6 research outputs found
The sustained increase of plasma fibrinogen during ischemic stroke predicts worse outcome independently of baseline fibrinogen level
Hyperfibrinogenemia at the beginning of ischemic stroke is associated with poor outcome.
We hypothesized that the sustained increase of plasma fibrinogen during stroke predicts outcome independently
of baseline fibrinogen concentration. We included 266 patients with first-ever ischemic stroke
in whom plasma fibrinogen level was measured on days 1, 7, and 14. The sustained fibrinogen's
increase was defined as the persistent elevation of fibrinogen's concentration on days 7 and 14 by at least
20 % compared to the level on day 1. The functional outcome on day 30 was assessed using modified
Rankin Scale (mRS). Favorable outcome was defined as mRS 0-1. The sustained increase of fibrinogen
was found in 17 % of patients. On multivariate logistic regression analysis adjusted for age, NIHSS
score, baseline fibrinogen >2.66 mmol/L, presence of infection, and hyperglycemia, the sustained fibrinogen's
level was associated with reduced chance of favorable outcome (OR: 0.17, 95 % CI: 0.06-0.48, P<0.01)
Improvement of survival in Polish stroke patients is related to reduced stroke severity and better control of risk factors : the Krakow Stroke Database
Introduction: In the last decade, the stroke mortality rate in Poland significantly decreased. We hypothesised that stroke severity, the major determinant of outcome, is lowered in Polish stroke patients.
Material and methods: We compared the stroke severity in two cohorts of
first-ever ischaemic stroke patients admitted within 24 h after stroke onset
to the Department of Neurology, Jagiellonian University, Krakow in the years
1994-2000 and 2008-2012. To assess stroke severity we used the National
Institute of Health Stroke Scale (NIHSS). We defined mild stroke as an NIHSS
score ≤ 4.
Results: We included 816 patients hospitalised in the years 1994-2000 and
569 patients hospitalised in the years 2008-2012. NIHSS score on admission was higher in the former (mean: 12.0 ±7.0 vs. 8.0 ±6.0, p < 0.01), and
the frequency of mild stroke was higher in the latter (12.7% vs. 41.8%, p <
0.01). Although the frequency of hypertension (67.3% vs. 81.2%, p < 0.01),
diabetes mellitus (20.8% vs. 26.4%, p = 0.02) and atrial fibrillation (20.7%
vs. 26.2%, p = 0.02) was higher in patients hospitalised in the years 2008-
2012, the systolic and diastolic blood pressure values and the frequency
of fasting hyperglycaemia were lower in this cohort. This cohort also less
frequently suffered from hypercholesterolaemia (25.4% vs. 16.3%, p < 0.01).
Conclusions: Reduced stroke severity is associated with better recognition
and control of risk factors and explains the improvement of survival in Polish
stroke patients
4C Mortality Score correlates with in-hospital functional outcome after COVID-19-associated ischaemic stroke
Aim of the study. The 4C Mortality Score was created to predict mortality in hospitalised patients with COVID-19 and has to date been evaluated only in respiratory system disorders. The aim of this study was to investigate its application in patients with COVID-19-associated acute ischaemic stroke (AIS).Clinical rationale for study. COVID-19 is a risk factor for AIS. COVID-19-associated AIS results in higher mortality and worse functional outcome. Predictors of functional outcome in COVID-19-associated AIS are required.Materials and methods. This was a retrospective observational study of patients with AIS hospitalised in seven neurological wards in Małopolska Voivodship (Poland) between August and December 2020. We gathered data concerning the patients’ age, sex, presence of cardiovascular risk factors, type of treatment received, and the presence of stroke-associated infections (including pneumonia, urinary tract infection and infection of unknown source). We calculated 4C Mortality Score at stroke onset, and investigated whether there was a correlation with neurological deficit measured using the National Health Institute Stroke Scale (NIHSS) and functional outcome assessed using the modified Rankin Scale (mRS) at discharge.Results. The study included 52 patients with COVID-19-associated AIS. The 4C Mortality Score at stroke onset correlated with mRS (rs = 0.565, p < 0.01) at discharge. There was also a statistically significant difference in the mean 4C Mortality Score between patients who died and patients who survived the stroke (13.08 ± 2.71 vs. 9.85 ± 3.47, p = 0.04).Conclusions and clinical implications. 4C Mortality Score predicts functional outcome at discharge in COVID-19-associated AIS patients