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  • 1
    Online Resource
    Online Resource
    Abstract WP346: HIAT2 Predicts Poor Functional Outcome, Palliative Care Involvement, and In-hospital Mortality in tPA Treated and Untreated Ischemic Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: The HIAT2 (Houston Intra Arterial Therapy-2) score has been used to predict poor functional outcome in acute ischemic stroke (AIS) patients undergoing endovascular therapy (ET). Little is known about HIAT2’s ability to predict other outcomes in non-ET samples. Aim: To test the ability of HIAT2 to predict poor functional outcome (mRS 4-6), in-hospital mortality, and inpatient palliative care (PC) consult in (1) ET, (2) IV tPA, and (3) untreated patients. Methods: A retrospective review of consecutive AIS patients presenting to our comprehensive stroke center (CSC) from March 2014 to April 2015. Demographic and clinical data were collected. HIAT2 was calculated as follows: age (≤59=0, 60-79=2, ≥80=4), glucose ( 〈 150=0, ≥150=1), NIHSS (≤10=0, 11-20=1, ≥21=2), ASPECTS Score (8-10=0, ≤7=3). We used AUC to measure the ability of the HIAT2 score to predict our three outcomes of interest. Results: Among the 776 AIS patients admitted to our CSC, 6.6% received acute ET, 14.6% received IV tPA, and 79.8% received neither. For ET patients HIAT2 had an AUC of 0.592 for mRS 4-6, AUC 0.569 for PC, and AUC 0.656 for death. For tPA patients HIAT2 had an AUC of 0.686 for mRS 4-6, AUC 0.798 for PC, and AUC 0.825 for death. For untreated patients HIAT2 had an AUC of 0.629 for mRS 4-6, AUC 0.649 for PC, and AUC 0.641 for death. In the tPA treated sample, a HIAT2 score ≥4 had a sensitivity and specificity of 0.436 and 0.819 in predicting mRS 4-6, sensitivity and specificity of 0.667 and 0.782 for PC, and sensitivity and specificity of 0.733 and 0.806 for death. Discussion: Our results suggest that the variables used to create the HIAT2 score are useful in predicting poor outcomes in untreated, tPA treated, and ET patients. Despite its ability to predict poor outcome in these samples, treatment should not be withheld from patients that otherwise qualify.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp346
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 2
    Online Resource
    Online Resource
    Abstract T P326: The Utility of Charlson Comorbidity Index in Predicting Short-term Outcomes in Patients with Primary Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Background and Purpose: The Charlson Comorbidity Index (CCI) is used to evaluate a patient's risk of in-hospital, 1-year and 10-year mortality, and has been validated in acute ischemic stroke. Previous studies have shown that CCI influences functional outcomes. We sought to evaluate the association between CCI and outcomes in patients with primary ICH presenting to our center. Methods: Patients with primary ICH admitted to our center from 2008-2013 were included. Demographic and clinical data were collected. Primary outcomes were a discharge mRS (dmRS) of 4-6, death and poor discharge disposition (any disposition other than home or inpatient rehabilitation). Crude and adjusted logistic regressions were used to evaluate the association between CCI and outcomes. Results: A total of 383 patients were identified. There were 37 (9.7%) patients with a CCI of 0 or 1, 242 (63.2%) patients with a CCI of 2-5, and 104 (27.2%) with a CCI of 6 or greater (Figure). While the continuous CCI was not significantly associated with a dmRS of 4-6 (OR 1.08, 95% CI 0.99-1.19, p=0.09), it was associated with disposition. The odds of poor disposition increased 18% with each increase in CCI (OR 1.18, 95% CI 1.08-1.28, p=0.0003). The odds of death increased 12% with each point increase in CCI (OR 1.12, 95% CI 1.02-1.23, p=0.021). After adjusting for baseline ICH score, CCI remained significantly associated with poor disposition (OR 1.13, 95% CI 1.00-1.27, p=0.042), however the association between CCI and death was not statistically significant (OR 1.05, 95% CI 0.91-1.21, p=0.52). Conclusions: In contrast to previous studies, the CCI was not associated with poor short-term functional outcome or in-hospital mortality. However, it was significantly associated with poor discharge disposition. This suggests that cumulative comorbidities only predict disposition in ICH, because the ICH score strongly impacts poor functional outcome and in-hospital mortality.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tp326
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 3
    Online Resource
    Online Resource
    Abstract WMP74: Admission Volume Depletion is Associated With Poor Outcome in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Few large studies exist on volume depletion and its association with outcomes in acute ischemic stroke (AIS) patients. A common marker of volume status is the calculated blood urea nitrogen (BUN) to serum creatinine (SCr) ratio. We examined the association between admission volume depletion (BUN/SCr 〉 15) and discharge outcome in AIS patients. Methods: Consecutive patients (March 2014 - April 2015) who presented with AIS to our Comprehensive Stroke Center (CSC) were retrospectively analyzed. Demographics, medical history, imaging, initial lab values, stroke severity (NIHSS), and discharge disposition were recorded. Patients with BUN/SCr 〈 = 15 and 〉 15 were compared and good outcome defined as discharge home. We performed logistic regression adjusting for admission NIHSS and age. Results: We identified 776 patients who met inclusion criteria. Patients with BUN/SCr 〉 15, were older (median 61 vs. 68, p 〈 0.001), more often female (43.5 vs. 59.6%, p 〈 0.001), and had atrial fibrillation (9 vs. 16%, p=0.004). Greater proportions presented with a hyperdense artery sign (7.1 vs. 12.9%, p=0.010) and developed an in-hospital UTI (2.8 vs. 5.9%, p=0.034). Volume depleted patients had increased LOS (3 vs. 4 days, p=0.049) and higher in-hospital mortality (6.2 vs. 12.6%, p=0.003) with fewer discharged home (57.7 vs. 44.9%, p=0.001). A BUN/SCr 〉 15 was associated with lower odds of good outcome at discharge (OR=0.57, 0.42 - 0.78; p 〈 0.001), this relationship persisted after adjusting for known predictors (OR=0.70, 0.49 -1.00; p=0.055). Conclusions: After controlling for age and NIHSS, volume depletion in AIS patients estimated by BUN/SCr ratio was associated with poor discharge outcome, complicated hospital course, increased LOS, and in-hospital mortality. This simple ratio can be used in the early evaluation and treatment of AIS. However, multi-center prospective studies are needed to determine if volume correction is confounding this association.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wmp74
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Abstract W P333: Seizure as the Presenting Symptom of ICH Patient Characteristics and EEG Utilization
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Background and Purpose: Seizures are the presenting symptom in a significant number of patients with spontaneous ICH. The role of EEG in the routine evaluation patients, with or without clinical evidence of seizures, is unclear. This study was undertaken to better understand seizures and the use of EEG in patients with ICH. Methods: Retrospective review of consecutive spontaneous ICH patients at our institution from 2008-2013. Patients were considered to have a seizure on presentation if a clinical evidence of a seizure was documented in the medical record; EEG data was not required to confirm seizure on presentation. Demographics, vascular risk factors, ICH score, and EEG findings were assessed. Results: Of 402 spontaneous ICH patients (mean age 63, 42% black, 43% female), 10% presented with seizure. Patients presenting with seizure were younger (mean age 65 vs. 54, p 〈 .001). Compared to patients with ICH presenting without a seizure, blacks presented more frequently with seizure (62% vs. 40%, p=.009). A higher proportion of patients who presented with seizure had a history of alcohol use (50% vs. 27%, p=.008) and substance abuse (23% vs. 10%, p=.025). Patients who presented with seizure more frequently had cortical ICH (54% vs. 32%, p=.007). EEGs were performed more frequently in ICH patients that presented with seizure (66% vs. 19%, p 〈 .001). Among patients with an EEG, epileptiform discharges or rhythmic pattern was more common in patients who presented with seizure (30% vs. 10%, p=.040) and with a cortical ICH (29% vs. 9%, p=.036). There were no significant differences in the proportion of patients that received EEG based on race, history of alcohol abuse, or history of substance abuse. Conclusions: Patients who presented with seizure were younger, black, and a higher proportion had a history of alcohol and substance abuse compared to patients with ICH who did not present with a seizure. Only 66% of those presenting with clinical seizure underwent EEG. Despite the prevalence of subclinical seizures in ICH patients, only 19% of patients who did not present with a seizure underwent EEG. Our study suggests that there may be room for improvement on the part of stroke neurologists in the diagnosis and management seizure of ICH patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.wp333
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Abstract TP345: The Association Between Stress Hyperglycemia, Hemorrhagic Transformation (HT), and Functional Outcomes in Diabetics and Non-diabetics
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Nearly 40% of stroke patients present with hyperglycemia, yet little is known about the mechanism by which hyperglycemia affects hemorrhagic transformation (HT) and functional outcome in diabetics as compared to non-diabetics. Methods: We performed a retrospective review of consecutive ischemic stroke patients presenting to our comprehensive stroke center (CSC) from March 2014 to April 2015. Demographic, clinical, and neuroimaging data were collected. Patients were divided into four groups: (1) no type II diabetes (DM) with glucose on admission 〈 180 [reference group], (2) No DM with glucose 〉 180, (3) DM with glucose 〈 180, and (4) DM with glucose 〉 180. Hemorrhagic transformation (HT) and poor functional outcome at discharge, as measured by modified Rankin scale (mRS) score 3-6, were compared amongst groups. Results: A total of 773 consecutive patients were admitted during the 14-month period (mean age 64, 49.3% women, and 36.6% Black). When compared to the reference group (n=467), patients without DM, but with glucose 〉 180 (n=50) had higher odds of developing HT (OR 10.6, 95%CI 5.47-20.4, p 〈 0.0001). This association persisted even after adjusting for age, stroke severity, IV tPA use, and endovascular therapy (NIHSS, OR 3.65, 95%CI 1.34-9.97, p=0.011). When compared to the reference group (n=467), patients with DM and glucose 〉 180 (n=104) had higher odds of poor functional outcome even after adjusting for age, stroke severity, IV tPA use, and endovascular therapy (NIHSS, OR 1.88, CI 1.04-3.42, p=0.037). Conclusions: We observed that hyperglycemia on admission was associated with HT in non-diabetics and associated with poor functional outcome in diabetics. Reasons that diabetics with hyperglycemia do not experience HT remain unclear. A better understanding of the pathophysiology of acute hyperglycemia in patients with and without DM is needed in order to minimize the risk of HT and its adverse effects.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp345
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 6
    Online Resource
    Online Resource
    Abstract W P324: The Influence Of Low Density Lipoprotein On Intracerebral Hemorrhage Volume
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Background and Purpose: High dose statin use either before (pre-morbid) or after an acute ischemic stroke has been associated with an increased risk of ICH. Prior studies suggest that premorbid statin use has a beneficial effect whereas lower LDL levels have a detrimental effect on functional outcomes in primary ICH. We sought to evaluate if pre-morbid statin use and serum LDL levels impacted ICH volume and outcomes in ICH. Methods: Patients with ICH admitted to our center from 2008-2013 were included. Demographic and clinical data were collected. Primary outcomes of interest were a large volume ICH (defined as volume greater than or equal to 30cc), and poor functional outcome at discharge defined as mRS of 4-6. Crude and adjusted logistic regression models were used to assess the relationship between LDL, statins and outcomes. Results: Of 403 patients, 18.6% (n=75) were taking a statin prior to ICH onset. The odds of a large volume ICH decreased by 12% for each 10 point decrease in serum LDL (OR 0.888, 95%CI 0.81-0.97, p=0.0115). In statin-naïve patients, the odds of a large volume ICH decreased by 16% for each 10 point decrease in LDL value (OR 0.84, 95%CI 0.76-0.94, p=0.0019). Patients who were on a statin prior to their ICH had no association between large volume ICH and LDL (OR 1.07, 95%CI 0.88-1.32, p=0.49). Statin use prior to ICH had no significant association with volume and location of ICH, admission NIHSS and a discharge mRS of 4-6 compared to statin-naïve patients (see Table). Conclusions: Statin use prior to ICH onset had no significant association with ICH volume or location, admission NIHSS, or poor short-term functional outcomes in comparison to statin-naïve patients. Lower serum LDL values were significantly associated with a decreased odds of large volume ICH, with the effect being driven by statin-naïve patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.wp324
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 7
    Online Resource
    Online Resource
    Abstract TMP7: The Effect of Admission Systolic Blood Pressure on Mortality in Patients With Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: It is unknown what significance different initial Systolic Blood Pressure (SBP) values have for patients presenting with acute ischemic stroke (AIS). We investigated factors associated with admission SBP, including hemorrhagic transformation (HT) and discharge outcome. Methods: This is a retrospective study of consecutive AIS patients presenting from April 2014 to March 2015. Demographic and clinical data were collected, including admission SBP divided into three tiers: 〈 140, 140-165 and 〉 165. Primary measure of outcome was in-hospital mortality. Results: A total of 776 patients were included with mean age 64, 49.2% females and 36.5% Black Race. Most patients with Black Race, hypertension (HTN) and hyperlipidemia (HLD) had SBP between 140-165 and 〉 165, whereas most patients with heart failure had lower SBP ( 〈 140) (Table 1). The median SPB was 123 (113-133) in the 〈 140 group, 152 (146-158) in the 140-165 group, and 188 (177-201) in the 〉 165 group. A similar number of patients amongst the three groups were on BP medications (63.5% vs. 69.3% vs. 64.1%), and there were no differences in proportion of HT (15.7% vs. 18.7% vs.12.6%). Although the proportion of patients treated with IV TPA were evenly distributed among tiers (14.4% vs. 13.6% vs. 15.7%), more patients with blood pressure 〈 166 were treated with endovascular therapy (7.8% vs. 8.9% vs. 3.7%; p=0.0321). In comparison to SBP 〈 140, SBP 〉 165 was associated with lower odds of in-hospital mortality (OR 0.536, 95%CI 0.295-0.975, p=0.041). This was significant after adjusting for age and NIHSS (OR 0.431, 95%CI 0.193-0.962, p=0.0399). Conclusions: Normal presenting SBP in patients with AIS was associated with in-hospital mortality. This may be related to heart failure. Further research is needed to define the ideal range to maintain SBP after AIS.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tmp7
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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