Sex-related differences in the risk factors for in-hospital mortality and outcomes of ischemic stroke patients in rural areas of Taiwan

Ong, Cheung-Ter; Wong, Yi-Sin; Sung, Sheng-Feng; Wu, Chi-Shun; Hsu, Yung-Chu; Su, Yu-Hsiang; Hung, Ling-Chien

doi:10.1371/journal.pone.0185361

Cited by 26 publications

(24 citation statements)

References 32 publications

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“…Case fatality after 27 days and after 90 days was the same in men and women, after adjustment for the aforementioned covariates. Women’s all-cause mortality has been put forward to be lower after adjustments for relevant risk factors in some reports 7 , 13 but also, conversely, to be higher 24 , 30 or similar between men and women, 8 , 31 , 32 as in the present report. Variations in mortality between sexes may be caused by a disparity in the studied populations or may reflect differences in performed statistical adjustments.…”

Section: Discussionsupporting

confidence: 64%

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Sex differences in risk factors, treatment, and prognosis in acute stroke

Dahl

Hjalmarsson

Andersson

2020

Womens Health (Lond Engl)

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Objectives: Stroke is a major cause of long-term disability and death worldwide. Several studies have shown that women in general have more severe symptoms at arrival to hospital and are less likely to return home and independent living. Our aim with the present study was to update previous results concerning sex differences in baseline characteristics, stroke management, and outcome in a population study from Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: This study included patients with acute ischemic and hemorrhagic stroke in 2014 at Sahlgrenska University Hospital. All data were collected from The Swedish National Stroke Registry (Riksstroke). Results: The study population consisted of 1453 patients, with 46.7% females. Women were 5 years older than men. There was no sex difference in acute stroke severity. Frequency of revascularization was equal between men and women. The stroke mortality rate was the same between the sexes. At 3-months follow-up, women had a worse functional outcome and a higher frequency of depression and post-stroke fatigue. Conclusion: Our results show that there are no sex differences in management of acute stroke. However, the cause of worse functional outcome in women at 3-months follow-up, independent of other risk factors, is not clear and warrants further investigations.

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Section: Discussionsupporting

confidence: 64%

“…6,9,13,28 This latter finding was not corroborated in the present study, which may partly explain the same stroke severity between men and women. Previous studies 28,30,31 have shown that cases of cardioembolic stroke are often more severe than those related to other causes.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in risk factors, treatment, and prognosis in acute stroke

Dahl

Hjalmarsson

Andersson

2020

Womens Health (Lond Engl)

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“…In accordance with the results of our study, in literature it was proven that the prevalence of stroke in females is lower than males, and several studies have shown that females suffered from more severe strokes, had higher short-term mortality than males, but long-term sex differences in mortality persist up to 5 years after stroke (10,11,12). Ghosh et al also reported that female patients had significantly higher incidence of poor outcome, but female gender was not a significant predictor of stroke severity and mortality (6).…”

Section: -4: Resultssupporting

confidence: 92%

Parameters Affecting Stroke Severity and Outcome in Acute Stroke Patients Treated With Iv Thrombolysis

Arslan

Cilli

2019

IJMBS

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Aim: Our aim is to evaluate vascular risk factors and laboratory findings in patients treated with IV thrombolysis, to compare these parameters according to neurological findings scored by a National Institutes of Health Stroke Scale (NIHSS) at admission, after 7 days and to investigate the impact of these parameters on stroke severity and outcome at 3rd month. Methods: We reviewed 53 consecutive acute ischemic stroke patients admitted within 0-4.5 h after stroke onset and treated with IV thrombolysis between 2014 March-2018 May. Patients with acute posterior circulation stroke, and who underwent endovascular intervention after thrombolysis were excluded. Demographic features, vascular risk factors, laboratory findings and hemorrhagic transformation, and NIHSS scores of patients at admission and after 7 days, and also 3rd month mRS scores were recorded. Results: The mean age of patients was 64.79±12.26 and 60.37 % of them were male. Mean NIHSS score at admission was 10.60±5.16 and one week after IV r-tPA treatment, the mean score was 7.07±5.39. Hemorrhagic transformation was 18.9%. The male ratio was significantly higher in mild-moderate stroke group (p=0.008), the prevalence of hypertension, diabetes, hemorrhagic transformation and blood urea levels were also significantly higher in severe stroke group than mild-moderate group (p≤ 0.05). In addition neutrophil levels was higher in severe group, but not statistically significant. Creatine levels were significantly higher in the poor outcome group (NIHSS difference <6) after one week. Conclusion: Female gender, hemorrhagic transformation and high neutrophil levels were found to have impact on stroke severity towards poor prognosis independently.

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“…Sex differences in the risk factor distribution, severity, and outcomes of ischemic stroke are multifactorial and related to genetics, environmental factors, and social influences [21][22][23]. Previous studies have revealed that older women with higher stroke severity at stroke onset have higher platelet counts, higher prevalence of cardioembolism, and more unfavorable clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

High levels of immuno-inflammatory markers predicts unfavorable short-term outcomes in patients with acute ischemic stroke

Lin¹,

Chen²,

Chen³

et al. 2020

Preprint

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Background Atherosclerosis is a chronic inflammatory process that occurs in the arterial wall. This immuno-inflammatory process plays a role throughout all stages of stroke. Neutrophils, lymphocytes, and platelets are crucial blood cells for innate and adaptive immunity. This study investigated the associations of four types of immuno-inflammatory markers, namely the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil count (NC), with clinical outcomes in patients with acute ischemic stroke. Methods In this retrospective study, we enrolled 2903 inpatients with acute ischemic stroke from May 2010 to May 2019. Data included risk factors, laboratory parameters, and clinical features during hospitalization. The National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) were used to assess stroke severity and outcomes. Results All four immuno-inflammatory markers exhibited positive linear correlations with age, glucose, creatinine, length of hospital stay, NIHSS score on admission, and mRS score at discharge. The levels of the four immuno-inflammatory markers were significantly higher in patients with large-artery atherosclerosis and cardioembolism and were highest in patients with other determined etiology. Patients with levels of immuno-inflammatory markers higher than their cutoff values for unfavorable outcomes also exhibited higher rates of cancer history (except for SII and NC), uremia (except for NC), elevated troponin I, and in-hospital complications. Multivariate analysis including SII revealed that admission NIHSS score ≥ 5, age > 75 years, SII > 724, diabetes mellitus, female sex, elevated troponin I, heart disease, and prior stroke were significant predictors for unfavorable outcomes. These significant predictors were retained after replacing SII > 724 with NLR > 143, PLR > 3.5, or NC > 6 × 10 3 /mL, except for prior stroke. For a basic model comprising seven significant predictors of unfavorable outcomes, the C-statistic was 0.860. The addition of SII, NLR, and PLR to the basic model resulted in a significant improvement in the prediction performance to 0.864, 0.863, and 0.863, respectively. Conclusions Immuno-inflammatory markers provide more useful information than conventional risk factors and other laboratory parameters for the prediction of stroke outcomes. SII > 724 is the most appropriate marker when combined with other predictors.

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Sex-related differences in the risk factors for in-hospital mortality and outcomes of ischemic stroke patients in rural areas of Taiwan

Cited by 26 publications

References 32 publications

Sex differences in risk factors, treatment, and prognosis in acute stroke

Sex differences in risk factors, treatment, and prognosis in acute stroke

Parameters Affecting Stroke Severity and Outcome in Acute Stroke Patients Treated With Iv Thrombolysis

High levels of immuno-inflammatory markers predicts unfavorable short-term outcomes in patients with acute ischemic stroke

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