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Acute ischemic non-embolic stroke and serum level of uric acid  [cached]
Farhad Iranmanesh,Nazanin Zia Sheykholeslami,Faranak Gadari,Jafar Ahmady
Iranian Journal of Neurology , 2012,
Abstract: Background: Impact of high level of uric acid on stroke isstill controversial. We conducted this study to investigatethe relationship between acute ischemic non-embolicstroke and serum levels of uric acid.Methods: This was a case-control study on patients withacute ischemic non-embolic stroke in Rafsanjan, Iran. Thecontrol group consisted of normal persons who were similarto the case group in terms of age and gender. Serum level ofuric acid in the first 24 hours of admission was measuredwith photometry method.Results: In a total of 130 patients (59 mens), hyperuricemiawas seen in 13.0% of subjects in the control group and10.7% of subjects in the case group. Nine patients in casegroup and 7 patients in control group with hyperuricemiawere women. No significant relationship was foundbetween acute ischemic non-embolic stroke and serumlevel of uric acid.Conclusion: There was no relationship between uric acidand acute ischemic non-embolic stroke.
Serum Uric Acid Levels and Cerebral Microbleeds in Patients with Acute Ischemic Stroke  [PDF]
Wi-Sun Ryu, Chi Kyung Kim, Beom Joon Kim, Seung-Hoon Lee
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0055210
Abstract: Unlike experimental studies indicating a neuroprotective property of uric acid, clinical studies have shown that elevated levels of uric acid are associated with a risk of ischemic stroke. However, the association of uric acid with cerebral hemorrhage has seldom been tested. We aimed to elucidate the association between uric acid and cerebral microbleeds (CMBs), a hemorrhage-prone cerebral microangiopathy. Seven hundred twenty-four patients with ischemic stroke who were consecutively admitted to our hospital were included in this study. We collected demographic, clinical, and laboratory data, including uric acid level, and examined the presence of CMBs using T2*-weighted gradient-echo MRI. We used logistic regression analysis to examine an independent association between uric acid and CMBs. Two-hundred twenty-six patients had CMBs (31.2%). After adjusting for possible confounders, elevated uric acid was independently associated with the presence of CMBs (the highest quartile vs. lowest quartile, adjusted odd ratio [OR], 1.98; 95% confidence interval [CI], 1.16–3.39). This association retained in patients with deep or infratentorial CMBs (with or without lobar CMBs) but not among those with lobar CMBs. In addition, this association was robust among patients with hypertension (the highest quartile vs. lowest quartile, adjusted OR, 2.74; 95% CI, 1.43–5.24). In contrast, we did not find the association in patients without hypertension. We demonstrated that serum uric acid is independently associated with the presence of CMBs. In particular, the relation between uric acid and CMBs was robust in hypertensive patients.
Cortisol as a Prognostic Marker of Short-Term Outcome in Chinese Patients with Acute Ischemic Stroke  [PDF]
Wen-Jie Zi, Jie Shuai
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0072758
Abstract: Background Early prediction of outcome is important for allocation of therapeutic strategies. Endocrine alterations of the hypothalamus–pituitary–axis are one of the first stress-induced alterations after cerebral ischemia. We therefore evaluated the prognostic value of serum cortisol in Chinese patients with an acute ischemic stroke. Methods In a prospective observational study, serum cortisol was measured using a solid-phase, competitive chemiluminescent enzyme immunoassay on admission in serum of 226 consecutive Chinese patients with an acute ischemic stroke. The prognostic value of serum cortisol to predict the functional outcome, mortality within 90 days, was compared with clinical variables (e.g., advanced age and the National Institutes of Health Stroke Scale [NHISS] score) and with other known predictors. Results Patients with a poor outcome and nonsurvivors had significantly increased serum cortisol levels on admission (P<0.0001, P<0.0001). There was a positive correlation between levels of cortisol and the NIHSS (r = 0.298, P<0.0001), glucose levels (r = 0.324, P<0.0001) and infarct volume (r = 0.328, P<0.0001). Cortisol was an independent prognostic marker of functional outcome and death [odds ratio 3.44 (2.58–6.23) and 4.21 (1.89–9.24), respectively, P<0.0001 for both, adjusted for age, the NIHSS and other predictors] in patients with ischemic stroke. In receiver operating characteristic curve analysis, cortisol could improve the NIHSS score in predicting short-term functional outcome (Area under the curve [AUC] of the combined model, 0.87; 95% CI, 0.82–0.92; P = 0.01) and mortality (AUC of the combined model, 0.90; 95% CI, 0.84–0.95; P = 0.01). Conclusion Cortisol can be seen as an independent short-term prognostic marker of functional outcome and death in Chinese patients with acute ischemic stroke even after correcting confounding factors. Combined model can add significant additional predictive information to the clinical score of the NIHSS.
Prognostic value of copeptin in patients with acute ischemic stroke  [cached]
Tu Wen-Jun,Chen Hui,Cui Li-Hua
Iranian Journal of Neurology , 2011,
Abstract: Stroke is the second leading cause of mortality in the Chinaand one of the leading causes of severe morbidity. An earlyrisk assessment with estimate of the severity of disease andprognosis is pivotal for optimized care and allocation ofhealthcare resources. Reliable prognostic markers availableduring the initial phase after acute stroke may aid clinicaldecision-making.Vasopressin (AVP) is a potent synergistic factor ofcorticotropin-releasing hormone as hypothalamic stimulator ofthe hypothalamo-pituitary-adrenal axis.1 Some studies foundincreased AVP levels in patients with ischemic stroke werecorrelated with stroke severity2 and outcome.3 Copeptin isreleased in an equimolar ratio to AVP, and is more stable inthe circulation and easy to measure.4We designed a preliminary prospective cohort study toevaluate the prognostic value of copeptin in acute strokepatients. Adult patients with a persistent neurological deficitdue to ischemic stroke were eligible. Sixty-ninenonconsecutive patients admitted at 3 hospitals with adiagnosis of acute ischemic stroke confirmed by CT scanningwere evaluated. All patients provided informed consent. Inpatients who died within 24 hours after admission or inpatients who were discharged, data from admission or untildischarge were collected. The National Institute of HealthStroke Scale (NIHSS) score was assessed on admission.Functional outcome was obtained on days 90 according to themodified Rankin Scale (mRS) blinded to copeptin levels. Poorfunctional outcome at 3 months was considered as a mRSscore > 2. Blood samples were collected on admission andimmediately centrifuged and sera stored at –70°C. Copeptinwas measured with a sandwich immunoluminometricassay.1 Discrete variables are summarized as counts(percentage), and continuous variables as medians andinterquartile ranges (IQRs). Two-group comparison of notnormally distributed data was performed using Mann–Whitney U test, and a Kruskal–Wallis one-way analysis ofvariance was used for multi-group comparisons.The median age of the 69 patients was 62 years (IQR,55 to 84), 61% were men and the median NIHSS score onadmission was 7 points (IQR, 3 to 12). In 38 patients(55%) with a poor functional outcome (13 patients died),copeptin levels were higher compared with those inpatients with a favorable outcome (23.5; IQR, 10.6 to 64.3pmol/L vs. 7.5; IQR, 3.8 to 13.6 pmol/L; P < 0.0001).Multivariate logistic regression analysis adjusted for ageand NIHSS score showed that copeptin was anindependent predictor of poor functional outcome (oddsratio = 3.12; 95%CI, 1.54–6.46). The area under the
Insulin-Like Growth Factor-1 as a Prognostic Marker in Patients with Acute Ischemic Stroke  [PDF]
Jian-Hua Tang, Li-Li Ma, Tian-Xia Yu, Juan Zheng, Hui-Juan Zhang, Hui Liang, Peng Shao
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099186
Abstract: Objective Insulin-like growth factor-1 (IGF-1) has been associated with cardiovascular risk factors and atherosclerosis. The aim of the present study was to evaluate the prognostic value of IGF-1 levels in patients with acute ischemic stroke (AIS). Methods All patients with first-ever AIS from August 1, 2012 to August 31, 2013 were recruited to participate in the study. Clinical data were collected. The National Institutes of Health Stroke Scale (NIHSS) score was assessed on admission blinded to serum IGF-1 levels. For the assessment of functional outcome at 90 days Modified Rankin Scale (mRS) was used. On admission, serum IGF-1 levels were determined by chemiluminescence immunoassay. The influence of IGF-1 levels on functional outcome and death was assessed by multivariate logistic regression analysis. Results Patients with an unfavorable outcomes and non-survivors had significantly decreased serum IGF-1 levels on admission (P<0.0001 for both). IGF-1 was an independent prognostic marker of functional outcome and death [odds ratio 0.89 (0.84–0.93) and 0.90 (0.84–0.95), respectively, P<0.0001 for both, adjusted for age, NIHSS score and other predictors] in patients with ischemic stroke. Serum IGF-1 levels ≤130 ng/mL was as an value indicator for unfavorable functional outcome (OR 3.31, 95% CI:1.87–5.62; P<0.0001), after adjusting for other significant confounders. Conclusions We reported a significant association between low serum IGF-1 levels and unfavorable functional outcome and death.
Clinical Analysis on Alteration of Thyroid Hormones in the Serum of Patients with Acute Ischemic Stroke  [PDF]
Yonghua Zhang,Michael A. Meyer
Stroke Research and Treatment , 2010, DOI: 10.4061/2010/290678
Abstract: Low T3 has been associated with increased short-term mortality in intensive care unit and long-term mortality in cardiovascular disease. The objective of this retrospective study is to investigate associations of thyroid hormone status with clinical severity and outcome in acute ischemic stroke, and whether there is association between the pituitary axis abnormality and the anterior/posterior circulation involvement. Patients with no history of thyroid abnormality who presented first ever stroke were studied. Total T3, T4, TSH levels, basic and clinical characteristics were collected and categorized. Neurological impairment was assessed using NIHSS and modified Rankin Scale. Twenty-nine patients (61%) had T3 ≤ 75?ng/dL. Low T3 group had significant higher NIHSS compared to normal T3 group. There was a significant negative correlation between T3 levels and NIHSS scores on admission. A significantly smaller percentage of patients with low T3 showed favorable neurological function improvement by both NIHSS and mRS measures compared to those with normal T3. There was no significant difference for anterior or posterior circulation involvement between low T3 and normal T3 groups. It is suggested that low T3 is associated with worse neurological outcome. The severity of low T3 may be a predictor of functional improvement in acute ischemic stroke. 1. Introduction Neuroendocrine profile is significantly altered in acute ischemic stroke; low triiodothyronine (T3) has been associated with increased short-term mortality in intensive care unit patients and long-term mortality in patients with heart disease [1–4]. This is known as nonthyroidal illness syndrome (NTIS; or euthyroid sick syndrome or “low-T3 syndrome”). The most common hormone pattern in NTIS is a decrease in T3 level with normal levels of thyroxine (T4) and thyroid-stimulating hormone (TSH) [2, 5]. For more severe illness, a decrease in T4 level occurs while the TSH level does not show the expected pituitary thyroid axis reactivity [2, 5]. In acute stroke, several factors such as C-reactive protein (CRP), glucose levels on admission, fibrinogen concentration, erythrocyte sedimentation rate, and leukocyte count have been examined as prognostic factors for stroke outcome and have been found to be associated with the increased morbidity and mortality [6–8]. A reduction of serum T3 without elevation of thyroid-stimulating hormone appears to be associated with the severity of stroke and worse clinical outcome [9, 10]. Thus far, there were two studies that have been published to address the importance of
Selected acute phase CSF factors in ischemic stroke: findings and prognostic value
Maia Beridze, Tamar Sanikidze, Roman Shakarishvili1, Nino Intskirveli, Natan M Bornstein
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-41
Abstract: Ninety five acute ischemic stroke patients were investigated. Ischemic region visualized at the twenty fourth hour by conventional Magnetic Resonance Imaging. Stroke severity evaluated by National Institute Health Stroke Scale. One month outcome of disease was assessed by Barthel Index. Cerebrospinal fluid was taken at the sixth hour of stroke onset. CSF pro- and anti-inflammatory cytokines were studied by Enzyme Linked Immunosorbent Assay. Nitric Oxide and Lipoperoxide radical were measured by Electron Paramagnetic Resonance. CSF Nitrate levels were detected using the Griess reagent. Statistics performed by SPSS-11.0.At the sixth hour of stroke onset, cerebrospinal fluid cytokine levels were elevated in patients against controls. Severe stroke patients had increased interleukin-6 content compared to less severe strokes (P < 0.05). Cerebrospinal fluid Electron Paramagnetic Resonance signal of nitric oxide was increased in patients against controls. Severe stroke group had an elevated Electron Paramagnetic Resonance signal of lipoperoxiradical compared to less severe stroke. Cerebrospinal fluid nitrate levels in less severe stroke patients were higher than those for severe stroke and control. Positive correlation was established between the initial interleukin-6 content and ischemic lesion size as well as with National Institute Health Stroke Scale score on the seventh day. Initial interleukin-6 and nitrate levels in cerebrospinal fluid found to be significant for functional outcome of stroke at one month.According to present study the cerebrospinal fluid contents of interleukin-6 and nitrates seem to be the most reliable prognostic factors in acute phase of ischemic stroke.Modern concepts of acute cerebral ischemia highlight the role of neurovascular units and emphasize the importance of integrative tissue responses that result from dynamic interactions of endothelial cells, vascular sooth muscles, matrix elements, astroglia, microglia and neurons. By means of infla
How to Design Economic Predictive Laboratory Panel Evaluating Acute Ischemic Stroke Outcome  [PDF]
Hasnaa A. Abo-Elwafa, Hazem K. Ibrahim, Hassan M. El-Nady, Asmaa H. Abbas
Neuroscience & Medicine (NM) , 2019, DOI: 10.4236/nm.2019.101001
Abstract: Background: acute ischemic stroke (AIS) remains the third cause of death and disability, and acute phase responses, both increasing international normalized ratio (INR) and activated partial thromboplastin time (APTT) are associated with worse outcome. Erythrocyte sedimentation rate (ESR) serves as severity marker, and non-fasting triglycerides (TG) indicates remnants of chylomicrons and very low density lipoproteins potentially pro-inflammatory. Aims: to design predictive economic panel evaluating AIS. Patients and methods: 100(AIS) patients were included, clinically evaluated by Scandinavian Stroke Scale (SSS) and Modified Rankin Score (MRS), subjected to complete blood count (CBC) on Cell-Dyne3700, manual ESR, INR and APTT on SYSMEX-CA1500, serum uric acid (SUA), serum albumin and non-fasting (TG) on Beckman Coulter AU480. Statistical analysis: STATA intercooled version 9.2. Results: odd ratio (OR), confidence interval (CI) of (MRS) in correlation to WBCs count in quartile (Q)3, 4 (OR 8.14, CI 2.29 - 8.90, significant P = 0.01; and OD13.5, CI 3.39 - 53.68, high significant P = 0.001 respectively), to APTT in Q3 (OD 4.15, CI 1.09 - 15.82, P = 0.04), SUA in Q3 (OD 0.19, CI 0.05 - 0.68, P = 0.01), TG in Q3,4 (OD 0.24 CI 0.06 - 0.88, P = 0.03; and OD 0.09, CI 0.02 - 0.34 P = 0.001 respectively) and serum albumin in Q3(OD 0.13, CI 0.04 - 0.51, P = 0.003), insignificant correlations to ESR, INR and platelets. Conclusion: according to (MRS), the economic predictive panel should be included WBCs, APTT, SUA, and non-fasting TG with serum albumin as prognostic tool evaluating functional disability in AIS.
Prognostic Value of Complete Blood Count and Electrolyte Panel during Emergency Department Evaluation for Acute Ischemic Stroke  [PDF]
Latha Ganti,Rachel M. Gilmore,Amy L. Weaver,Robert D. Brown Jr.
ISRN Stroke , 2013, DOI: 10.1155/2013/974236
Abstract: Objective. To determine whether routine laboratory parameters are predictors of early mortality after acute ischemic stroke (AIS). Methods. The cohort consisted of 522 consecutive patients with AIS presenting to the emergency department (ED) at a tertiary referral center during a 27-month period, residing within the surrounding ten counties. Serum laboratory values were obtained for all patients and categorized according to whether the levels were low, normal, or high. These laboratory results were evaluated as potential predictors of 90-day mortality using Cox proportional hazards models. The associations were summarized by calculating risk ratios (RRs) and 95% confidence intervals (CI). Results. The presence of elevated white blood cell count (RR 2.2, 95% CI 1.5–3.4), low bicarbonate (RR 4.2, 95% CI 2.6–6.7), low calcium (RR 2.9, 95% CI 1.4–5.9), and high glucose (RR 1.3, 95% 1.1–1.6) were each univariately associated with significantly higher mortality within the first 90 days. Based on fitting a multivariate Cox regression model, elevated white blood cell count, low bicarbonate, and high glucose were each identified as being jointly associated with early mortality ( ). Conclusion. Early leukocytosis, acidosis, and hyperglycemia and hypocalcemia in AIS appear to be associated with early mortality. Whether addressing these factors will impact survival remains to be investigated. 1. Introduction For patients who present with chief complaint of acute ischemic stroke, the American Stroke Association recommends a set of diagnostic studies [1] to be done at presentation, with the intent of optimizing and expediting the care of these patients. From the Emergency Physicians’ perspective many tests are simply part of a routine battery, often without direct impact on emergency department (ED) management, diagnostic or prognostic value. In this study, we sought to determine whether the routine complete blood count (CBC) and electrolyte panel include any components that are markers of early mortality in acute ischemic stroke. Specifically, the parameters of interest were those obtained as part of routine clinical investigation. 2. Methods 2.1. Study Design This study was an observational study using a consecutive sample of local residents presenting to the ED with acute ischemic stroke (AIS). The primary outcome measure was death at 90 days. This study was approved by the Mayo Clinic Institutional Review Board. 2.2. Study Population and Setting This study was conducted at the Saint Marys Hospital, a tertiary referral academic medical center with an annual ED
Serum triglyceride level and prognosis of acute cerebral ischemic stroke
Toghae M,Namakian F,Gheini MR,Aloosh M
Tehran University Medical Journal , 2010,
Abstract: "nBackground: Cerebrovascular ischemic accident is the third most common cause of death in community. Management of high-risk patients reduces complications and mortality. Serum lipid profile is one of the most important factors influencing the prognosis."n "nMethods: In this cross sectional study, 123 (58 female and 65 male) patients with acute ischemic stroke, mean aged 65.1± 11.16 years, were admitted to Sina Hospital between September 2008 and September 2009. The inclusion criteria were age between 40-90 years and ischemic stroke within the anterior or posterior brain blood system. The exclusion criteria were brain tumor or abscess, venous sinus thrombosis, liver disease, renal failure, hypothyroidism or metabolic problems. Serum lipid profile was evaluated during the first 24 hours after stroke and after 12 hours of fasting. Furthermore, the patients' inability was evaluated on the first and fifth day of hospitalization by NIH Stroke Scale (NIHSS)."n "nResults: Patients' total serum cholesterol was 189.93± 51.46 mg/dl and mean total serum triglycerides was 157.72± 72.67 mg/dl. The mean HDL and LDL was 47.70± 14.43 and 105.98± 37 mg/dl, respectively. In the analysis, a significant inverse relationship was found between serum triglyceride levels and fifth day's NIHSS. In addition, age and a history of heart disease had a significant direct relationship with the first day's NIHSS. (p< 0.05)"n "nConclusion: The study showed a better prognosis in cases with increased plasma triglyceride levels, after cerebral ischemic stroke. Besides, older age and a history of ischemic heart disease were associated with a worse prognosis.
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