Predictors of Early Neurological Deterioration and Functional Outcome in Acute Ischemic Stroke: The Importance of Large Artery Disease, Hyperglycemia and Inflammatory Blood Biomarkers

Rashid, Avan Sabir; Huang‐Link, Yumin; Johnsson, Marcus; Wetterhäll, Simon; Gauffin, Helena

doi:10.2147/ndt.s365758

Cited by 20 publications

(23 citation statements)

References 44 publications

(91 reference statements)

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“…Inflammatory factors can not only induce cell death responsible for functional injury ( 5 ), but also underlie the development of atherosclerosis by regulating macrophages, cytokines, and leukocyte adhesion molecules to induce endothelial dysfunction, plaque formation and rupture, platelet aggregation, and thrombosis ( 6 , 7 ). Therefore, some inflammatory cytokines are investigated as predictors of functional outcomes after stroke ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

The role of high-sensitivity C-reactive protein serum levels in the prognosis for patients with stroke: a meta-analysis

et al. 2023

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BackgroundThe impact of high-sensitivity C-reactive protein (hs-CRP) as a biomarker of inflammation on the prognosis of stroke patients remains controversial, this study was conducted to evaluate the prognostic value of hs-CRP levels for patients with stroke.MethodsPubMed, Web of Science, Embase, and Cochrane Library databases were searched from inception to October 28, 2022. Outcome measures were all-cause mortality, recurrent stroke, and poor prognosis. The relationship between the highest versus lowest levels of hs-CRP or per unit increment and outcomes as measured by risk ratio (RR) and corresponding 95% confidence intervals (CI).ResultsA total of 39 articles were eligible for meta-analysis. High hs-CRP levels at admission were associated with mortality among patients with acute ischemic stroke (AIS) [RR = 3.84, 95% CI (2.41 ~ 6.111); p < 0.001], risk of recurrent stroke [RR = 1.88, 95%CI (1.41 ~ 2.52); p < 0.001], and poor prognosis [RR = 1.77, 95% CI (1.59 ~ 1.97); p < 0.001]. The risk ratios for the association of per unit increase in hs-CRP levels with mortality, risk of recurrent stroke, and poor prognosis were as follows, respectively: 1.42 [95% CI (1.19–1.69); p < 0.001], 1.03 [95% CI (1.01–1.04); p = 0.003], and 1.27 [95% CI (1.10–1.47); p = 0.001]. For hemorrhagic stroke (HS), the risk ratios (RR) for the highest versus the lowest (reference) category of hsCRP or per unit increment to all-cause mortality were 4.36 [95% CI (1.38–13.73); p = 0.012] and 1.03 [95% CI (0.98–1.08); p = 0.238].ConclusionHs-CRP levels are strongly associated with mortality, risk of stroke recurrence and poor prognosis in stroke patients. Therefore, hs-CRP levels may contribute to the prognosis prediction of these patients.

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Section: Introductionmentioning

confidence: 99%

The role of high-sensitivity C-reactive protein serum levels in the prognosis for patients with stroke: a meta-analysis

et al. 2023

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“…Multivariate analysis for the influence of facility features on head elevation revealed an interesting result, in that facilities with board-certified rehabilitation doctors were more cautious regarding head elevation in BAD, AT, and CE, as situations in which neurological deterioration often occur [24][25][26]. Rehabilitation doctors may prioritize the maintenance of cerebral blood flow when considering head positioning.…”

Section: Discussionmentioning

confidence: 99%

Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey

Oki¹,

Nakajima²,

Koyama³

et al. 2023

Cerebrovasc Dis

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Introduction: Many guidelines now recommend early rehabilitation for acute stroke patients. However, evidence remains lacking regarding the specific timings for initiation of various rehabilitation steps and management when complications are encountered in acute stroke rehabilitation. This survey aimed to investigate actual clinical situations in acute stroke rehabilitation in Japan and to improve the medical systems for rehabilitation and plan further studies. Methods: This nationwide, cross-sectional, web-based questionnaire survey was administered between February 7, 2022, and April 21, 2022, targeting all primary stroke centers (PSCs) in Japan. Among several components of the survey, this paper focused on the timing of the initiation of three rehabilitation steps (passive bed exercise; head elevation; and out-of-bed mobilization), along with the management of rehabilitation (continued or suspended) in the event of complications during acute stroke rehabilitation. We also investigated the influence of facility features on these contents. Results: Responses were obtained from 639 of the 959 PSCs surveyed (response rate: 66.6%). In cases of ischemic stroke and intracerebral hemorrhage, most PSCs initiated passive bed exercise on day 1, head elevation on day 1, and out-of-bed mobilization on day 2 (with day of admission defined as day 1). In cases with subarachnoid hemorrhage, rehabilitation steps were delayed compared to other stroke subtypes or showed wide variation depending on the facility. Passive bed exercise was accelerated by the presence of protocols for rehabilitation and weekend rehabilitation. Out-of-bed mobilization was accelerated by the presence of a stroke care unit. Facilities with board-certified rehabilitation doctors were cautious regarding the initiation of head elevation. Most PSCs suspended rehabilitation training in the event of symptomatic systemic/neurological complications. Conclusion: Our survey revealed the actual situation of acute stroke rehabilitation in Japan and indicated that some facility features appear to influence early increases in physical activity levels and early mobilization. Our survey provides fundamental data to improve the medical systems for acute stroke rehabilitation in the future.

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“…Previous reports have shown that patients with LAA have a greater risk of developing END after thrombolysis in AIS. 5,22,23 Another study found that acute neurological deterioration was observed at a median of 3.6 h from arrival in nearly 20% patients with large-vessel occlusion and mild stroke. 24 In our study, there was a significant association between the occurrence of VEND and underlying LAA, especially ICAD.…”

Section: Discussionmentioning

confidence: 99%

Very early neurological deterioration after thrombolysis in patients with acute ischemic stroke

Shen

Yeh

Chen

et al. 2023

Preprint

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BackgroundEarly neurological deterioration within 24 h after thrombolysis in patients with acute ischemic stroke (AIS) is associated with poor outcomes. Evidence is lacking regarding neurological deterioration within 1 h after thrombolysis.MethodsPatients who received intravenous thrombolysis with tissue plasminogen activator (tPA) for AIS between January 2018 and December 2021 were consecutively enrolled. Very early neurological deterioration (VEND) was defined as a ≥ 4-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 1 h after starting thrombolysis compared with the pre-treatment score. A modified Rankin Scale score of 3–6 at 3 months was defined as a poor functional outcome.ResultsOf the 353 AIS patients (age 69.7 ± 13.3 years, 57% men) receiving thrombolysis with tPA, 29 (8.4%) had VEND. VEND was associated with symptomatic intracranial atherosclerotic disease (ICAD) (41% vs. 17%,P= 0.005) and was an independent predictor of poor functional outcomes at 3 months (adjusted odds ratio 3.04,P= 0.043). The VEND group had higher NIHSS scores at 1 h (19.2 ± 7.3 vs. 9.0 ± 7.1,P< 0.001) and 24 h (14.1 ± 9.8 vs. 7.3 ± 7.5,P= 0.001) after initiating tPA than the non-VEND group. In patients with an initial NIHSS score < 6, VEND was significantly associated with ICAD, receiving endovascular thrombectomy (EVT), and poor functional outcomes. In patients with VEND, EVT with successful recanalization led to lower NIHSS scores at 24 h than in those without successful recanalization (12 ± 9 vs. 26 ± 7,P= 0.047), and 24-h NIHSS scores predicted poor functional outcomes.ConclusionsIn patients receiving thrombolysis, VEND was independently associated with poor functional outcomes. Identifying VEND is crucial for underlying ICAD and salvageability by EVT. Successful recanalization by EVT effectively reduced 24-h stroke severity in patients with VEND.

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Predictors of Early Neurological Deterioration and Functional Outcome in Acute Ischemic Stroke: The Importance of Large Artery Disease, Hyperglycemia and Inflammatory Blood Biomarkers

Cited by 20 publications

References 44 publications

The role of high-sensitivity C-reactive protein serum levels in the prognosis for patients with stroke: a meta-analysis

The role of high-sensitivity C-reactive protein serum levels in the prognosis for patients with stroke: a meta-analysis

Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey

Very early neurological deterioration after thrombolysis in patients with acute ischemic stroke

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