vascular disease (1.39, 1.23–1.57), cancers (1.37, 1.27–1.47), heart failure (1.24, 1.15–1.34), 1-point increment in pre-stroke mRS (1.20, 1.17–1.22), atrial fibrillation (1.17, 1.10–1.24), coronary heart disease (1.09, 1.02–1.16), chronic obstructive pulmonary disease (1.13, 1.03–1.25) and hypertension (0.77, 0.72–0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.

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“…In 6,988 patients with ischemic stroke, the CCI predicted 1-year and in-hospital mortality [127], 1-year and 30-day mortality in another 3,605 patients after acute stroke [128], and 1-year mortality among 1,031 patients with stroke admitted in Denmark [129]. Among 950 patients with ischemic stroke, the CCI predicted increased risk of death significantly over 9 years [130].…”

Section: Predictive Validitymentioning

confidence: 99%

Charlson Comorbidity Index: A Critical Review of Clinimetric Properties

Charlson

Carrozzino

Guidi

et al. 2022

Psychother Psychosom

583

317

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The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient’s unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.

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Early Prediction of One-Year Mortality in Ischemic and Haemorrhagic Stroke

Cited by 15 publications

References 19 publications

Cerebral Autoregulation in Ischemic Stroke: From Pathophysiology to Clinical Concepts

Cerebral Autoregulation in Ischemic Stroke: From Pathophysiology to Clinical Concepts

Predicting 10-year stroke mortality: development and validation of a nomogram

Charlson Comorbidity Index: A Critical Review of Clinimetric Properties

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