Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"StentRetriever- aspiration (SRa) vs direct aspiration (DA) in the treatment of acute M2 segment occlusion of middle cerebral artery: A single center randomized prospective study","authors":"M. Cernigliaro ,&nbsp;C. Stanca ,&nbsp;M. Spinetta ,&nbsp;SM. Tettoni ,&nbsp;M. Sassone ,&nbsp;A. Siani ,&nbsp;C. Coda ,&nbsp;D. Laganà ,&nbsp;R. Minici ,&nbsp;C. Airoldi ,&nbsp;G. Campone ,&nbsp;R. Di Fiore ,&nbsp;A. Galbiati ,&nbsp;G. Guzzardi ,&nbsp;A. Carriero","doi":"10.1016/j.jstrokecerebrovasdis.2024.108037","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108037","url":null,"abstract":"<div><div>Decision making and patient selection for isolated occlusion of the M2 segment of the middle cerebral artery is challenging, with the efficacy of treatment for such distal occlusions still controversial in recent studies, as occlusion in such small and thin vessels tends to manifest with less severe symptoms initially and hold higher surgical risks. It is even less clear which endovascular technique is more effective for this type of occlusion, with the choice usually left to the radiologist's preference. We conducted a controlled prospective study of consecutive patients presenting to Novara Hospital with an acute M2 occlusion diagnosed at the AngioCt and, following a predetermined randomization, we divided them into two treatment arms with either stent retriever aspiration (SRa) or direct aspiration (DA). All patients were examined on admission, at discharge and after 3 months, and clinical data as well as mRS and NIHSS scale scores were recorded. Our primary aim was to evaluate the difference in recanalization rate in the two groups by comparing the angiographic eTICI obtained with the two techniques. We then investigated whether there were differences in clinical outcomes and complications. Our data confirm a good recanalization rate with an eTICI ≥ 2b in 76.19% of patients in the cohort. An overall good outcome was achieved in 57% of patients as ∆NIHSS and in 50.79% of patients considering mRS. We found no statistically significant difference in recanalization rate nor higher complication rate in either the SRa or DA group. Both techniques are safe, effective and can be considered equally.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108037"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer and left atrial enlargement in patients with ischemic stroke","authors":"Morin Beyeler MD ,&nbsp;Anokhi Pawar BS ,&nbsp;Eric Buffle MD ,&nbsp;Cenai Zhang MS ,&nbsp;Vanessa Liao BS ,&nbsp;Ava L. Liberman MD ,&nbsp;Thomas Pabst MD ,&nbsp;Martin D. Berger MD ,&nbsp;Simon Jung MD ,&nbsp;Hooman Kamel MD ,&nbsp;Babak B. Navi MD MS","doi":"10.1016/j.jstrokecerebrovasdis.2024.108045","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108045","url":null,"abstract":"<div><h3>Background</h3><div>Cancer is associated with an increased risk of atrial fibrillation. Whether cancer is also associated with atrial cardiopathy, another atrial pathology associated with heightened ischemic stroke risk, is uncertain.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study among consecutive patients hospitalized with acute ischemic stroke at a quaternary care center in New York, United States from 2011 through 2016. The study exposure was active cancer. The study outcome was atrial cardiopathy, defined as a left atrial volume index ≥35 mL/m² on echocardiography. We used multivariable logistic regression, adjusting for baseline characteristics, to evaluate the relationship between cancer (active or historical) and atrial cardiopathy. We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS).</div></div><div><h3>Results</h3><div>The final cohort included 1104 patients with acute ischemic stroke, of whom 10 % had active cancer and 47 % had atrial cardiopathy. Patients with atrial cardiopathy, compared to those without, were older (median age, 77 versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation. Active cancer was present in 9.6 % of patients with atrial cardiopathy (<em>n</em> = 50/520) and 10.4 % of patients without (<em>n</em> = 61/584). There was no association between active cancer and atrial cardiopathy among the overall ischemic stroke cohort (adjusted odds ratio [OR], 0.91; 95 % confidence interval [CI], 0.60-1.37) nor in patients with ESUS (aOR, 0.64; 95 % CI, 0.30-1.36). When the cancer exposure was broadened to include any history of cancer (<em>n</em> = 236, 21.4 %), there still was no significant association with atrial cardiopathy (aOR, 0.93; 95 % CI, 0.68-1.25).</div></div><div><h3>Conclusions</h3><div>When defining atrial cardiopathy by left atrial volume, we did not find an association between cancer and atrial cardiopathy in patients with ischemic stroke, including among those with ESUS. Future studies, evaluating other atrial cardiopathy biomarkers and settings, are needed to further investigate any potential link between cancer and atrial cardiopathy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108045"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in cerebrovascular disease-related mortality among older adults in the United States from 1999 to 2020: An analysis of gender, race/ethnicity, and geographical disparities.","authors":"Muhammad Saad, Maria Saleem, Umar Maqbool, Fareeha Khan, Maleeha Saleem, Eman Alamgir, Salvia Qazi, Haram Rehman, Aleena Arshad Ali, Arfa Ahmed Assad, Aasma Javed, Qais Bin Abdul Ghaffar, Ammad Adeel, Faheemullah Khan, Adarsh Raja","doi":"10.1016/j.jstrokecerebrovasdis.2024.108043","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108043","url":null,"abstract":"<p><strong>Background: </strong>One of the most prevalent causes of morbidity and death is cerebrovascular disease in the US. The manifestations and pathophysiology of cerebrovascular disease are significantly impacted by ageing and determine the quality of one's late life. However, contemporary mortality trends in cerebrovascular disease and comparison to older adults of different gender, race, and geographic disparities have not been fully examined. A thorough comprehension of these correlations and current cerebrovascular disease death patterns can impact medical treatment and strategies.</p><p><strong>Objective: </strong>We examined the mortality trends according to gender, race, and geographical disparities in cerebrovascular disease among older adults, using mortality data (1999 - 2020) from the Centers for Disease Control and Prevention WONDER database METHODS: This research study aims to analyze disparities in cerebrovascular disease among senior citizens in the United States. The analysis has considered factors such as gender, race, and geographical variations over 21 years from 1999 to 2020. Mortality data obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database has been utilized for this retrospective cohort analysis, focusing on individuals aged 75 and above.</p><p><strong>Results: </strong>From 1999 to 2020, there were 3,813,729 deaths related to Cerebrovascular disease in older adults, demonstrating a declining trend (AAPC=). Males (880.6) had slightly higher AAMRs than females (866.7). Non-Hispanic (NH) Black (1050) had higher AAMRs than NH whites (880.8) followed by NH American Indians (699.7), Hispanic (673.2), and NH Asians (669.3). AAMRs also varied by region with the Midwest (922) having the highest AAMRs followed by the South (918.2), West (884.3), and Northeast (744). Among states, Tennessee had the highest AAMRs (1076.3), whereas New York had the lowest (609.7).</p><p><strong>Conclusion: </strong>These results indicate a significant decline in cerebrovascular disease-related mortality among older adults from 1999 to 2020, highlighting improvements in healthcare and preventive measures over the two decades. Despite the overall decrease, elderly females had more deaths, elderly males had a higher AAMR, non-Hispanic blacks had the highest AAMR, and the Midwest and non-metropolitan areas had higher mortality burdens. The recent uptick in mortality rates from 2018 to 2020 underscores the need for ongoing public health efforts to address cerebrovascular diseases, particularly targeting vulnerable populations and high-risk regions.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108043"},"PeriodicalIF":2.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332406","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":"Diet-derived circulating antioxidants and functional outcome after ischemic stroke: Evidence from genetic studies","authors":"Xudong Li ,&nbsp;Wei Liu ,&nbsp;Tianyu Jin ,&nbsp;Tong Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108039","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108039","url":null,"abstract":"<div><h3>Objective</h3><div>Diet-derived circulating antioxidants have been associated with functional outcome after ischemic stroke (IS), but the causality remains unclear. The aim of our study is to explore the potential causal effect of diet-derived circulating antioxidants on long-term functional outcome (at 3 months) following IS through the utilization of the Mendelian randomization (MR) approach.</div></div><div><h3>Materials and methods</h3><div>For this two-sample MR analysis, genetic variants associated with the diet-derived circulating antioxidants, including selenium, zinc, vitamin A (retinol), vitamin C, and vitamin E (α-tocopherol and γ-tocopherol), were identified in a large-scale Genome-Wide Association Studies (GWAS) database and utilized as instrumental variables (IVs). Summary data for long-term functional outcome after IS were obtained from the Genetics of Ischemic Stroke Functional Outcome (GISCOME) network of 6021 patients. Our study used the Inverse-variance weighting method as our primary MR method and also performed a series of sensitivity analyses for pleiotropy and heterogeneity.</div></div><div><h3>Results</h3><div>We observed that selenium (odds ratio (OR)=0.81; 95 % confidence interval (CI): 0.68-0.97; <em>p</em>=0.02) was significantly associated with poor functional outcome (modified Rankin Scale score≥3) after IS. Genetic liabilities to other diet-derived circulating antioxidants were not strongly associated with functional outcome after IS (all <em>p</em>&gt;0.05). Sensitivity analyses confirmed the reliability of these results.</div></div><div><h3>Conclusion</h3><div>This MR study suggested the positive effect of selenium on the long-term functional outcome after IS. Giving a longer period of selenium exposure can be used as a potential treatment to improve recovery after IS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108039"},"PeriodicalIF":2.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332390","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 characteristics and functional dependent risk of intracerebral hemorrhage in patients with nephrotic syndrome","authors":"Wen-Yi Huang MD, Ph.D ,&nbsp;Chun-Wei Chang MD ,&nbsp;Kuan-Hsing Chen MD, Ph.D ,&nbsp;Chien-Hung Chang MD ,&nbsp;Hsiu-Chuan Wu MD, Ph.D ,&nbsp;Kuo-Hsuan Chang MD, Ph.D","doi":"10.1016/j.jstrokecerebrovasdis.2024.108038","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108038","url":null,"abstract":"<div><h3>Background</h3><div>While an increased incidence of intracerebral hemorrhage (ICH) has been reported in patients with nephrotic syndrome (NS), comprehensive understanding of the characteristics of ICH in this population remains elusive. This study explored the clinical features of ICH in a larger cohort of NS patients.</div></div><div><h3>Methods</h3><div>To compare the clinical characteristics of ICH in patients with and without NS, we conducted a multi-institutional retrospective cohort study using the data from Chang Gung Research Database of Taiwan from January 1, 2001, to December 31, 2017.</div></div><div><h3>Results</h3><div>This study enrolled a total of 120 ICH patients with NS, and 271 ICH patients without NS. Patients with NS had a longer average length of stay in the acute medicine ward (17.7 ± 15.9 days vs 14.4 ±13.3 days, <em>P</em> = 0.047) and higher incidence of urinary tract infection (20.0% vs 10.0%, <em>P</em> = 0.006), gastrointestinal bleeding (16.7% vs 4.8%, <em>P</em> &lt; 0.001), and pulmonary edema (4.2% vs 0%, <em>P</em> = 0.003) compared to those without ICH. Furthermore, the risk of 30-day dependent outcome (modified Rankin Scale score≧3) was significantly higher in ICH patients with NS compared to those without NS (Odds ratio 3.43, 95% confidence interval 1.49 to 7.91, <em>P</em> = 0.004). However, the 30-day mortality rate was similar between the NS patients and the control group.</div></div><div><h3>Conclusions</h3><div>NS is associated with a significantly increased risk of functional dependence following ICH, highlighting the critical need for tailored intensive treatment and rehabilitation specifically for this patient population.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108038"},"PeriodicalIF":2.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332407","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 features, hemorrhage risk and epilepsy outcomes of familial cerebral cavernous malformation: A 20-year observational pragmatic single-center study","authors":"Gustavo da Fontoura Galvão M.D., Ph.D. ,&nbsp;Vinicius Barbosa Neumann M.D. ,&nbsp;Gabriel Verly ,&nbsp;Pablo Valença M.D., M.Sc. ,&nbsp;Alexandre Martins Cunha M.D., M.Sc. ,&nbsp;Marcello Reis da Silva M.D., M.Sc. ,&nbsp;Flavio Sampaio Domingues M.D., M.Sc. ,&nbsp;Jorge Marcondes de Souza M.D., Ph.D.","doi":"10.1016/j.jstrokecerebrovasdis.2024.108041","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108041","url":null,"abstract":"<div><h3>Introduction</h3><div>Familial Cerebral Cavernous Malformations (fCCMs) are rare, hereditary conditions characterized by multiple central nervous system lesions. Despite their rarity, CCMs can cause significant clinical challenges when symptomatic, manifesting as seizure and symptomatic hemorrhage (CASH). Guidelines suggest neurosurgical intervention for symptomatic or previously symptomatic lesions, while conservative management is recommended for new-onset epilepsy<strong>.</strong> However, the natural history and optimal management remain unclear, necessitating further research.</div></div><div><h3>Objective</h3><div>This study aims to provide a comprehensive analysis of the clinical features, hemorrhage risk, and epilepsy outcomes in fCCM patients over an extended follow-up period, offering a more precise estimate of CASH and epilepsy rates in this population.</div></div><div><h3>Methods</h3><div>This retrospective longitudinal cohort study included fCCM patients enrolled from 2001 to May 2024. Data collected included demographic information, new neurological symptoms, symptomatic hemorrhages, seizures, and modified Rankin Scale (mRS) scores. Incidence rates of first symptomatic events and Kaplan-Meier survival curves were calculated, with logistic and Cox-proportional hazard regression models used to evaluate outcomes.</div></div><div><h3>Results</h3><div>A total of 47 patients were included in this study, with a mean age at diagnosis of 37.51 years. At diagnosis, 68 % were symptomatic, with 30 % having CASH and 36 % experiencing seizures without CASH. During a median follow-up of 126.0 months (interquartile range, 110.5 months), 17 % had a new CASH event, 20 % had seizures without CASH, and 60 % remained asymptomatic. The bleeding rate was 1.02 % per patient-year, with new focal neurological symptoms at 2.045 per 1000 patient-years and new CASH at 10.225 per 1000 patient-years. Most patients maintained minimal or no disability (mRS 0 or 1). Presenting with epilepsy at baseline significantly increased the odds of future seizures (OR 18.13, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>This study highlights the complex presentation and progression of fCCMs, emphasizing the necessity for long-term monitoring. Baseline epilepsy is a significant predictor of future seizures, underscoring the need for individualized management strategies. Future research with larger cohorts and standardized criteria is essential to refine the understanding and management of fCCMs.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108041"},"PeriodicalIF":2.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332389","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":"Response to the Letter to the Editor: Linear positive association of metabolic score for insulin resistance with stroke risk among American adults: a cross-sectional analysis of National Health and Nutrition Examination Survey datasets","authors":"Ruwen Zheng ,&nbsp;Xu Dong ,&nbsp;Tianyi Wang ,&nbsp;Hongyan Zhang ,&nbsp;Yihao Zhou ,&nbsp;Dongyan Wang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108036","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108036","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108036"},"PeriodicalIF":2.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of European Stroke Organisation secondary prevention guideline for ischaemic stroke / transient ischaemic attack","authors":"Cameron Smith BSc ,&nbsp;Struan Wallis BSc ,&nbsp;Georgios Katsas MSc,&nbsp;Ozzy Dincarslan BSc,&nbsp;Jesse Dawson MD,&nbsp;Alan Cameron PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108034","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108034","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess secondary prevention strategies after ischaemic stroke or transient ischaemic attack (TIA).</div></div><div><h3>Materials and Methods</h3><div>We investigated the impact of European Stroke Organisation (ESO) Guideline recommendations for secondary prevention on recurrent events among people with non-cardioembolic ischaemic stroke or TIA. We assessed the following interventions by survival analysis or modelling impacts from clinical trial data: two blood pressure (BP) drugs compared to one drug; LDL-cholesterol target &lt;1.8 mmol/L; and pioglitazone therapy. Outcomes were mortality, major adverse cardiovascular events (MACE) and recurrent stroke or myocardial infarction (MI).</div></div><div><h3>Results</h3><div>We included 4,037 people admitted between 01/12/2015 to 31/12/2018: mean (SD) age 68.6 (12.9) years; 1984 (49.1 %) female and median (IQR) follow-up 2.2 (1.5-3.1) years.</div><div>Prescription of two BP drugs was associated with reduced mortality in our sample of 2238 people with hypertension (HR 0.64, 95 %CI 0.51-0.81; P&lt;0.001).</div><div>We estimate an LDL-cholesterol target &lt;1.8 mmol/L could reduce MACE incidence from 128 to 114 events (95 %CI 103-127) in our sample of 1024 people with LDL-cholesterol 1.8 mmol/L who were not already prescribed intensive lipid-lowering therapy over median (IQR) 2.2 (1.5-2.9) years follow-up (ARR 1.38 %, NNT 73).</div><div>We estimate pioglitazone therapy could reduce incidence of recurrent stroke or MI from 192 to 169 events (95 %CI 156-185) in our sample of 1587 people with diabetes or insulin resistance over median (IQR) 2.4 (1.7-3.2) years follow-up (ARR 1.45 %, NNT 69).</div></div><div><h3>Conclusions</h3><div>We estimate that implementing ESO guidelines in a Scottish population after ischaemic stroke or TIA would reduce mortality and recurrent cardiovascular events.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108034"},"PeriodicalIF":2.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the C-reactive protein to albumin ratio and poor clinical outcome in patients with spontaneous intracerebral hemorrhage","authors":"Yang Du MD ,&nbsp;Yijun Lin MD ,&nbsp;Anxin Wang PHD ,&nbsp;Jia Zhang MD ,&nbsp;Ning Li MD ,&nbsp;Xiaoli Zhang BS ,&nbsp;Xinmin Liu MD ,&nbsp;Dandan Wang MD ,&nbsp;Wenjuan Wang MD ,&nbsp;Xingquan Zhao MD, PHD ,&nbsp;Liheng Bian MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108026","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108026","url":null,"abstract":"<div><h3>Background</h3><div>The C-reactive protein-to-albumin ratio (CAR) is a novel prognostic biomarker of systemic inflammation and nutritional status. The association between CAR and the long-term outcome of spontaneous intracerebral hemorrhage (ICH) remains unclear.</div></div><div><h3>Methods</h3><div>From January 2014 to September 2016, 497 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. According to the CAR quartiles, patients were classified into four groups (Q1-Q4). Logistic regression was applied to analyze the relationship between different CAR levels and main outcome (90-day and 1-year mRS 4-6). Restricted cubic splines and receiver operating characteristic (ROC) curves of CAR for poor clinical outcomes were assessed.</div></div><div><h3>Results</h3><div>In the multivariate logistic regression model, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q2, Q3, and Q4 group for 90-day mRS score of 4-6 were 3.64 (1.61–8.23), 3.83 (1.67–8.77), and 8.91 (3.85–20.64). In terms of 1-year mRS score of 4-6, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q3 and Q4 group were 3.31 (1.33–8.22) and 6.87 (2.81–16.78).</div></div><div><h3>Conclusions</h3><div>A high CAR level was associated with a high risk of long-term adverse prognosis in patients with ICH, and the risk of ICH poor outcome increased steadily with CAR rising in a certain range, and maintained in a high level thereafter.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108026"},"PeriodicalIF":2.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327778","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":"Neighborhood income inequality associated with functional independence after ischemic stroke: a cohort study","authors":"Kathryn E. Coté MD, MPH,&nbsp;Megan E. Pudlo MD,&nbsp;Emma Jost-Price BA,&nbsp;Lester Y. Leung MD, MSc","doi":"10.1016/j.jstrokecerebrovasdis.2024.108035","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108035","url":null,"abstract":"<div><h3>Background</h3><div>Individual measures of socioeconomic status have been associated with post-stroke disability in patients with ischemic stroke. However, it is not known whether the distribution of income in a community may have an impact on stroke recovery. We hypothesized that increased neighborhood income inequality (as measured by the Gini index) may be associated with a slower recovery after stroke.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of adult patients hospitalized at a comprehensive stroke center with acute ischemic stroke between 1/1/2018-12/31/2019. Individual patient data was abstracted from the EHR, and zip code Gini index was obtained from the US Census Bureau. Binary logistic regression was used to assess the relationship between Gini index and functional independence (modified Rankin scale ≤2) at discharge and first outpatient follow-up. These models controlled for patient demographics, stroke risk factors, stroke severity, and stroke treatment. A second binary regression was also performed using a subset of patients to assess possible predictors of being discharged as recommended (i.e. having a discharge destination that was consistent with the recommendation of the inpatient medical team).</div></div><div><h3>Results</h3><div>Three hundred and thirty-seven patients were included in this analysis. The median time to first outpatient follow-up was 35 days. Zip code Gini index was not associated with functional independence at discharge but was associated with independence at follow-up (modified Rankin scale ≤2) such that patients from higher inequality neighborhoods had decreased odds of being independent. More specifically, each 1% increase in neighborhood Gini index was associated with 8% decreased odds of independence at follow-up (OR=0.923, 95% CI: 0.863-0.987). Being discharged as recommended was associated with increased odds of independence at follow-up (OR=3.359, 95% CI: 1.055-10.695). Greater income inequality (OR=0.909, 95% CI: 0.841-0.983) and Asian race (OR=0.093, 95% CI: 0.011-0.766) were associated with decreased odds of being discharged as recommended.</div></div><div><h3>Conclusion</h3><div>Among a cohort of patients with ischemic stroke, increased neighborhood income inequality was associated with decreased odds of achieving functional independence up (modified Rankin scale ≤2) by the time of first outpatient follow-up (at a median of 35 days following discharge). This disparity may be driven by discharge destination and race.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108035"},"PeriodicalIF":2.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332410","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}