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  • 1
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    Abstract W P309: Serum Albumin Predicts Outcome In 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 & Purpose: Low serum albumin is associated with poor outcomes in ischemic stroke. Albumin levels are a marker of nutritional status; albumin also has neuro-protective effects. The role of serum albumin in outcomes in patients with ICH has not been investigated. We examined the association between initial admission albumin and functional outcome at discharge. Subjects & Methods: Consecutive patients (2008 - 2013) diagnosed with primary ICH at our academic stroke center in the Southeast US were retrospectively analyzed. Demographics, initial lab values, and ICH scores were recorded. A poor outcome was defined as mRS 4-6 at discharge. Eligible patients were divided into two groups based on ICH score (0-2 and 3-6). Statistical significance was determined using logistic regression. Results: A total of 103 patients met inclusion criteria (mean age 63, 45% women, 49% black). In patients with an ICH score of 0-2 (n=85), higher albumin was associated with lower odds of poor functional outcome at discharge (OR=0.40, 0.18 - 0.89; p=0.026). For every 1g/dL increase in albumin, the odds of poor outcome were reduced by 60%. This relationship was not observed in patients with an ICH score of 3-6 (n=18, OR=2.41, 0.06 - 99.5; NS). Conclusions: Serum albumin on admission predicts outcome at discharge. Patients with low ICH severity seem to be most sensitive to lower serum albumin levels. Early nutritional support may translate into better clinical outcomes in ICH patients. Future studies incorporating other measures of nutritional status are needed to better delineate optimal serum albumin levels and to understand this effect.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.wp309
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 2
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    Abstract W P332: Ratio of Blood Urea Nitrogen to Serum Creatinine Predicts Primary 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 & Purpose: Dehydration is associated with poor outcomes in stroke patients. A common marker of hydration status is the calculated blood urea nitrogen (BUN) to serum creatinine (SCr) ratio. Few studies in primary ICH patients have focused on intravascular volume depletion and ICH volume. We examined if dehydration (BUN/SCr 〉 15) predicted admission ICH volume. Subjects & Methods: Consecutive patients (2008 – 2013) who presented with a spontaneous ICH to our academic stroke center in the Southeast US were retrospectively analyzed. Demographics, initial lab values, ICH volumes, and ICH scores were recorded. Patients with INR 〈 = 1.5 were divided into two groups: BUN/SCr 〈 = 15 and 〉 15. ICH volumes were compared between groups. Statistical significance was determined using linear regression adjusting for admission systolic blood pressure (SBP) and ICH score. Results: We identified 326 patients who met inclusion criteria (mean age 63; SD=15, 43% women, 45% black). Patients with ratio 〉 15 were older (68 vs.60 years, p 〈 0.001). In addition, a higher proportion were white (63% vs.40%, p 〈 0.001) and female (56% vs. 36%, p 〈 0.001). The average SBP on arrival was similar between groups (176 vs.181 mmHg, p=0.159). The average initial ICH volumes for those with BUN/SCr 〉 15 were higher than patients with BUN/SCr 〈 = 15 (29.6 mL vs. 20.6 mL, p = 0.022). After adjusting for SBP and ICH score, patients with elevated BUN/SCr had an average of 9 mL larger ICH volumes on admission. Conclusions: Elevated BUN/SCr ratio is linked to larger initial ICH volumes even after controlling for ICH score and SBP. This simple ratio is an independent predictor of ICH volume, may reflect poor hydration status, and can potentially be used in the early evaluation and treatment of ICH patients. Future studies to determine if correction impacts functional outcomes are warranted.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.wp332
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 3
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    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
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  • 4
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    Online Resource
    Admission Systolic Blood Pressure Predicts the Number of Blood Pressure Medications at Discharge in Patients With Primary Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  The Neurologist Vol. 23, No. 2 ( 2018-03), p. 60-64
    Details
    In: The Neurologist, Ovid Technologies (Wolters Kluwer Health), Vol. 23, No. 2 ( 2018-03), p. 60-64
    Abstract: Control of systolic blood pressure (SBP) after primary intracerebral hemorrhage improves outcomes. Factors determining the number of blood pressure medications (BPM) required for goal SBP 〈 160 mm Hg at discharge are unknown. We hypothesized that higher admission-SBPs require a greater number of BPM for goal discharge-SBP 〈 160 mm Hg, and investigated factors influencing this goal. Materials and Methods: We conducted a retrospective review of 288 patients who presented with primary intracerebral hemorrhage. Admission-SBP was obtained. Primary outcome was the number of BPM at discharge. Comparison was made between patients presenting with and without a history of hypertension, and patients discharged on 〈 3 and ≥3 BPM. Results: Patients with hypertension history had a higher median admission-SBP compared with those without (180 vs. 157 mm Hg, P =0.0001). In total, 133 of 288 (46.2%) patients were discharged on 〈 3 BPM; 155/288 (53.8%) were discharged on ≥3 BPM. Hypertension history ( P 〈 0.0001) and admission-SBP ( P 〈 0.0001) predicted the number of BPM at discharge. In patients without hypertension history, every 10 mm Hg increase in SBP resulted in an absolute increase of 0.5 BPM at discharge ( P =0.0011), whereas in those with hypertension, the absolute increase was 1.3 BPM ( P =0.0012). In comparison with patients discharged on 〈 3 BPM, patients discharged on ≥3 BPM were more likely to have a higher median admission-SBP, be younger in age, belong to the African-American race, have a history of diabetes, have higher median admission–National Institutes of Health Stroke Scale and modified Rankin Scale of 4 to 5 at discharge. Conclusions: An understanding of the factors influencing BPM at discharge may help clinicians better optimize blood pressure control both before and after discharge.
    Type of Medium: Online Resource
    ISSN: 1074-7931
    URL: Article
    DOI: 10.1097/NRL.0000000000000173
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2070987-0
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  • 5
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    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
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  • 6
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    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
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  • 7
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    Abstract W P334: Admission Blood Pressure Predicts The Number Of Medications Upon Discharge 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: Previous studies have shown that controlling blood pressure (BP) may limit hematoma expansion in primary ICH. We hypothesize that aggressive management requires multiple BP medications and sought to evaluate what factors are associated with the number of BP medications at discharge. Methods: Patients with primary ICH admitted to our center from 2008-2013 were included. Patients whose care was transitioned to palliative medicine were excluded. Primary outcome of interest was the number of BP medications at discharge. Poisson distribution was used to assess the relationship between baseline variables and number of BP meds at discharge. Results: A total of 288 patients met eligibility criteria. The median age of the population of 62, 44.2% females, and 47.9% patients of African-American ethnicity. There were 236 patients (81.9%) with a history of hypertension (HTN). Patients with HTN had a higher admission systolic blood pressure (SBP) compared to those without HTN (180 vs. 157; p=0.0001). Number of BP medications at discharge ranged from 0-7, with the majority of patients discharged on 3 or more meds (29.9%). Only 4% of patients were discharged with no BP medications, whereas 7.3% were discharged on 5 or more. The only baseline variables that were significantly associated with number of BP meds on discharge in univariable analyses were a history of HTN (p 〈 0.0001) and admission SBP (p 〈 0.0001). In patients without a history of HTN, every 10-point increase in SBP on arrival resulted in an increase in 0.5 BP meds at the time of discharge (p=0.0011). For patients with a history of HTN, each 10-point increase in SBP on arrival resulted in an increase in 1.3 BP meds at the time of discharge (p=0.0012). Conclusions: A history of hypertension and admission systolic blood pressure were significant predictors of the number of BP medications at discharge. Admission SBP was also significantly associated with the number of BP medications on discharge for patients without a history of hypertension. Further research is needed to assess if the BP elevation is a stress response in patients without hypertension, or an indicator of uncontrolled hypertension in patients with a history of hypertension.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.wp334
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 8
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    Abstract TP56: The Impact of Early Ischemic Changes on Head CT on Hemorrhagic Conversion and Outcomes 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: Early ischemic changes (EIC) on head CT are associated with increased hemorrhagic transformation (HT) following treatment with TPA. We examined the associations between EIC, HT, and outcomes in patients treated and not treated with IV TPA. Methods: We conducted a retrospective review of consecutive acute ischemic stroke (AIS) patients presenting to our CSC from April 2014 to March 2015. Demographic and clinical data, including initial head CT findings (parenchymal hypodensity, loss of gray-white differentiation, sulcal effacement, hyperdense vessel) were collected. HT on repeat neuroimaging, poor functional outcome, as measured by a modified Rankin Scale (mRS) of 3-6, and in-hospital mortality were assessed. Results: A total of 679 patients were included (50.4% men). One hundred and eight patients (15.9%) received IV TPA. EIC were observed in 38.5% of untreated patients and 17.6% in IV TPA treated patients (p 〈 0.0001). For patients treated with IV TPA, EIC was seen more frequently in patients with pre-stroke anticoagulant use (26.3% vs. 6.7%, p=0.010) and less frequently in patients with pre-stroke statin use (15.8% vs. 43.3%, p=0.025). A higher proportion of HT was observed in patients with EIC (12.8% vs. 6.8%, p=0.016 untreated, 36.8% vs. 14.6%, p=0.024 IV TPA) and with hyperdense artery sign (8.2% vs. 3.7%, p=0.022 untreated, 36.8% vs. 15.7%, p=0.035 IV TPA). For untreated patients, EIC was observed in a larger proportion of patients with an NIHSS 〉 14 (14.8% vs. 9.6%, p=0.016), and discharge mRS 3-6 (53.6% vs. 44.5%, p=0.040). For patients treated with IV TPA, in-hospital mortality was more common in patients with EIC (31.6% vs. 10.0%, p=0.013). Conclusions: In untreated patients, EIC may serve as a harbinger for HT on repeat imaging and poor functional outcome at discharge, whereas in patients treated with IV TPA, it is associated with HT and in-hospital mortality. Patients with EIC may be at increased risk of HT and poor outcomes even without thrombolytics.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp56
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 9
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    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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