Association of Serum Bilirubin with Acute Ischemic Stroke – An Observational Study

@#Introduction: Stroke is a common cause of mortality and morbidity and has an increasing prevalence across the world.1 Bilirubin is now being considered an antioxidant which increases in response to diseases associated with increased oxidative stress. Hence the present observational study was undertaken to assess the bilirubin levels with the outcome of acute ischemic stroke. Methods: This observational study was conducted from January 2018 to December 2018 on 64 ischemic stroke patients admitted at KLE’S Dr. Prabhakar kore hospital at Belagavi, Karnataka. All adult patients above 18 years of age presenting with cerebrovascular accident and proved as ischemic stroke on CT scan or MRI scan were included. The patients were empirically divided into different Groups based on the bilirubin level. They were then analysed with their NIHSS scores for assessing stroke severity. Results: A total of 64 patients were included in the final analysis. The mean total bilirubin level in the patients was 0.68±0.34 mg/dl ( mean±SD). 34.3% (22) of ischemic stroke patients in the study had serum total bilirubin levels 0.7 mg/dl or more. Mean NIHSS Score for Group 1(Low) total bilirubin group was 9.37 and for Group 2(High) bilirubin group was 10.9, which was statistically not significant. This indicates that there was no significant correlation between total bilirubin and severity of symptoms at the time of admission.There was no statistically significant correlation between NIHSS and direct bilirubin levels Conclusion: The current study has documented no association between the bilirubin levels and stroke severity and prognosis.

Wake Up and Non-Wake up stroke: A comparative Hospital Based Study.

Background: Almost 25% of all acute ischemic strokes occur during sleep with the patients or relatives become aware of the neurological deficits as they wake up. The present study was conducted with an aim to find out the prevalence of wakeup stroke along with clinical profile and outcome of wake up stroke as compared to non-wake up stroke. Methods: All patients of age group 18 years or more presenting with stroke during the 12-month study period were included. Data was compared with non-wakeup stroke by applying Chi square test, Fischer exact test and Yates corrections was used to evaluate the association between the variables defining the clinical profile and outcome. Results: Patients of non wake-up stroke were higher (63%) as compared to wake-up stroke (37%). Out of 37 wake-up stroke patients, ischemic stroke was found in 23(62.16%) and hemorrhagic stroke in 14(37.83%) patients. Out of 14(37.83%) wakeup strokes; in 8(57.14%) patients lesion was parenchymal and in 5(35.71%) multiple lesions were present. Higher incidence of diabetes mellitus in wake up strokes was found. Atherothrombotic and cardioembolic strokes contribute to majority of the cases of ischemic stroke. Conclusions: The incidence of stroke increases dramatically with advancing age irrespective of gender. .Diabetes mellitus emerged as the main risk factor in wake-up stroke. In wake up hemorrhagic stroke, the higher percentage of thalamic bleed was found. Improvement was appreciated more in non wake-up stroke as compared to wake-up stroke.

Low-Density-Lipoprotein Particle Size Predicts a Poor Outcome in Patients with Atherothrombotic Stroke

BACKGROUND AND PURPOSE: Low-density lipoprotein (LDL) particle size is considered to be one of the more important cardiovascular risk factors, and small LDL particles are known to have atherogenic potential. The aim of this study was to determine whether LDL particle size is associated with stroke severity and functional outcome in patients with atherothrombotic stroke. METHODS: Between January 2009 and May 2011, 248 patients with first-episode cerebral infarction who were admitted to our hospital within 7 days after symptom onset were prospectively enrolled. LDL particle size was measured using the nondenaturing polyacrylamide gradient gel electrophoresis assay. Stroke severity was assessed by applying the National Institutes of Health Stroke Scale (NIHSS) at admission. Functional outcome was investigated at 3 months after the index stroke using the modified Rankin Scale (mRS), and poor functional outcome was defined as an mRS score of > or =3. RESULTS: The LDL particle size in the 248 patients was 25.9+/-0.9 nm (mean+/-SD). LDL particle size was inversely correlated with the degree of cerebral artery stenosis (p=0.010). Multinomial multivariate logistic analysis revealed that after adjustment for age, sex, and variables with p or =5; reference, NIHSS score 0-2; odds ratio=0.38, p=0.028) and poor functional outcome (odds ratio=0.44, p=0.038). CONCLUSIONS: The results of this study demonstrate that small LDL particles are independently correlated with stroke outcomes. LDL particle size is thus a potential biomarker for the prognosis of atherothrombotic stroke.

Statins in Acute Ischemic Stroke: A Systematic Review / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Statins have pleiotropic effects of potential neuroprotection. However, because of lack of large randomized clinical trials, current guidelines do not provide specific recommendations on statin initiation in acute ischemic stroke (AIS). The current study aims to systematically review the statin effect in AIS. METHODS: From literature review, we identified articles exploring prestroke and immediate post-stroke statin effect on imaging surrogate markers, initial stroke severity, functional outcome, and short-term mortality in human AIS. We summarized descriptive overview. In addition, for subjects with available data from publications, we conducted meta-analysis to provide pooled estimates. RESULTS: In total, we identified 70 relevant articles including 6 meta-analyses. Surrogate imaging marker studies suggested that statin might enhance collaterals and reperfusion. Our updated meta-analysis indicated that prestroke statin use was associated with milder initial stroke severity (odds ratio [OR] [95% confidence interval], 1.24 [1.05-1.48]; P=0.013), good functional outcome (1.50 [1.29-1.75]; P<0.001), and lower mortality (0.42 [0.21-0.82]; P=0.0108). In-hospital statin use was associated with good functional outcome (1.31 [1.12-1.53]; P=0.001), and lower mortality (0.41 [0.29-0.58]; P<0.001). In contrast, statin withdrawal was associated with poor functional outcome (1.83 [1.01-3.30]; P=0.045). In patients treated with thrombolysis, statin was associated with good functional outcome (1.44 [1.10-1.89]; P=0.001), despite an increased risk of symptomatic hemorrhagic transformation (1.63 [1.04-2.56]; P=0.035). CONCLUSIONS: The current study findings support the use of statin in AIS. However, the findings were mostly driven by observational studies at risk of bias, and thereby large randomized clinical trials would provide confirmatory evidence.

Correlation of previous treatment of hypertension with the severity of ischemic stroke / 医学研究生学报

Objective Hypertension is a leading modifiable risk factor for cardiovascular disease .However , a lot of hyper-tension patients hold inactive attitudes to hypertension treatment .The purpose of this study was to investigate the relationship between previous treatment of hypertension and stroke severity in acute ischemic stroke . Methods We retrospectively analyzed the clinical data of 653 in-hospital ischemic stroke patients with hypertension between January 2011 and December 2014 .According to the National Institutes of Health Stroke Scale (NIHSS) at admission, the stroke patients were divided into a mild group (NIHSS≤3) and a severe group (NIHSS >3) and, based on their history of hypertension treatment , allocated to a regular treatment, an irregular treatment, a non-treatment , and an unawareness group .We studied the relationship of previous hypertension treatment with stroke severity by Spearman correlation analysis and identified the potential factors associated with stroke severity by multivariate logistic regression anal-ysis. Results Previous treatment of hypertension was positively correlated with stroke severity (r=0.146, P=0.000 2).Compared with the patients of the regular treatment group , those in the irregular treatment group (OR: 2.21; 95%CI:1.39 -3.52; P =0.001), non-treatment group ( OR: 2.18; 95%CI: 1.41 -3.36; P =0.0004) and unawareness group (OR:1.80;95%CI:1.12-2.88; P=0.015) tended to have more severe stroke. Conclusion Previous treatment of hypertension is closely related to the severity of ischemic stroke .

Post-Stroke Survivors: The Relationship between Clinical Characteristics and the Levels of Depression

Stroke is frequently associated with long-term disability. Stroke leads to high risk of physical and neuropsychological consequences. Residual disabilities among post-stroke survivors can lead them to depression. This study aimed to determine the relationship between clinical characteristics and the levels of depression among post-stroke survivors at a teaching hospital in Kuala Lumpur. This cross-sectional study recruited 195 post-stroke survivors who attended follow-up Rehabilitation Clinic of a teaching hospital over a study period of 4 months. Information collected included socio-demographic, clinical characteristics (post stroke duration, stroke types and stroke severities) and level of depression. Beck’s Depression Inventory (BDI) was used to assess the level of depression. The mean age of participants was 61 years (SD=13.86, range: 22-87 years), with 118 male and 81 female survivors having a median duration of post-stroke of 12 months (range: 1–79 months). This study showed post stroke survivors 116 (59.5%) with depression. A Chi-square test for level of stroke severity was significantly associated with depression, χ2 (2, n=195) = 28.724, p<0.001, phi = 0.384. The results of the present study showed that survivors with mild stroke had less depression (44.0%) compared to moderate stroke (81.7%) and severe stroke (87.5%).

The analysis of the correlation between lesion location of the first onset acute cerebral infarction, stroke severity and post-stroke depression / 中国基层医药

Objective To explore the relationship between iesion location ot the frst onset acute cerebral infarction(ACI),stroke severity and post-stroke depression (PSD).Methods The lesion Iocations of ACI were observed by CT or MRI.100 patients with the first onset ACI were assessed by Hamilton Depression Scale and the National Institutes of Health Stroke Scale two weeks after stroke.Results There was no significant difference in the incidence of PSD among the patients with left,right and bilateral lesions in acute stroke(23.91％,25.00％,33.33％,x2 =0.2512,P ＞0.05 ).The incidence of PSD had significant difference between the anterior-circulation and posterior-circulation infarction(33.96％,14.89％,x2 =4.8307,P ＜ 0.05 ).Stroke severity was positively correlated withthe incidence of PSD( 16.67％,31.37％,36.36％,x2 =3.9188,P ＜ 0.05 ).Conclusion The incidence of PSD was no significant correlation with the stroke site of patients with the first onset ACI,and the patients with anterior circulation infarction and severe neurological deficit have high incidence of PSD.

Clinical significance and levels of serum vascular endothelial growth factor in the patients with acute intracerebral hemorrhage / 中国医师进修杂志

Objective To observe the dynamic changes of vascular endothelial growth factor (VEGF) levels in the patients with acute intracerebral hemorrhage during different phases and study the relationships between the VEGF levels and the volume of hemorrhage or stroke severity. Methods Fifty-six patients with acute intracerebral hemorrhage were divided into three groups by the volume of hemorrhage:group A(＜ 20 ml,23 caees),group B(20-30 ml, 18 cases),group C(＞ 30 ml, 15 cases) and light group (1-15 scores,22 cases),midrange group (16-30 scores,20 cases),severe group (31-45 scores, 14 cases)by China stroke scale (CSS) score in 24 hours of hospitalization. The serum VEGF level was determined at 24 h,48 h,72 h,7 d and 14 d after the onset of disease by enzyme linked immunosorbent assay(ELISA).Results The serum levels of VEGF during different phases (within 24 h,48 h,72 h,7 d,14 d) had statistical differences between group A and group C (P ＜0.01). Within 24 h,48 h,72 h,7 d,there was statistical difference between group B and group C (P ＜0.01).Within 48 h,72 h,7 d,14 d,there was statistical significance between group A and group B (P＜ 0.05). The serum levels of VEGF during different phases(24 h,48 h,72 h,7 d, 14 d) were higher in severe group than those in light group(P＜ 0.01). Within24 h,48 h,72 h,7 d,there was statistical difference between severe group and midrange group (P＜ 0.01).Within 48 h, 72 h, 7 d, 14 d, there was significant difference between midrange group and light group (P ＜0.05). The volume of hemorrhage had positive correlation with the CSS scores of neurologic impairment on admission (r = 0.916, P ＜ 0.05). Conclusion The serum VEGF levels might be related to the volume of hemorrhage and the severity of the disease.

Is post-stroke hyperglycemia a marker of stroke severity and prognosis: A pilot study

Various physiological parameters like blood pressure, temperature, blood sugar after onset of stroke have been proposed as possible marker of stroke prognosis to study the glycaemic status after acute stroke and assess the role of glycaemic status along with other clinical parameters in influencing stroke outcome. Forty-two confirmed stroke patients attending hospital within 6 hours of onset of stroke onset were included in the study. The time lag for hospitalization, blood pressure, blood sugar, HbA1c, stroke severity according to Toronto Scale, demographic factors, stroke onset type, type of stroke, past history of stroke, diabetes, and hypertension were recorded. The outcome was whether patient survived at the end of forth week. Twenty-one percent of patients who were not known diabetic found to be hyperglycemic though their HBA1C level was normal. Eighty-nine percent of such patients died. This rate was significantly higher than patients known to be diabetic with raised sugar and HBA1c level (26% patients, 12% mortality). There was strong and significant association between stroke severity and poor outcome. Strong and significant association was also found between stroke severity and blood sugar level. Modeling of stroke outcome using decision tree analysis (QUEST) found stroke severity as most important and significant predictor especially for severe stroke cases. In mild and moderately severe stroke, high sugar level was found to be a predictor, though not statistically significant.This study suggests that stroke severity is the most important predictor of stroke outcome, with high sugar level as a marker of stroke severity.