ABSTRACT
Introduction: The current guidelines on diagnosis and management of new-onset seizures in stroke are not well defined, especially in the Indian setting. Our study aims at providing insight into the hospital prevalence risk of new-onset seizures following ischemic stroke and to correlate seizure risk with the characteristics of stroke and other clinical parameters. Methods: A total of 127 patients were analyzed for the study where we assessed the clinical severity and the imaging severity of stroke using the National Institute of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT (ASPECT) score, respectively. Seizure-related variables including semiology, timing, and details of antiepileptic drugs (AEDs) were assessed under the domain of early and late poststroke seizures (PSSs). All patients were followed for 6 months for the seizure recurrence and change in Barthel index. In statistical analysis, quantitative variables were compared using the independent t-test/Mann–Whitney U test, and qualitative variables were correlated using Chi-square test/Fisher’s exact test. Univariate and multivariate logistic regression was used to find out the significant risk factors of acute symptomatic seizure. Results: The mean age of the study population was 59.72 years (±14.77), with a male predominance (60.63%). About 78.74% of the cases had an NIHSS score more than or equal to 6.24% had posterior circulation strokes and the rest had anterior circulation strokes. A cortical location of infarct was observed in 62.2% of cases and a subcortical location in 61.4% of cases. The prevalence of early PSSs observed in our study was 10.6%. Of those, 80% had generalized seizures, 13.3% had focal seizures, and 6.67% had focal seizures with secondary generalizations. No patient in the study group had late-onset seizures. Total leukocyte count, serum protein levels, serum uric acid levels, and erythrocyte sedimentation rate (ESR) values were associated with early seizures (p<0.05). Patients with early seizures were found to have a longer hospital stay (8 vs 6 days with p<0.05). In the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) etiological classification, an acute stroke of undetermined etiology was found to have a significant association with the occurrence of early seizure in both univariate and multivariate analysis [p = 0.030; odds ratio (OR) 4.735 (1.160–22.576)]. There was no difference in change in the Barthel index among the two groups. Conclusion: There was no recurrence of seizures in those who defaulted for AED and one patient had a seizure even on AED. Prophylactic AEDs in stroke patients based on stroke characteristics could not be ascertained, but the sample size was small. Knowing the fact that antiepileptics cause sedation and increase the chance of aspiration, continuing AEDs in patients who develop acute symptomatic seizures should be judged judiciously.
ABSTRACT
Introduction: The frailty index’s potential as a prognostic marker of sepsis is so far been untapped. Here we studied the predictive value of frailty index in the elderly with sepsis. Methods: This prospective cohort study was conducted in a tertiary level hospital in North India. The duration of the study was 18 months starting from January 2020 to July 2021. The frailty index was calculated along with traditional markers of sepsis such as sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), and systemic inflammatory response syndrome (SIRS) within 24 hours of admission in elderly patients suspected to have sepsis. The area under the receiver operating characteristic (AUROC) of frailty index, SOFA, qSOFA, and SIRS was compared for in-hospital and 3-month mortality. Results: There was no significant difference between the performance of the frailty index and SOFA (DeLong’s test p = 0.242) in predicting in-hospital mortality, but there was a statistical difference between the AUROC of SOFA score (AUC = 0.548) and frailty in predicting 3-month mortality (DeLong’s test p ?0.001). Conclusion: The frailty index had greater sensitivity and negative predictive value among the other scores in predicting in-hospital mortality, whereas SOFA had higher specificity in predicting in-hospital mortality. The frailty index was superior to SOFA and the other prognostic markers of sepsis in predicting 3-month mortality.