Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit

Koennecke, Hans–Christian; Belz, W.; Berfelde, D.; Endres, Matthias; Fitzek, Sabine; Hamilton, Frank A.; Kreitsch, P.; Mackert, Bruno-Marcel; Nabavi, Darius G.; Nolte, Christian H.; Pöhls, Wiebke; Schmehl, Ingo; Schmitz, Bettina; Brevern, Michael von; Walter, G.; Heuschmann, Peter U.

doi:10.1212/wnl.0b013e31822dc795

Cited by 292 publications

(273 citation statements)

References 27 publications

Supporting

Mentioning

238

Contrasting

Unclassified

Order By: Relevance

“…8 Moreover, infectious complications after stroke also worsen neurologic outcome. [9][10][11] Recent experimental and clinical data suggest that the deleterious combination of stroke-facilitated aspiration and stroke-induced immunodeficiency dramatically increases susceptibility to infection in stroke patients. 12 Despite general measures to prevent aspiration, stroke-associated pneumonia remains a common and severe clinical challenge even for patients treated in specialized stroke units.…”

Section: Introductionmentioning

confidence: 99%

Superiority of Preventive Antibiotic Treatment Compared with Standard Treatment of Poststroke Pneumonia in Experimental Stroke: A Bed to Bench Approach

Hetze

Engel

Römer

et al. 2013

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Stroke patients are prone to life-threatening bacterial pneumonia. Previous experimental stroke studies have demonstrated that preventive antibiotic treatment (PAT) improves outcome compared with placebo treatment, which however does not model the clinical setting properly. Here we investigate whether PAT is superior to the current clinical 'gold standard' for treating poststroke infections. Therefore, we modeled stroke care according to the current stroke guidelines recommending early antibiotic treatment after diagnosing infections. To reliably diagnose pneumonia in living mice, we established a general health score and a magnetic resonance imaging protocol for radiologic confirmation. Compared with standard treatment after diagnosis by these methods, PAT not only abolished pneumonia successfully but also improved general medical outcome. Both, preventive and standard antibiotic treatment using enrofloxacin improved survival in a similar way compared with placebo treatment. However, in contrast to standard treatment, only PAT improved functional outcome assessed by gait analysis. In conclusion, standard and preventive treatment approach reduced poststroke mortality, however at the cost of a worse neurologic outcome compared with preventive approach. These data support the concept of PAT for treating patients at risk for poststroke infections and warrant phase III trials to prove this concept in clinical setting.

show abstract

Section: Introductionmentioning

confidence: 99%

Superiority of Preventive Antibiotic Treatment Compared with Standard Treatment of Poststroke Pneumonia in Experimental Stroke: A Bed to Bench Approach

Hetze

Engel

Römer

et al. 2013

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

show abstract

“…There are a multitude of benefits to this, including earlier rehabilitation in the community and reduced hospital-acquired infections. The mSOAR could miss some patients who may deteriorate unexpectedly following admission (eg haemorrhagic transformation or secondary pneumonia) 10 as well as others improving despite severe infarct or haemorrhage. Therefore, we would advise that no prognostic tool should be used as the sole basis of management decisions.…”

Section: Discussionmentioning

confidence: 99%

mSOAR: an effective bedside stroke prognosis tool

Thaller

Mitchell

2017

Clinical Medicine

View full text Add to dashboard Cite

The modifi ed-SOAR (mSOAR) score is composed of the stroke subtype, Oxfordshire Community Stroke Project classifi cation, age, pre-stroke modifi ed Rankin score (mRS) and the National Institutes of Health Stroke Scale score. It has previously been shown to be a reliable predictor of mortality and length of hospital stay. This study sought to identify whether the mSOAR can also be used to predict patient disability on discharge. A post-hoc calculation of mSOAR using Sentinel Stroke National Audit Programme (SSNAP) data and electronic discharge summaries was performed on all stroke admissions to Bridgend Hospital over an 11-month period. This study included 230 patients, of which 88% had suffered infarcts and 23% had experienced a previous cerebrovascular episode or transient ischaemic attack; 52% were female. The mortality rate was 13% and 57% had slight disability or less (mRS≤2) on discharge. Each increase in mSOAR score was associated with signifi cantly worse discharge disability (p<0.05). We conclude that the mSOAR score is an excellent tool for predicting both discharge disability and mortality. As such, it's useful for admission prognosis discussions with patients, their relatives and the multidisciplinary team and for early supported discharge decision making.

show abstract

“…In our study hyperglycemia and normal HgbA1C level (<6.5) have been shown to be significantly associated with increased incidence of SAP, however, hyperglycemia and high HgbA1C level (>6.5) have not been shown to be associated with SAP. The presence of hyperglycemia has been demonstrated to be associated with an increased risk of infection in acute stroke [6] [7]. This might be the result of suppressing immune functions by hyperglycemia secondary to impaired phagocytosis, diminished production of oxygen radicals from neutrophils, and chemotaxis [25].…”

Section: Discussionmentioning

confidence: 99%

“…In these infection, the incidence of stroke-associated pneumonia (SAP) may as high as 40%, it occurs most frequently during the first week after stroke and especially the first 3 days after stroke onset [1] [2]. SAP independently increases in-hospital mortality 2 -6 times [3]- [6]. There is an increasing body of literature on the importance of SAP after acute ischemic stroke, but information on SAP after intra-cerebral hemorrhage (ICH) is limited [7].…”

Section: Introductionmentioning

confidence: 99%

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

Ren¹,

Yang²,

Li³

et al. 2015

OJEM

View full text Add to dashboard Cite

Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p < 0.01). Multivariate logistic regression analyses showed the SAP was significantly associated with hyperglycemia (OR, 2.48; 95% CI, 2.37 -5.72), in the subgroup analysis we found hyperglycemia with normal HgbA1C level (<6.5) had been shown to be significantly associated with increased incidence of SAP (OR, 3.86; 95%CI, 2.98 -6.72), however, hyperglycemia with high HgbA1C level (>6.5) (OR, 1.57; 95%CI, 0.81 -3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based co-hort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.

show abstract

Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit

Cited by 292 publications

References 27 publications

Superiority of Preventive Antibiotic Treatment Compared with Standard Treatment of Poststroke Pneumonia in Experimental Stroke: A Bed to Bench Approach

Superiority of Preventive Antibiotic Treatment Compared with Standard Treatment of Poststroke Pneumonia in Experimental Stroke: A Bed to Bench Approach

mSOAR: an effective bedside stroke prognosis tool

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

Contact Info

Product

Resources

About