Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Platelet related gene IQGAP1 contributes to the onset and abnormal immune landscape of ischemic stroke patients.","authors":"Youle Su, Bo Chao, Junhao Ren, Lian Shuang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108194","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108194","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic stroke (IS) is a complex illness resulting from a combination of numerous environmental and genetic risk factors. Recent reports have shed light on the vital role that platelets play in the pathophysiology of IS. Here, we aimed to explore the potential platelet-related genes in IS and investigate the effect of platelet-related genes in the immune microenvironment of IS.</p><p><strong>Methods: </strong>The data of IS were retrieved from the Gene Expression Omnibus database. Firstly, we screened the platelet-related genes that were correlated with the onset of IS using differential expression analysis, enrichment analyses, and protein-protein interaction (PPI) network. Moreover, we analyzed the clinical value and functional information of platelet-related genes in IS. Finally, we explored the correlation between platelet-related genes and immune cells' infiltration.</p><p><strong>Results: </strong>Ten platelet-related genes that were correlated with the onset of IS were identified, among which IQGAP1 was located at the core of the PPI network. IQGAP1 was found to be expressed in the normal brain tissue and its expression was significantly elevated in IS samples. The area under the curve (AUC) values for IQGAP1 in both the GSE16561 and GSE58294 datasets were close to 1. IQGAP1 knockdown might increase OGD/R‑induced HT22 cell viability. Additionally, FoxO signaling pathway, NOD-like receptor signaling pathway, Phagosome and Platelet activation pathways were significantly activated in IS patients with high IQGAP1 expression compared to those with low IQGAP1 expression. The IS patients in the IQGAP1^high and IQGAP1^low groups showed dramatically different proportions of immune cells and immune-related functions, and the IQGAP1 expression was correlated with the immune cell' infiltration in IS.</p><p><strong>Conclusions: </strong>In this study, we identified the IQGAP1 might serve as a potential diagnostic marker for IS, and the IQGAP1 expression was very relevant in determining the immune cell' infiltration in IS patients.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108194"},"PeriodicalIF":2.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke recurrence and all-causemortality in CPAP-treated sleep-disordered-breathing patients.","authors":"Jeppe Suusgaard, Anders Sode West, Laura B Ponsaing, Helle Klingenberg Iversen, Katrin Rauen, Poul Jørgen Jennum","doi":"10.1016/j.jstrokecerebrovasdis.2024.108204","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108204","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) affects about 70 % of stroke patients and is closely linked to stroke development. It is unclear whether treatment with continuous positive airway pressure (CPAP) reduces the risk of stroke recurrence or mortality in post-stroke patients, partly due to limited follow-up time and small sample sizes of previous studies. To close this knowledge gap, this study investigated changes in stroke recurrence and mortality among CPAP-treated post-stroke patients with sleep-disordered breathing.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the Danish National Patient Registry covering the period from 2003 to 2016, involving 1821 patients diagnosed with sleep-disordered breathing and a prior ischemic stroke or transient ischemic attack (TIA). Patients were categorized into three groups: CPAP users, CPAP-non-users, and no CPAP treatment. We used Cox hazard regression to assess the risk of recurrent stroke or TIA over a 5-year follow-up period, and all-cause mortality over a 14-year follow-up period.</p><p><strong>Results: </strong>CPAP treatment improved survival rate in CPAP users compared to patients categorized as no CPAP treatment (hazard ratio 0.75, 95 % CI [0.60;0.92], p = 0.007). This effect persisted after adjusting for age, sex, and pre-existing comorbidities within three years (the Quan-updated Charlson Comorbidity Index). There was no difference in recurrence of stroke/TIA among the three CPAP groups.</p><p><strong>Conclusions: </strong>In this registry-based study, we found that CPAP was associated with a reduction in all-cause mortality in post-stroke/TIA patients with sleep-disordered breathing. CPAP treatment did not seem to affect the risk of re-stroke/TIA during the five years of follow-up.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108204"},"PeriodicalIF":2.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical implications of cerebral venous outflow pattern in malignant middle cerebral artery infarction.","authors":"Jae-Chan Ryu, Sang-Hun Lee","doi":"10.1016/j.jstrokecerebrovasdis.2024.108203","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108203","url":null,"abstract":"<p><strong>Background: </strong>Malignant middle cerebral artery (MCA) infarction is one of the most devastating strokes. However, the role of the cerebral venous outflow pattern in malignant MCA infarction is not well established. We investigated the association between the transverse sinus (TS) shape and functional outcomes in patients with malignant MCA infarction.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with malignant MCA infarction. Baseline characteristics, clinical variables, and cerebral venous outflow patterns (TS shape) were obtained. Incomplete TS shapes are referred to as unilateral TS hypoplasia, TS aplasia, or TS occlusion. We analyzed the effect of an incomplete TS shape on functional outcomes after malignant MCA infarction. The main outcome assessed was the change in ordinal shifts within the modified Rankin Scale score, indicating a deterioration in the outcome at three months.</p><p><strong>Results: </strong>Among 71 patients with malignant MCA infarction, incomplete TS shapes were observed in 33 (46.5 %). There were no significant differences in the baseline characteristics, vascular risk factors, or factors associated with malignant MCA infarction. Patients with incomplete TS shapes had a higher proportion of unfavorable functional outcomes (5.0 [4.0-5.0] vs. 5.0 [5.0-6.0], P < 0.001). Multivariable ordinal logistic regression analysis showed that patients with incomplete TS shapes (odds ratio = 6.30, 95 % confidence interval = 2.42-17.90, P < 0.001) had a substantial shift towards the unfavorable functional outcome at 3 months.</p><p><strong>Conclusions: </strong>Among patients diagnosed with malignant MCA infarction, those with incomplete TS shapes had poorer functional outcomes and higher mortality rates. This underscores the significant clinical association between cerebrovenous patterns and functional outcomes.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108203"},"PeriodicalIF":2.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative fragmentation and distal migration of Carotid Stent in vascular Eagle Syndrome.","authors":"Masahiro Nishihori, Takashi Izumi, Shunsaku Goto, Shinsuke Muraoka, Hirotaka Kogame, Ryuta Saito","doi":"10.1016/j.jstrokecerebrovasdis.2024.108202","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108202","url":null,"abstract":"<p><strong>Objectives: </strong>Vascular Eagle syndrome (ES) is a rare condition involving vessel compression by an elongated styloid process, leading to neurologic symptoms. Here, we present the case of a patient with a complication of carotid artery stenting for vascular ES and discuss the implications of treatment of this rare condition.</p><p><strong>Case description: </strong>A 35-year-old previously healthy male patient presented with transient aphasia and right-sided hemiparesis following ischemic stroke in left frontal lobe. Digital subtraction angiography revealed a large aneurysm with stenosis of the left cervical internal carotid artery, and computed tomography (CT) demonstrated elongated ipsilateral styloid process. Progressive aneurysm enlargement required coil embolization and carotid artery stenting (CAS). Cervical X-ray obtained 1 year later revealed the fracture and fragmentation of the carotid stent. Imaging studies identified multiple stent fragments dispersed in distal arteries and a dissecting aneurysm with an irregular wall at the site of the stent site. Dynamic cone-beam CT scan without contrast performed during neck movement, revealed that the styloid process tip was adjacent to the stent fracture line, confirming vascular ES. The symptomatic left styloid process was resected, followed by repeat CAS. The dissecting aneurysm was thrombosed post-CAS, and the patient remained asymptomatic without complications at 6-month follow-up.</p><p><strong>Conclusion: </strong>In patients with vascular ES, diagnostic imaging should include dynamic evaluations to assess cervical dynamics and the resection of styloid process is essential to prevent chronic stent fracture.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108202"},"PeriodicalIF":2.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of leptomeningeal collateral blood flow in hypertensive rats during ischemic stroke.","authors":"Magdalena Litman, Kristy Martin, Neil J Spratt, Daniel J Beard","doi":"10.1016/j.jstrokecerebrovasdis.2024.108195","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108195","url":null,"abstract":"<p><strong>Objectives: </strong>There is increasing evidence that poor leptomeningeal collateral blood flow in hypertensive animals is due to increased vascular myogenic tone, indicating that therapies to enhance collateral blood flow during ischemic stroke may be particularly effective. To develop such therapies, we need a greater understanding of the factors that regulate collateral blood flow in the setting of hypertension. Therefore, we aimed to quantify blood flow velocity, diameter and absolute blood flow in individual collateral vessels in an ischemic stroke model in spontaneously hypertensive rats (SHRs) and determine which factors had the greatest influence on blood flow.</p><p><strong>Materials and methods: </strong>We quantified collateral flow velocity and vessel diameter and calculated absolute collateral blood flow in SHRs (n = 5) during 70 min of middle cerebral artery occlusion (MCAO), using a fluorescent microsphere method.</p><p><strong>Results: </strong>Average collateral blood flow significantly increased post-occlusion relative to baseline (pre-MCAO: 16.8 ± 7.1nL/min vs. post-MCAO: 146.4 ± 37.7nL/min, p = 0.02). Within animal linear regression analysis showed a strong positive correlation between changes in collateral blood flow versus changes in collateral diameter during stroke (r = 0.7-0.99, p = 0.3-0.002). In contrast, collateral blood flow was only weakly correlated with collateral blood flow velocity during stroke (r = -0.03-0.97, p = 0.9-0.1).</p><p><strong>Conclusions: </strong>Collateral blood flow and velocity significantly increased post-occlusion. Collateral flow was strongly influenced by vessel diameter, likely because of marked baseline vasoconstriction of collaterals which is flow-limiting.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108195"},"PeriodicalIF":2.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with social isolation in stroke patients: a systematic review and meta-analysis.","authors":"Yue Li, Huiqiong Xu, Ting Zhang, Xianying Lu, Xuemei Xie, Jing Gao","doi":"10.1016/j.jstrokecerebrovasdis.2024.108201","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108201","url":null,"abstract":"<p><strong>Objective: </strong>Systematic evaluation of factors influencing social isolation in stroke patients for further intervention studies.</p><p><strong>Methods: </strong>We searched for observational studies in 7 databases from inception to January 2024. Two researchers performed literature screening, quality assessment, and data extraction independently according to inclusion and exclusion criteria, and meta-analysis was performed using R4.3.1 software.</p><p><strong>Results: </strong>A total of 10 studies with a total sample size of 4162 cases were included. Meta-analysis showed that social isolation in stroke patients was associated with economic status (β'=-0.21, 95%CI:0.39, -0.02; P=0.0261), degree of education (β'=-0.16, 95%CI:0.29, -0.03; P=0.0171), marital status (β'=0.13, 95%CI:0.04, 0.23; P=0.0069), social support (β'=-0.37, 95%CI;-0.50, -0.25; P<0.0001), stigma(β'=0.48, 95%CI:0.25, 0.72; P<0.0001), symptom burden (β'=0.25, 95%CI:0.18, 0.31; P<0.0001), course of disease (β'=0.23, 95%CI:0.08, 0.37; P=0.0021), combined chronic diseases (β'=0.14, 95%CI:0.04, 0.24; P=0.0057), and limb function (β'=0.33, 95%CI:0.23, 0.43; P<0.0001) were associated. Meta-regression and subgroup analyses showed that disease stage and sample source were sources of heterogeneity.</p><p><strong>Conclusion: </strong>There are many factors influencing the social isolation of stroke patients, and healthcare professionals should take timely and targeted measures to prevent and intervene effectively, with a view to improving the social participation of stroke patients and reducing their social isolation.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108201"},"PeriodicalIF":2.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mendelian randomization assessing causal relationship between fibrinogen levels and ischemic stroke.","authors":"Gie Ken-Dror, Tanya Khanna, Emily Hills, Louise Lepert, Sana Mughal, Thang Sieu Han, Pankaj Sharma","doi":"10.1016/j.jstrokecerebrovasdis.2024.108199","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108199","url":null,"abstract":"<p><strong>Objective: </strong>High fibrinogen levels are associated with an increased risk of ischaemic stroke (IS). We used mendelian randomisation (MR) to explore a potential causal relationship.</p><p><strong>Materials and methods: </strong>Data for assessing the relationship between gene variant, disease and biological levels needed for a MR approach was collected using a meta-analytical approach. Inverse-variance weighted (IVW) approach was used for the main analyses and alternative approach for sensitivity analyses. The relationship between fibrinogen levels and IS was assessed using Odds Ratio (OR), while mean difference (g/L) was used for the relationship between SNP (rs1800790) and fibrinogen levels.</p><p><strong>Results: </strong>The variant FGB rs1800790 SNP was interrogated as an instrumental variable of fibrinogen levels. A meta-analysis with 24 studies (12 case-control and 12 cohort studies, totalling 20,902 cases and 76,510 controls was conducted. Homozygotes (AG) of rs1800790 have 0.14g/L (95%CI: 0.08-0.19, P<0.001) and minor allele (AA) have 0.18g/L (95%CI: 0.01-0.35, P=0.037) higher levels of plasma fibrinogen concentration compared with homozygous for the major allele (GG). The risk of IS was significantly increased in 1-g/L (OR=1.83, 95%CI: 0.92-3.62, P=0.084), or 1-SD of fibrinogen levels (OR=1.39, 95%CI: 1.03-1.87, P=0.030), or above median levels (OR=1.22, 95%CI: 1.02-1.46, P=0.029) or categorical levels tertiles (OR=1.50, 95%CI: 1.26-1.79, P<0.001). Each 1-g/L increase in fibrinogen levels was causally associated with a higher risk of ischemic stroke (OR=2.28, 95%CI: 1.53-3.03, P<0.001) in the Mendelian randomisation analysis.</p><p><strong>Conclusions: </strong>Elevated fibrinogen levels are a causative risk factor for ischaemic stroke with each 1g/L increase doubling its risk.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108199"},"PeriodicalIF":2.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of clinical prediction model for functional independence measure following stroke rehabilitation.","authors":"Shinya Fukuda, Norio Yamamoto, Yosuke Tomita, Takeshi Matsumoto, Tomoya Shinohara, Tatsuro Ohno, Hitoshi Fukuda, Tetsuya Ueba","doi":"10.1016/j.jstrokecerebrovasdis.2024.108185","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108185","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and internally validate a clinical prediction model that includes balance ability and nutritional indices for the motor-functional independence measure (M-FIM) at 90 days post-stroke stroke.</p><p><strong>Materials and methods: </strong>This retrospective, single-center study included 566 patients with stroke undergoing rehabilitation at our rehabilitation hospital. The primary outcome was the M-FIM score of >61 at 3 months post-strokes onset. Stepwise conditional forward selection was first used to identify predictors for the achievement of M-FIM>61 at 90 days post-stroke, from 25 potential predictors at admission. The selected predictors were dichotomized with cut-off values to establish scoring systems, resulting in the B-ADL model, which includes postural balance (B), albumin level, age, arm function (A), days since stroke onset (D), and level of activities of daily living (ADL) (L). For internal validation, we corrected the optimism of the area under the curve of receiver operating characteristic curve (AUROC) induced by overfitting the original data using the bootstrap validation method. Calibration capacity was assessed using a calibration plot.</p><p><strong>Results: </strong>We developed a clinical model to predict the M-FIM at 90 days post-stroke onset. The AUROC of the B-ADL model was 0.92 (sensitivity, 93.7%; specificity, 89.7%). The B-ADL model showed high accuracy with an AUROC of 0.970 in the internal validation. The scoring system in the validation cohort had a cut-off value of 5.5/12 points to predict the achievement of M-FIM>61 (AUROC: 0.950; 95% CI 0.930-0.970).</p><p><strong>Conclusions: </strong>The B-ADL model accurately predicted M-FIM >61 at 90 days post-stroke on the day of admission to the recovery rehabilitation ward. The B-ADL model is useful for optimizing rehabilitation programs and resource allocation, allowing for targeted interventions after stroke.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108185"},"PeriodicalIF":2.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal association of inflammation with ischemic stroke and its subtypes: a bidirectional Mendelian randomization study.","authors":"FangFang Qian, XiaoHui Du, YouHua He","doi":"10.1016/j.jstrokecerebrovasdis.2024.108190","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108190","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence underscores a bidirectional relationship between ischemic stroke (IS) and inflammation, yet the causality of this association remains uncertain. We conducted a two-sample bidirectional Mendelian randomization (MR) study aimed at investigating the causal links between inflammation and IS.</p><p><strong>Methods: </strong>Single nucleotide polymorphism from genome-wide association studies of 112 inflammatory cytokines and IS were chosen as instrumental variables. We evaluated the causal effects of inflammatory factors on IS outcomes and examined the mediating effects of risk factors for IS. Additionally, reverse MR analysis was conducted to determine whether the occurrence of IS influenced levels of inflammatory cytokines. Causal associations were assessed using inverse variance weighting, complemented by sensitivity analyses incorporating weighted median and MR-Egger methods.</p><p><strong>Results: </strong>We found associations between genetically predicted plasma levels of 25 inflammatory factors and IS along with its subtypes. MR supports smoking, body mass index, atrial fibrillation, coronary artery disease, heart failure, systolic blood pressure, diastolic blood pressure and type 2 diabetes as risk factors for IS. Notably, coronary artery disease and heart failure seemed to mediate the RANTES, HGF, IL-5 associations with IS. In addition, reverse MR analysis suggested a causal relationship between IS and its subtypes and 19 inflammatory factors.</p><p><strong>Conclusion: </strong>In summary, inflammation was suggestively causally associated with the risk of IS, and inflammatory cytokines had downstream effect on IS. Future studies should explore whether inflammatory factors found to have significant associations with IS risk could be manipulated to reduce IS risk, and the neuroinflammatory mechanisms after IS.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108190"},"PeriodicalIF":2.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of stroke-associated hospital-acquired pneumonia: Machine learning approach.","authors":"Ahmad A Abujaber, Said Yaseen, Abdulqadir J Nashwan, Naveed Akhtar, Yahia Imam","doi":"10.1016/j.jstrokecerebrovasdis.2024.108200","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108200","url":null,"abstract":"<p><strong>Background: </strong>Stroke-associated Hospital Acquired Pneumonia (HAP) significantly impacts patient outcomes. This study explores the utility of machine learning models in predicting HAP in stroke patients, leveraging national registry data and SHapley Additive exPlanations (SHAP) analysis to identify key predictive factors.</p><p><strong>Methods: </strong>We collected data from a national stroke registry covering January 2014 to July 2022, including 9,840 patients diagnosed with ischemic and hemorrhagic strokes. Five machine learning models were trained and evaluated: XGBoost, Random Forest, Support Vector Machine (SVM), Logistic Regression, and Artificial Neural Network (ANN). Performance was assessed using accuracy, precision, recall, F1-score, AUC, log loss, and Brier score. SHAP analysis was conducted to interpret model outputs.</p><p><strong>Results: </strong>The ANN model demonstrated superior performance, with an F1-score of 0.86 and an AUC of 0.94. SHAP analysis identified key predictors: stroke severity, admission location, Glasgow Coma score (GCS), systolic and diastolic blood pressure at admission, ethnicity, stroke type, mode of arrival, and age. Patients with higher stroke severity, dysphagia, and those arriving by ambulance were at increased risk for HAP.</p><p><strong>Conclusion: </strong>This study enhances our understanding of early predictive factors for HAP in stroke patients and underlines the potential of machine learning to improve clinical decision-making and personalized care.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108200"},"PeriodicalIF":2.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}