High prevalence of non-alcoholic fatty liver disease in patients with a first episode of acute ischemic stroke. Impact on disability and death

IntroductionNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, and it is associated with an increased risk of overall mortality being cardiovascular disease the most common cause of mortality. Strategies are needed to identify high risk groups for NAFLD to improve screening approaches. Moreover, there is a lack of information about the prevalence of NAFLD on patients with acute ischemic stroke (AIS) and the influence of NAFLD on the prognosis of the stroke. The aim of the study was to define the prevalence of NAFLD in patients with a first episode of AIS and the secondary aims were to evaluate the prevalence of NAFLD at different ages and its impact on the severity and prognosis of the AIS.Materials and methodsObservational study including consecutive patients admitted for the first AIS from January 2005 to May 2018. Patients with harmful alcohol intake, other liver diseases and malignancies were excluded. Sociodemographic data, cardiovascular risk factors, comorbidities, and blood test at admission were reviewed. NAFLD and liver fibrosis were assessed with the serological scores Fatty Liver Index (FLI) and Fibrosis-4 respectively. NAFLD was defined by a FLI>60. Stroke severity and prognosis were evaluated with the National Institute of Health Stroke Scale and modified Rankin Scale respectively in patients aged from 40 to 79 years old.ResultsWe included 1601 patients, 52.4% were female and median (IQR) age of 77 (66 – 83) years. The 41% of the total cohort had a FLI>60 with different prevalence according to age in decades: in 30-39 years: 35.7%; in 40-49: 47.5%; in 50-59: 51.1%, in 60-69: 56%, in 70-79: 41.4%; in 80-89: 34.9% (p<0.001). The presence of NAFLD did not impact on the severity or the prognosis of stroke. However, patients with NAFLD were younger than those without NAFLD (74 vs. 78; p<0.001).ConclusionPresence of NAFLD did not impact on disability and death after the stroke. However, patients with a first episode of stroke showed a high prevalence of NAFLD, especially at intermediate ages, and therefore, screening for NAFLD should be advisable

Influencia de los hábitos dietéticos y de la obesidad abdominal en el ictus isquémico /

Objetivos: Analizar si existen diferencias dietéticas y antropométricas entre pacientes con ictus isquémico y controles de una misma población y evaluar si existen diferencias por género y subtipos de ictus. Se estudió también si los patrones dietéticos de prevención eran igual de saludables en los pacientes con ictus isquémico y en los controles. Material y métodos: Estudio prospectivo que incluyó pacientes ingresados con el diagnóstico de ictus isquémico y controles sanos. Se registraron datos demográficos, antropométricos (peso, talla y perímetro abdominal), edad, sexo y factores de riesgo vascular. En un subgrupo de sujetos se evaluaron los hábitos dietéticos mediante un cuestionario de frecuencia de alimentos validado, que registra la ingesta habitual de nutrientes durante el año previo. Se cuantificó el consumo de los macronutrientes que se han descrito asociados a un aumento de incidencia de ictus, las diferentes formas de preparar los alimentos y los hábitos alimenticios para controlar el riesgo vascular antes del ictus. Resultados: Se observó una mayor ingesta calórica en los pacientes con ictus que en los controles, de proteínas (p 0.001; OR 1.02), de colesterol total (P=0.001; OR 1.04) y de alimentos rebozados (p=0.001; OR 1.94) y un menor consumo de yogur con lactobacilos (p=0.002; OR 0.88). Se observaron también diferencias entre los subtipos de ictus. No se constataron diferencias entre sexos respecto al consumo calórico, ingesta de nutrientes o forma de procesar los alimentos. Los controles referían una mayor propensión a seguir una dieta saludable y las mujeres con ictus isquémico estaban más concienciadas para mantener hábitos dietéticos saludables que los hombres. En el estudio univariado, el incremento del IMC no se asoció con un aumento de riesgo de ictus en mujeres o de forma global, pero fue un factor protector en hombres (p=0.03; OR 0.59 [0.37-0.94]). Estratificada por sexo, la obesidad abdominal se asoció significativamente con el riesgo de ictus en las mujeres, tanto en medidas de circunferencia de cintura (p 0.001; OR 5.79 [3.10-10.85]) como de índice cintura-altura (p 0.001; OR 3.61 [1.99-6.54]), mientras que la asociación no fue significativa en hombres. Sin embargo, en el análisis multivariado ajustado por factores de riesgo vascular, la obesidad abdominal constituyó un factor de riesgo para ambos sexos, pero la magnitud de la asociación fue significativamente mayor en las mujeres. Conclusiones: Existen diferencias dietéticas y antropométricas entre los pacientes con ictus isquémico y una población control. Los pacientes con ictus presentan un mayor consumo previo de proteínas y de colesterol total y una mayor frecuencia de formas de preparación de alimentos descritos como perjudiciales para el desarrollo de ictus. Los pacientes con ictus están menos concienciados para mantener hábitos dietéticos saludables, especialmente los hombres. El aumento de peso mediante el índice de masa corporal no se asocia con un aumento de riesgo de ictus en mujeres o de forma global y es un factor protector en hombres. Sin embargo, la obesidad abdominal sí que aumenta el riesgo de ictus isquémico y constituye un factor de riesgo para ambos sexos, mayor en las mujeres. Estos hallazgos apoyan la necesidad de insistir en patrones de dieta saludable y en la reducción de la obesidad abdominal, en prevención primaria, especialmente en sujetos con factores de riesgo cardiovascular.Objectives: To analyze if there are dietary and anthropometric differences between patients with ischemic stroke and controls of the same population and to evaluate if there are differences by gender and stroke subtypes. It was also studied whether dietary prevention patterns were equally healthy in patients with ischemic stroke and in controls. Material and methods: Prospective study that included hospitalized patients with a diagnosis of ischemic stroke and healthy controls. Demographic and anthropometric data (weight, height, and waist circumference), age, sex and vascular risk factors were recorded. In a subgroup of subjects, dietary habits were assessed using a validated food frequency questionnaire, recording the usual intake of nutrients during the previous year. The consumption of macronutrients described associated with an increase in the incidence of stroke, the different ways of preparing food and eating habits to control the vascular risk before the stroke were quantified. Results: A higher caloric intake was observed in patients with stroke than in controls, proteins (p 0.001; OR 1.02), total cholesterol (P = 0.001, OR 1.04), and breaded foods (p = 0.001, OR 1.94) and lower consumption of yogurt with lactobacillus (p = 0.002; OR 0.88). Differences between stroke subtypes were also observed. There were no gender differences regarding caloric intake, nutrient intake or food processing methods. The controls reported a greater propensity to follow a healthy diet and women with ischemic stroke were more aware of maintaining healthy dietary habits than men. In the univariate study, the increase in BMI was not associated with an increased risk of stroke in women or globally, but it was a protective factor in men (p = 0.03; OR 0.59 [0.37-0.94]). Stratified by gender, abdominal obesity was significantly associated with the risk of stroke in women, both in waist circumference (p 0.001; OR 5.79 [3.10-10.85]) and waist to height ratio (p 0.001; OR 3.61 [1.99-6.54]), whereas the association was not significant in men. However, in the multivariate analysis adjusted for vascular risk factors, abdominal obesity was a risk factor for both genders, but the magnitude of the association was significantly higher in women. Conclusions: There are dietary and anthropometric differences between patients with ischemic stroke and a control population. Patients with stroke have a higher consumption of protein and total cholesterol and a greater frequency of food preparation forms described as detrimental to the development of stroke. Patients with stroke are less conscious to maintain healthy dietary habits, especially men. Weight gain measured by body-mass index is not associated with an increased risk of stroke in women or globally and it is a protective factor in men. However, abdominal obesity does increase the risk of ischemic stroke and is a risk factor for both genders, higher in women. These findings support the need to emphasize healthy dietary patterns and reduction of abdominal obesity in primary prevention, especially in subjects with cardiovascular risk factors

Increased COVID-19 mortality in people with previous cerebrovascular disease: a population-based cohort study

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Ictus hemorràgic; Ictus isquèmic; Hemorràgia subaracnoideaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Ictus hemorrágico; Ictus isquémico; Hemorragia subaracnoideaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Hemorrhagic stroke; Ischemic stroke; Subarachnoid hemorrhageBackground: The aim of the study was to determine the association between previous stroke and mortality after coronavirus disease 2019 (COVID-19) according to sex, age groups, and stroke subtypes. Methods: Prospective population-based cohort study including all COVID-19 positive cases between February 1 and July 31, 2020. Comorbidities and mortality were extracted using linked health administration databases. Previous stroke included transient ischemic attack, ischemic stroke, hemorrhagic stroke, spontaneous subarachnoid hemorrhage, and combined stroke for cases with more than one category. Other comorbidities were obesity, diabetes, hypertension, ischemic heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, cirrhosis, dementia, individual socioeconomic index, and deprivation index. Cases were followed up until December 31, 2020. Primary outcome was mortality of any cause after COVID-19 positivity. Cox proportional regression analysis adjusted for comorbidities was used. Stratified analyses were performed for sex and age (<60, 60-79, and ≥80 years). Results: There were 91 629 COVID-19 cases. Previous strokes were 5752 (6.27%), of which 3887 (67.57%) were ischemic, 1237 (21.50%) transient ischemic attack, 255 (4.43%) combined, 203 (3.53%) hemorrhagic, and 170 (2.96%) subarachnoid hemorrhage. There were 9512 deaths (10.38%). Mortality was associated with previous stroke (hazard ratio [HR]=1.12 [95% CI, 1.06-1.18]; P<0.001), in both sexes separately (men=1.13 [1.05-1.22]; P=0.001; women=1.09 [1.01-1.18]; P=0.023), in people <60 years (HR=2.97 [1.97-4.48]; P<0.001) and 60 to 79 years (HR=1.32 [1.19-1.48]; P<0.001) but not in people ≥80 years (HR=1.02 [0.96-1.09]; P=0.437). Ischemic (HR=1.11 [1.05-1.18]; P=0.001), hemorrhagic (HR=1.53 [1.20-1.96]; P=0.001) and combined (HR=1.31 [1.05-1.63]; P=0.016) strokes were associated but not transient ischemic attack. Subarachnoid hemorrhage was associated only in people <60 years (HR=5.73 [1.82-18.06]; P=0.003). Conclusions: Previous stroke was associated with a higher mortality in people younger than 80 years. The association occurred for both ischemic and hemorrhagic stroke but not for transient ischemic attack. These data might help healthcare authorities to establish prioritization strategies for COVID-19 vaccination.This work was supported, in part, by Spain’s Ministry of Health (Instituto de Salud Carlos III FEDER, RD16/0019/0002 and RD16/0019/0010 INVICTUS-PLUS

Machine learning approximations to predict epigenetic age acceleration in stroke patients

Age acceleration (Age-A) is a useful tool that is able to predict a broad range of health outcomes. It is necessary to determine DNA methylation levels to estimate it, and it is known that Age-A is influenced by environmental, lifestyle, and vascular risk factors (VRF). The aim of this study is to estimate the contribution of these easily measurable factors to Age-A in patients with cerebrovascular disease (CVD), using different machine learning (ML) approximations, and try to find a more accessible model able to predict Age-A. We studied a CVD cohort of 952 patients with information about VRF, lifestyle habits, and target organ damage. We estimated Age-A using Hannum\u27s epigenetic clock, and trained six different models to predict Age-A: a conventional linear regression model, four ML models (elastic net regression (EN), K-Nearest neighbors, random forest, and support vector machine models), and one deep learning approximation (multilayer perceptron (MLP) model). The best-performing models were EN and MLP; although, the predictive capability was modest (

Comparison of the impact of atrial fibrillation on the risk of early death after stroke in women versus men

BACKGROUND: Atrial fibrillation (AF) is considered a predictive factor of poor clinical outcome in patients with an ischemic stroke (IS). This study addressed whether the impact of AF on the in-hospital mortality after first ever IS is different according to the patient’s gender. METHODS: We prospectively studied 1678 patients with first ever IS consecutively admitted to two University Hospitals. We recorded demographic data, vascular risk factors, and the stroke severity (NIHSS) at admission analyzing their impact on the in-hospital mortality and on the combined mortality-dependency at discharge using a Cox proportional hazards model. Two variable interactions between those factors independently related to in-hospital mortality and combined mortality-dependency at discharge were tested. RESULTS: Overall in-hospital mortality was 11.3%. Cox proportional hazards model showed that NIHSS at admission (HR: 1.178 [95% CI 1.149–1.207]), age (HR: 1.044 [95% CI 1.026–1.061]), AF (HR: 1.416 [95% CI 1.048–1.913]), male gender (HR: 1.853 [95% CI 1.323–2.192) and ischemic heart disease (HR: 1.527 [95% CI 1.063–2.192]) were independent predictors of in-hospital mortality. A significant interaction between gender and AF was found (p = 0.017). Data were stratified by gender, showing that AF was an independent predictor of poor outcome just for woman (HR: 2.183 [95% CI 1.403–3.396]; p < 0.001). The independent predictors of combined mortality-disability at discharge were NIHSS at admission (HR: 1.052 [95% CI 1.041–1.063]), age (HR: 1.011 [95% CI 1.004–1.018]), AF (HR: 1.197 [95% CI 1.031–1.390]), ischemic heart disease (HR: 1.222 [95% CI 1.004–1.488]), and smoking (HR: 1.262 [95% CI 1.033–1.541]). CONCLUSIONS: The impact of AF is different in the twogenders and appears as a specific ischemic stroke predictor of in-hospital mortality just for women

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry

Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score 85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors

HTLV-1 infection in solid organ transplant donors and recipients in Spain

HTLV-1 infection is a neglected disease, despite infecting 10-15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy

PATJ Low Frequency Variants Are Associated with Worse Ischemic Stroke Functional Outcome: A Genome-Wide Meta-Analysis

RATIONALE: Ischemic stroke is among the leading causes of adult disability. Part of the variability in functional outcome after stroke has been attributed to genetic factors but no locus has been consistently associated with stroke outcome. OBJECTIVE: Our aim was to identify genetic loci influencing the recovery process using accurate phenotyping to produce the largest GWAS (genome-wide association study) in ischemic stroke recovery to date. METHODS AND RESULTS: A 12-cohort, 2-phase (discovery-replication and joint) meta-analysis of GWAS included anterior-territory and previously independent ischemic stroke cases. Functional outcome was recorded using 3-month modified Rankin Scale. Analyses were adjusted for confounders such as discharge National Institutes of Health Stroke Scale. A gene-based burden test was performed. The discovery phase (n=1225) was followed by open (n=2482) and stringent joint-analyses (n=1791). Those cohorts with modified Rankin Scale recorded at time points other than 3-month or incomplete data on previous functional status were excluded in the stringent analyses. Novel variants in PATJ (Pals1-associated tight junction) gene were associated with worse functional outcome at 3-month after stroke. The top variant was rs76221407 (G allele, β=0.40, P=1.70×10-9). CONCLUSIONS: Our results identify a set of common variants in PATJ gene associated with 3-month functional outcome at genome-wide significance level. Future studies should examine the role of PATJ in stroke recovery and consider stringent phenotyping to enrich the information captured to unveil additional stroke outcome loci

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Influencia de los hábitos dietéticos y de la obesidad abdominal en el ictus isquémico

Objetivos: Analizar si existen diferencias dietéticas y antropométricas entre pacientes con ictus isquémico y controles de una misma población y evaluar si existen diferencias por género y subtipos de ictus. Se estudió también si los patrones dietéticos de prevención eran igual de saludables en los pacientes con ictus isquémico y en los controles. Material y métodos: Estudio prospectivo que incluyó pacientes ingresados con el diagnóstico de ictus isquémico y controles sanos. Se registraron datos demográficos, antropométricos (peso, talla y perímetro abdominal), edad, sexo y factores de riesgo vascular. En un subgrupo de sujetos se evaluaron los hábitos dietéticos mediante un cuestionario de frecuencia de alimentos validado, que registra la ingesta habitual de nutrientes durante el año previo. Se cuantificó el consumo de los macronutrientes que se han descrito asociados a un aumento de incidencia de ictus, las diferentes formas de preparar los alimentos y los hábitos alimenticios para controlar el riesgo vascular antes del ictus. Resultados: Se observó una mayor ingesta calórica en los pacientes con ictus que en los controles, de proteínas (p< 0.001; OR 1.02), de colesterol total (P=0.001; OR 1.04) y de alimentos rebozados (p=0.001; OR 1.94) y un menor consumo de yogur con lactobacilos (p=0.002; OR 0.88). Se observaron también diferencias entre los subtipos de ictus. No se constataron diferencias entre sexos respecto al consumo calórico, ingesta de nutrientes o forma de procesar los alimentos. Los controles referían una mayor propensión a seguir una dieta saludable y las mujeres con ictus isquémico estaban más concienciadas para mantener hábitos dietéticos saludables que los hombres. En el estudio univariado, el incremento del IMC no se asoció con un aumento de riesgo de ictus en mujeres o de forma global, pero fue un factor protector en hombres (p=0.03; OR 0.59 [0.37-0.94]). Estratificada por sexo, la obesidad abdominal se asoció significativamente con el riesgo de ictus en las mujeres, tanto en medidas de circunferencia de cintura (p<0.001; OR 5.79 [3.10-10.85]) como de índice cintura-altura (p<0.001; OR 3.61 [1.99-6.54]), mientras que la asociación no fue significativa en hombres. Sin embargo, en el análisis multivariado ajustado por factores de riesgo vascular, la obesidad abdominal constituyó un factor de riesgo para ambos sexos, pero la magnitud de la asociación fue significativamente mayor en las mujeres. Conclusiones: Existen diferencias dietéticas y antropométricas entre los pacientes con ictus isquémico y una población control. Los pacientes con ictus presentan un mayor consumo previo de proteínas y de colesterol total y una mayor frecuencia de formas de preparación de alimentos descritos como perjudiciales para el desarrollo de ictus. Los pacientes con ictus están menos concienciados para mantener hábitos dietéticos saludables, especialmente los hombres. El aumento de peso mediante el índice de masa corporal no se asocia con un aumento de riesgo de ictus en mujeres o de forma global y es un factor protector en hombres. Sin embargo, la obesidad abdominal sí que aumenta el riesgo de ictus isquémico y constituye un factor de riesgo para ambos sexos, mayor en las mujeres. Estos hallazgos apoyan la necesidad de insistir en patrones de dieta saludable y en la reducción de la obesidad abdominal, en prevención primaria, especialmente en sujetos con factores de riesgo cardiovascular.Objectives: To analyze if there are dietary and anthropometric differences between patients with ischemic stroke and controls of the same population and to evaluate if there are differences by gender and stroke subtypes. It was also studied whether dietary prevention patterns were equally healthy in patients with ischemic stroke and in controls. Material and methods: Prospective study that included hospitalized patients with a diagnosis of ischemic stroke and healthy controls. Demographic and anthropometric data (weight, height, and waist circumference), age, sex and vascular risk factors were recorded. In a subgroup of subjects, dietary habits were assessed using a validated food frequency questionnaire, recording the usual intake of nutrients during the previous year. The consumption of macronutrients described associated with an increase in the incidence of stroke, the different ways of preparing food and eating habits to control the vascular risk before the stroke were quantified. Results: A higher caloric intake was observed in patients with stroke than in controls, proteins (p <0.001; OR 1.02), total cholesterol (P = 0.001, OR 1.04), and breaded foods (p = 0.001, OR 1.94) and lower consumption of yogurt with lactobacillus (p = 0.002; OR 0.88). Differences between stroke subtypes were also observed. There were no gender differences regarding caloric intake, nutrient intake or food processing methods. The controls reported a greater propensity to follow a healthy diet and women with ischemic stroke were more aware of maintaining healthy dietary habits than men. In the univariate study, the increase in BMI was not associated with an increased risk of stroke in women or globally, but it was a protective factor in men (p = 0.03; OR 0.59 [0.37-0.94]). Stratified by gender, abdominal obesity was significantly associated with the risk of stroke in women, both in waist circumference (p <0.001; OR 5.79 [3.10-10.85]) and waist to height ratio (p <0.001; OR 3.61 [1.99-6.54]), whereas the association was not significant in men. However, in the multivariate analysis adjusted for vascular risk factors, abdominal obesity was a risk factor for both genders, but the magnitude of the association was significantly higher in women. Conclusions: There are dietary and anthropometric differences between patients with ischemic stroke and a control population. Patients with stroke have a higher consumption of protein and total cholesterol and a greater frequency of food preparation forms described as detrimental to the development of stroke. Patients with stroke are less conscious to maintain healthy dietary habits, especially men. Weight gain measured by body-mass index is not associated with an increased risk of stroke in women or globally and it is a protective factor in men. However, abdominal obesity does increase the risk of ischemic stroke and is a risk factor for both genders, higher in women. These findings support the need to emphasize healthy dietary patterns and reduction of abdominal obesity in primary prevention, especially in subjects with cardiovascular risk factors