The influence of initial stroke severity on mortality, overall functional outcome and in-hospital placement at 90 days following acute ischemic stroke: A tertiary hospital stroke register study

Bhaskar, Sonu; Stanwell, Peter; Bivard, Andrew; Spratt, Neil J; Walker, Rhonda; Kitsos, Gemma; Evans, Malcolm; Jordan, Louise; Nilsson, Michael; Attia, John; Levi, Christopher

doi:10.4103/0028-3886.217947

Cited by 37 publications

(32 citation statements)

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“…Our finding is consistent with that of previous reports of a major negative impact of initial stroke severity on the likelihood of death following acute stroke [11]. In this regard, Bhaskar et al [12] observed that initial stroke severity (aOR 1.16; 95%CI 1.12 -1.20) independently predicted mortality following acute ischemic stroke. Similar finding has been also reported by Papagianni et al [13] who found National Institute of Health Stroke Scale (NIHSS) at admission (RR 1.19; 95%CI 1.14 -1.23; p < 0.001) to be one of the main predictors of in-hospital mortality after ischemic stroke.…”

Section: Discussionsupporting

confidence: 93%

Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo

Tshituta¹,

Lepira²,

Kajingulu³

et al. 2019

WJCD

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BACKGROUND AND AIM: Although admission hyperglycemia has been reported to be associated with unfavorable outcomes in acute stroke, little is known about this association in sub-Saharan Africa. Therefore, the aim of the present study was to assess the prognostic significance of admission hyperglycemia in the acute phase of stroke in Congolese patients. METHODS: In a multicenter prospective cohort study, consecutive patients with acute stroke were examined in 5 Emergency Rooms or Intensive Care Units of Kinshasa between July 15 th , 2017 and March 15 th , 2018. The severity of stroke was assessed at admission using the Glasgow Coma Scale. Stress hyperglycemia was defined as random blood glucose levels at admission > 140 mg/dL in patients without known type 2 diabetes mellitus (T2DM). The endpoint was 10-day all-cause in-hospital mortality. Survival (time-to-death) curves were built using the Kaplan Meier methods. Cox proportional analysis was used to identify predictors of 10-day all-cause in-hospital mortality. The predictive performance of blood glucose level to predict 10-day all-cause in-hospital mortality was assessed using ROC curve analysis. RESULTS: Out of 194 patients (mean age 58.7 ± 13.1 years; 64% males, 74.7% light to moderate stroke severity; 63.4% ischemic stroke) enrolled, 106 (54.

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Section: Discussionsupporting

confidence: 93%

Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo

Tshituta¹,

Lepira²,

Kajingulu³

et al. 2019

WJCD

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“…15 Initial NIHSS were also reported as an independent predictor of death after thrombolysis. 16 Subtherapeutic international normalized ratio (INR) in patients using warfarin increases the risk for sICH after thrombolysis. 17 Previous meta-analysis revealed that use of warfarin did not increase mortality in patients received thrombolysis.…”

Section: Journal Of Neurosonology and Neuroimagingmentioning

confidence: 99%

Increased Risk of Intracranial Hemorrhage and Mortality Following Thrombolysis in Patients with Stroke and Active Cancer

Seo

Suh

Heo

et al. 2018

J Neurosonol Neuroimag

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Background: The cerebrovascular disease is not uncommon in cancer patients. However, the effectiveness and safety of thrombolysis for acute ischemic stroke in this patient group has not been established well. We aimed to investigate the outcomes of thrombolysis for the patients suffering from cancer. Methods: We conducted a retrospective analysis using database of patients who had received thrombolysis in two university hospitals. Included patients were those who had received intravenous thrombolysis or endovascular therapy. We compared mortality, and the incidence of hemorrhagic transformation (HT) and symptomatic intracerebral hemorrhage (sICH) between patients with active cancer and those without. Results: Among a total of 627 patients, 42 (6.7%) had a medical history of active cancer. The mortality was higher in cancer patients than the others (27.5% vs. 13.7%, p=0.023). The existence of cancer was one of the factors to increases the risk of mortality (adjusted odds ratio, 3.354; 95% confidence interval, 1.416-7.947; p=0.006). From the 240 patients treated with intravenous thrombolysis only, the incidence of HT (53.8% vs. 16.3%, p=0.003), sICH (30.8% vs. 2.2%, p=0.001), and mortality (41.7% vs. 8.1%, p=0.003) was higher in cancer patients than the patients without. Conclusion: Comorbidity with cancer raised the risk of mortality in patients when treated with thrombolysis. The patients with cancer had more bad outcomes with intravenous thrombolysis only. Our data suggest that the decision of thrombolytic treatment for cancer patients requires careful consideration.

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“…Severe stroke can be understood as a stroke resulting in a significant amount of brain tissue damage and multiple neurological impairments, which leads to a significant loss of function and residual disability 12. Dependent on how it is measured, 14%–31% of people who sustain a stroke globally are classified as having a severe stroke,13–18 a cohort of the stroke population that experiences worse outcomes compared with survivors of less severe stroke 19–30. In the initial hospitalisation phase poststroke, they are more likely to develop acute medical complications, which are negatively associated with functional recovery 19.…”

Section: Introductionmentioning

confidence: 99%

“…In the initial hospitalisation phase poststroke, they are more likely to develop acute medical complications, which are negatively associated with functional recovery 19. Three month mortality can be as high as 40%, compared with just under 5% for those patients with mild stroke 20–22. Survivors of severe stroke spend longer in hospital, resulting in increased hospital costs, and demonstrate slower and less functional recovery, resulting in greater dependency when they are discharged from hospital 14 15 23 25.…”

Section: Introductionmentioning

confidence: 99%

The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review

et al. 2020

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ObjectiveTo evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.DesignSystematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.Results28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.ConclusionsThere is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.PROSPERO registration numberCRD42017077737

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The influence of initial stroke severity on mortality, overall functional outcome and in-hospital placement at 90 days following acute ischemic stroke: A tertiary hospital stroke register study

Abstract: In this acute stroke cohort, initial stroke severity had a major impact on the likelihood of death following an AIS and appears to be the dominant influence on the overall stroke outcome and in-hospital placement.

Cited by 37 publications

References 1 publication

Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo

Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo

Increased Risk of Intracranial Hemorrhage and Mortality Following Thrombolysis in Patients with Stroke and Active Cancer

The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review

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