The effect of accurate control over blood glucose on immunity in patients with stroke-associated infection / 中华急诊医学杂志

Objective To investigate the correlation between blood glucose and stroke-associated infection (SAI) as well as the effect of accurate control over blood glucose on T-lymphocytes.Methods Stroke patients with stress hyperglycemia (random blood glucose ≥ 11.1 mmol/L) were divided into thc accurate control of blood glucose group (A) and the control group (C).The blood glucose was accurately controlled within 5.56-8.33 mmol/L in the group A and ＜ 11.10 mmol/L in the group C by infusion of regular insulin.The NIHSS and APACHE Ⅱ evaluation were performed at day 0,3 and 7 after admission,T-lymphocytes were measured by flow cytometry and the rate of stroke-associated infection was recorded.Results A total of 325 patients were enrolled in the present study.The patients in the group A had lower incidence of stroke-associated infection (51.8％ vs.64.0％,P =0.027) and lower incidence of hypoglycemia (2 vs.25,P ＜ 0.05).Lower level of average blood glucose [(7.00 ± 0.85) mmol/L vs.(8.97 ±1.68) mmoL/L,P ＜0.05] and lower blood sugar variability (12.1％ vs.18.7％,P ＜0.05) were found in the patients of group A compared with the group C.The patients in the group A at day 7 after admission showed higher counts of CD8 +,CD4 +and CD4 +/CD8 + [(0.42 ±0.13) × 109L-1vs.(0.34 ±0.12) ×109L-1,(0.50±0.13) ×109L-1vs.(0.39±0.17) ×109L-1and (1.36±0.14) vs.(1.14 ± 0.15) respectively,all P ＜ 0.05].Logistic regression analysis showed that blood glucose and CD4 + count were independent risk factors of stroke-associated infection.The AUCs of CD4 + and CD8 + for predicting stroke-associated infection were 0.814 and 0.724,respectively.The AUC (0.890) of a combination of CD4 + and CD8 + was significantly higher than that of CD4 + or CD8 + alone in predicting strokeassociated infection.Conclusions Accurate control over blood glucose decreases the fluctuation of the blood glucose level and the incidence of hypoglycemia.It improves the immunity associated with T lymphocyte,decreases the incidence of stroke-associated infection and thus improves prognosis of those patients.

Validity and Reliability of a Korean Version of the National Institutes of Health Stroke Scale

BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) is a clinical assessment tool that is widely used in clinical trials and practice to evaluate stroke-related neurological deficits. The aim of this study was to determine the validity and reliability of the Korean version of the NIHSS (K-NIHSS) for evaluating Korean stroke patients. METHODS: The K-NIHSS was translated and adapted with regard to cultural and linguistic peculiarities. To examine its content validity, we quantified the Content Validity Index (CVI), which was rated by 11 stroke experts. The validity of the K-NIHSS was assessed by comparison with the Glasgow Coma Scale (GCS), the modified Rankin Scale (mRS), and the Barthel Index. The reliability of the K-NIHSS was evaluated using the unweighted kappa statistics for multiple raters and an intraclass correlation coefficient (ICC). RESULTS: The CVI of the K-NIHSS reached 0.91-1.00. The median K-NIHSS score at baseline was 3 (interquartile range, 2-7), and the mean+/-SD score was 6.0+/-6.6. The baseline K-NIHSS had a significantly negative correlation with the GCS at baseline and the Barthel Index after 90 days. The K-NIHSS also had a significantly positive correlation with the mRS after 90 days. Facial paresis and dysarthria had moderate interrater reliability (unweighted kappa, 0.41-0.60); kappa values were substantial to excellent (unweighted kappa, >0.60) for all the other items. The ICC for the overall K-NIHSS score was 0.998. The intrarater reliability was acceptable, with a median kappa range of 0.524-1.000. CONCLUSIONS: The K-NIHSS is a valid and reliable tool for assessing neurological deficits in Korean acute stroke patients.

Validity and Reliability of Retrospective NIH Stroke Scale Assessment for Initial Stroke Severity

BACKGROUND: The retrospective severity scoring system of NIHSS for acute stroke patients was found to be valid and reliable by using patients' medical records in studies abroad. However, in Korea, medical records are often summarized and contain missing information which makes it difficult to conduct a restropective outcome study. The purpose of this research was to evaluate the validity and reliability of the retrospective NIHSS scoring system according to patients' medical records with written clinical histories and physical admission notes. METHODS: An algorithm for the retrospective NIHSS scoring system was developed and applied to 75 patients with acute ischemic stroke. Missing data on physical examination results were scored as normal. One neurologist who was blinded to this study measured the NIHSS score prospectively on the initial patient examination. After the patient's discharge, two other neurologists, blinded to the patient's clinical condition, evaluated the NIHSS score independently based on the information collected from the patient's physical admission notes. The criterion-related validity was evaluated by the Pearson Correlation Coefficient, and the measure of agreement between two raters was evaluated by the Kappa Statistic. RESULTS: The criterion-related validities of the retrospective NIHSS scoring system were high in the total and each itemized scores, except for the items of LOC command, limb ataxia, dysarthria, and neglect. The interrater reliabilities were also high except for the items of LOC command, limb ataxia, and dysarthria. CONCLUSIONS: The retrospective NIHSS scoring algorithm was found to be a reliable and unbiased tool even when some physical examination elements are missing from the written medical records.