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Objective:To evaluate the distribution characteristics of postinterventional cerebral hyperdensities (PCHDs) in patients with acute anterior circulation large vessel occlusive stroke after interventional therapy using the Alberta Stroke Program Early CT Score (ASPECTS) and to investigate its predictive value for symptomatic intracranial hemorrhage (sICH).Methods:Consecutive patients with acute anterior circulation large vessel occlusive stroke underwent endovascular mechanical thrombectomy (EMT) in the Stroke Center of Dongguan People's Hospital from January 2018 to December 2020 were retrospectively enrolled. The clinical, imaging and follow-up data were collected. The immediate PCHDs-ASPECTS after endovascular therapy were analyzed. Multivariate logistic regression analysis and receiver operator characteristic (ROC) curve were used to investigate its predictive value for sICH. Results:A total of 161 patients were enrolled in the study, including 115 males (71.4%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 13.6±5.6; 66 patients (41.0%) developed PCHDs and 35 (21.7%) had sICH. The baseline NIHSS score, the proportion of patients with severe stroke, the number of retrieval attempts and the detection rate of PCHDs in the sICH group were significantly higher than those in the non-sICH group, while diffusion weighted imaging-ASPECTS and PCHDs-ASPECTS were significantly lower than those in the non-sICH group (all P<0.05). Multivariate logistic regression analysis showed that PCHDs had a significant independent positive correlation with sICH (odds ratio 6.036, 95% confidence interval 1.45-25.123; P=0.013), and PCHDs-ASPECTS had a significant independent negative correlation with sICH (odds ratio 0.70, 95% confidence interval 0.496-0.992; P=0.045). ROC analysis showed that the area under the curve predicted by PCHDs-ASPECTS was 0.832 ( P<0.05). When its cut-off value was 8 points, the sensitivity and specificity were 74.3% and 83.3% respectively. Conclusions:In patients with acute anterior circulation large vessel occlusive stroke treated with EMT, the immediate postoperative PCHDs is an independent predictor of sICH, and PCHDs-ASPECTS can early predict the risk of sICH after EMT.
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Objective To investigate the predictive significance of thromboelastography ( TEG) for early neurological deterioration ( END) in patients with acute cerebral infarction. Methods This was a case-control study. From March 2016 to August 2017,a total of 195 consecutive patients with acute mild to moderate cerebral infarction (National Institute of Health stroke scale [NIHSS] score <16) within 24 h after onset were registered prospectively. The demography, clinical data, and laboratory test results were collected. The TEG examinations were completed after admission. According to whether having END or not within 3 d after admission,they were divided into either a END group (n=60) or a non-END group (n=135). A logistic regression model was established to analyze the relationship between TEG parameters and END. Results Of the 195 eligible patients,60 (30. 8%) experienced END. TEG reaction time (RT) and kinetic time ( RT) in patients of the END group were significantly less than those of the non-END group (4. 1 ± 1. 1 min vs. 4. 4 ± 1. 2 min;1. 3 ± 0. 3 min vs. 1. 5 ± 0. 4 min,t=3. 395 and 3. 093,respectively;all P<0. 01). The proportions of the shortened RT and KT in patients of the END group were significantly higher than those of the non-END group (80. 0％ [48/60] vs. 63. 0％ [85/135],18. 3％ [11/60] vs. 8. 1％ [11/135]). There were significant differences (χ2 =5. 560 and 4. 305,all P <0. 05). After adjusting for the factors of age,sex,diabetes mellitus,smoking,baseline NIHSS score,and serum hypersensitive C-reactive protein, logistic regression analysis showed that the shortened RT was independently correlated with END (OR,1. 612,95％ CI 1. 094-2. 376,P=0. 016). Conclusion The shortened TEG coagulation time RT on admission has a certain predictive value for END within 3 d after onset of acute mild to moderate cerebral infarction.
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Objective To investigate the correlation betw een visit-to-visit blood pressure variability and long-term stroke recurrence in patients w ith ischemic stroke. Methods Consecutive patients w ith first-ever acute ischemic stroke w ere registered. The demographic and clinical data w ere documented. The patients w ere follow ed up every month after discharge. Visit-to-visit blood pressure w as measured, and its mean value and blood pressure variability parameters w ere calculated.A 12-month follow-up period w as completed and the recurrent stroke events w ere documented.Univariate analysis w as used to compare the demographic and clinical data in the recurrent and non-recurrent groups.Multivariate logistic regression analysis w as used to identify the correlation betw een visit-to-visit blood pressure variability and stroke recurrence. Results A total of 556 patients completed the follow-up, including 62 (11.2%) w ith recurrent stroke. The standard deviation (16.5 ±4.7 mmHg vs.13.4 ±4.2 mmHg, 1 mmHg=0.133 kPa; t=1.953, P=0.042) and coefficient of variation (11.9 ±3.1 vs.9.8 ±2.4; t=2.287, P=0.001) of visit-to-visit systolic blood pressure in the recurrent group w ere significantly higher than those in the non-recurrent group.Multivariable logistic regression analysis show ed that visit-to-visit coefficient of variation of systolic pressure w as independently associated w ith stroke recurrence (odds ratio 1.305,95% confidence interval 1.004-7.491;P=0.017). Conclusion The visit-to-visit blood pressure variability w as independently associated w ith long-term stroke recurrence in patients w ith acute ischemic stroke.
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Objective To elucidate whether 24-hour blood pressure (BP) variability in the acute phase of ischemic stroke is associated with functional outcomes.Methods Case-control study was performed in patients with acute ischemic stroke admitted to our hospital from January 2013 to December 2015.Clinical data and 24-hour continuous BP monitoring data right after admission were recorded,and BP variability profiles were subsequently calculated.Functional outcomes were evaluated with modified Rankin scale (mRS) on discharge and at 6 months after discharge respectively (favorable outcome:mRS scores ＜2;poor outcome:mRS scores＞2).BP variability profiles were compared with distinctive functional outcomes.Logistic regression models were established to investigate factors contributing to poor outcome on discharge and at 6 months after discharge.Results Of 188 eligible patients,67 (35.6％) discharged with poor outcome and 95 (50.5％) were reported poor outcome at 6 months follow-up.Patients with poor outcome on discharge had significantly higher 24-hour mean systolic blood pressure (SBP,[149.6±20.0] mmHg vs.[137.6±20.2] mmHg) and SBP standard variation (SBP-SD,[13.4±3.8] mmHg vs.[12.1±3.8] mmHg,P＜0.05).After adjusting for crude variables,the increase of 24-hour mean SBP and SBP-SD was independently associated with poor outcome on discharge (OR=1.284,95％CI=1.067-1.544,P=0.008;OR=1.098,95％CI=1.016-1.188,P=0.019).Patients with poor outcome at 6 month after discharge had significantly higher 24-hour mean SBP ([146.6±20.6] mmHg vs.[137.1 ± 20.2] mmHg,P＜0.05).Conelusion Increased 24-hour BP variability after admission is associated with early functional outcome in patients with acute ischemic stroke,but not with midterm outcome.
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Objective To investigate the incidence,etiology and risk factors of activity of daily life (ADL) deterioration during recovery in patients with ischemic stroke.Methods Consecutive inpatients with acute ischemic stroke from Dongguan area were enrolled prospectively.The demographic,clinical and imaging data were documented,and the patients were followed-up for 6 months.The modified Rankin Scale (mRS) 9Q was used to evaluate ADL.The mRS score 0-2 was defined as independency,and the mRS score ＞2 was defined as dependency,and the ADL deterioration was defined as transition from independency to dependency.A multivariate logistic regression model was established to analyze the factors associated with ADL deterioration.Results A total of 362 patients completed the 6-month follow-up,50 patients (13.8％) had ADL deterioration,among them,14 (3.9％) attributed to early stroke recurrence and 12 (3.3％)attributed to cognitive impairment after ischemic stroke.Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 1.099,95％ confidence interval [CI] 1.049-1.152;P ＜0.001),female (OR] 2.026,95％ CI 1.068-6.437;P =0.035),previous stroke history (OR 1.251,95％ CI 1.024-1.530;P=0.029),and higher baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.167,95％ CI 1.016-1.284;P =0.001) were the independent risk factors for ADL deterioration.Conchtsions The ADL deterioration deterioration during recovery in patients with ischemic stroke is not uncommon.Advanced age,female,previous stroke history and higher baseline NIHSS score are the independent risk factors for ADL deterioration during recovery in patients with ischemic stroke.
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Objective To investigate the incidence,etiology and risk factors of activity of daily life (ADL) deterioration during recovery in patients with ischemic stroke.Methods Consecutive inpatients with acute ischemic stroke from Dongguan area were enrolled prospectively.The demographic,clinical and imaging data were documented,and the patients were followed-up for 6 months.The modified Rankin Scale (mRS) 9Q was used to evaluate ADL.The mRS score 0-2 was defined as independency,and the mRS score ＞2 was defined as dependency,and the ADL deterioration was defined as transition from independency to dependency.A multivariate logistic regression model was established to analyze the factors associated with ADL deterioration.Results A total of 362 patients completed the 6-month follow-up,50 patients (13.8％) had ADL deterioration,among them,14 (3.9％) attributed to early stroke recurrence and 12 (3.3％)attributed to cognitive impairment after ischemic stroke.Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 1.099,95％ confidence interval [CI] 1.049-1.152;P ＜0.001),female (OR] 2.026,95％ CI 1.068-6.437;P =0.035),previous stroke history (OR 1.251,95％ CI 1.024-1.530;P=0.029),and higher baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.167,95％ CI 1.016-1.284;P =0.001) were the independent risk factors for ADL deterioration.Conchtsions The ADL deterioration deterioration during recovery in patients with ischemic stroke is not uncommon.Advanced age,female,previous stroke history and higher baseline NIHSS score are the independent risk factors for ADL deterioration during recovery in patients with ischemic stroke.
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Objective To explore the relationship between 24-hour blood pressure variability after admission and early neurological deterioration in patients with acute non-cardioembolic ischemic stroke.Methods This was a case-control study.Patients with acute non-cardioembolic ischemic stroke within 72 hours after stroke onset were prospectively registered.Clinical and 24 -hour continuous blood pressure monitoring data were recorded, and subsequently compared with regard to whether early neurological deterioration ( END) occurred within 7 days after admission.Factors contributing to END were investigated by logistic regression model.Results Of 221 eligible patients, 59 cases ( 26.7%) exhabited END.Patients with END had higher 24-hour mean systolic blood pressure ( SBP) (145.8 ±18.2 mmHg vs.139.9 ± 20.3 mmHg, P=0.014) and SBP coefficient of deviation (SBP-CV) [9.0(7.3 -11.2) vs.8.4(6.9-10.2), P=0.011].After adjusting for crude variables, multivariate analysis showed that the increase in mean SBP (10 mmHg mean SBP,OR=1.285,95%CI(1.059~1.559) and SBP-CV [1 unit of SBP-CV, OR=1.206,95%CI(1.050~1.384)] was associated with higher risk of END.Conclusions Increased 24-hour blood pressure variability after admission is an independent risk factor for occurrence of END in patients with acute non-cardioembolic ischemic stroke.
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Objective To investigate the correlation betw een the short-term blood pressure variability and the recent outcome in patients w ith noncardioembolic ischemic stroke. Methods The patients w ith acute noncardioembolic ischemic stroke admitted to hospital betw een January 1, 2013 to June31, 2015 w ere enrol ed consecutively. The demographic and clinical data w ere col ected, and 24 h ambulatory blood pressure monitoring w as performed and each blood pressure variability parameter w as calculated. The modified Rankin scale (mRS) w as used to evaluate recent neurological outcome at the time of discharge or the fourteenth day in hospital. The mRS score 0-2 w as defined as good outcome, and >2 w as defined as poor outcome. Multivariate logistic regression analysis w as used to determine the correlation betw een the blood pressure and the short-term blood pressure variability indicators and recent neurological outcome. Results A total of 229 patients w ith acute noncardioembolic ischemic stroke w ere enrol ed, and 40.2% of them had recent poor functional outcome. The mean systolic pressure ( 147.8 ±19.6 mmHg vs.137.7 ± 19.1 mmHg; t=3.868, P<0.001; 1 mmHg=0.133 kPa) and the actual variation value of the mean systolic pressure (median, interquartile 11.7 [10.0-14.0] mmHg vs.10.6 [8.2-12.5] mmHg;Z=3.544, P<0.001) of the recent poor outcome group w ere significantly higher than those of the good functional outcome group. Multivariate logistic regression analysis show ed that after adjusting other confounders, the increased mean systolic pressure ( each 10 mmHg increase: odds ratio 1.189, 95% confidence interval 1.013-1.369; P=0.034) and the enlarged actual variation of systolic blood pressure (each 1 mmHg increase:odds ratio 1.182, 95% confidence interval 1.046-1.336; P=0.008) w ere associated w ith the recent poor functional outcome. Conclusions The increased short-term blood pressure variability w as associated w ith the recent poor functional outcome in patients w ith acute noncardioembolic ischemic stroke.
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Post-stroke infection mainly includes stroke-associated pneumonia and urinary tract infection.It is one of the major causes of increasing disability and mortality in patients with stroke.Its occurrence and development is associated with the basal state,stroke location,infarct volume,severity,dysphasia,aphasia and other factors of the whole body system in patients with stroke.In recent years,stroke-induced immunosuppression is receiving increasing attention.