Measuring the Efficacy of Medical Management Versus Decompressive Hemicraniectomy in Acute Stroke

Introduction: Stroke is a life-threatening condition requiring immediate treatment in order to optimize patient survival and functionality post-hospitalization. At present, the primary treatment modalities used are intensive medical management and surgical decompressive hemicraniectomy. We believe that application of skilled medical management can result in a lower mortality rate and higher functional score at 12 months than aggressive surgical decompressive hemicraniectomy. Methods: Epic data from Thomas Jefferson University will be used to identify patients with a large stroke (as defined by ischemic area on MRI) managed by the neurology department from 2016 to 2019. A survey will be administered by phone to assess mortality, as well as functionality with a modified Rankin scale. These data will then be used to assess the efficacy of medical management as compared to decompressive hemicrangiectomy. Results: At this time, no results are available

Frailty is characterized by biomarker patterns reflecting inflammation or muscle catabolism in multi-morbid patients

BACKGROUND: Frailty development is partly dependent on multiple factors like low levels of nutrients and high levels of oxidative stress (OS) and inflammation potentially leading to a muscle-catabolic state. Measures of specific biomarker patterns including nutrients, OS and inflammatory biomarkers as well as muscle related biomarkers like 3-methylhistidine (3MH) may improve evaluation of mechanisms and the complex networks leading to frailty. METHODS: In 220 multi-morbid patients (≥ 60 years), classified as non-frail (n = 104) and frail (n = 116) according to Fried's frailty criteria, we measured serum concentrations of fat-soluble micronutrients, amino acids (AA), OS, interleukins (IL) 6 and 10, 3MH (biomarker for muscle protein turnover) and serum spectra of fatty acids (FA). We evaluated biomarker patterns by principal component analysis (PCA) and their cross-sectional associations with frailty by multivariate logistic regression analysis. RESULTS: Two biomarker patterns [principal components (PC)] were identified by PCA. PC1 was characterized by high positive factor loadings (FL) of carotenoids, anti-inflammatory FA and vitamin D3 together with high negative FL of pro-inflammatory FA, IL6 and IL6/IL10, reflecting an inflammation-related pattern. PC2 was characterized by high positive FL of AA together with high negative FL of 3MH-based biomarkers, reflecting a muscle-related pattern. Frail patients had significantly lower factor scores than non-frail patients for both PC1 [median: −0.27 (interquartile range: 1.15) vs. 0.27 (1.23); P = 0.001] and PC2 [median: −0.15 (interquartile range: 1.13) vs. 0.21 (1.38); P = 0.002]. Patients with higher PC1 or PC2 factor scores were less likely to be frail [odds ratio (OR): 0.62, 95% CI: 0.46–0.83, P = 0.001 for PC1; OR: 0.64, 95% CI: 0.48–0.86, P = 0.003 for PC2] compared with patients with lower PC1 or PC2 factor scores. This indicates that increasing levels of anti-inflammatory biomarkers and increasing levels of muscle-anabolic biomarkers are associated with a reduced likelihood (38% and 36%, respectively) for frailty. Significant associations remained after adjusting the regression models for potential confounders. CONCLUSIONS: We conclude that two specific patterns reflecting either inflammation-related or muscle-related biomarkers are both significantly associated with frailty among multi-morbid patients and that these specific biomarker patterns are more informative than single biomarker analyses considering frailty identification