1
|
Zuo L, Dong Y, Liao X, Hu Y, Pan Y, Yan H, Wang X, Zhao X, Wang Y, Seet RCS, Wang Y, Li Z. Low HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score Increases the Risk of Post-Stroke Cognitive Impairment: A Multicenter Cohort Study. Clin Interv Aging 2024; 19:81-92. [PMID: 38223135 PMCID: PMC10788070 DOI: 10.2147/cia.s432885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024] Open
Abstract
Objective The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is a novel indicator that measures systemic inflammation and nutritional status that has not been correlated with the risk of post-stroke cognitive impairment in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods Study participants were recruited from 40 stroke centers in China. The HALP score was derived using a weighted sum of hemoglobin, albumin, lymphocytes and platelets, and study participants were categorized into 4 groups of equal sizes based on quartiles cutoffs of the HALP score. The Montreal Cognitive Assessment (MoCA)-Beijing Cognitive Assessment Scale (MoCA-Beijing) was performed at 2 weeks and 12 months following stroke onset. Post-stroke cognitive impairment was considered in patients with MoCA-Beijing≤22. Multiple logistic regression methods were employed to evaluate the relationship between the HALP score and the subsequent risk of developing post-stroke cognitive impairment. Results The study population comprised 1022 patients (mean age 61.6±11.0 years, 73% men). The proportion of individuals with MoCA-Beijing≤22 at 2 weeks was 49.2% and 32.4% at one year. Patients in the lowest quartile of HALP score (<36.56) were observed to harbor the highest risk of post-stroke cognitive impairment at 12 months post-stroke/TIA compared to those in the highest quartile (odds ratio=1.59, 95% CI=1.07-2.37, p=0.022), and lower domain scores for executive function, naming, and attention. There were no statistically significant differences between patients in the different quartiles of HALP score and HALP score at 2 weeks post-stroke/TIA. Conclusion The HALP score is a simple score that could stratify the risk of post-stroke cognitive impairment in stroke/TIA patients to facilitate early diagnosis and interventions.
Collapse
Affiliation(s)
- Lijun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yanhong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yang Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hongyi Yan
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xingao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Raymond C S Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, People’s Republic of China
- Chinese Institute for Brain Research, Beijing, People’s Republic of China
| |
Collapse
|
2
|
Hadianfar A, Sasannezhad P, Nazar E, Yousefi R, Shakeri M, Jafari Z, Hashtarkhani S. Predictors of in-hospital mortality among patients with symptoms of stroke, Mashhad, Iran: an application of auto-logistic regression model. Arch Public Health 2023; 81:73. [PMID: 37106443 PMCID: PMC10134659 DOI: 10.1186/s13690-023-01084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Stroke is the second leading cause of death in adults worldwide. There are remarkable geographical variations in the accessibility to emergency medical services (EMS). Moreover, transport delays have been documented to affect stroke outcomes. This study aimed to examine the spatial variations in in-hospital mortality among patients with symptoms of stroke transferred by EMS, and determine its related factors using the auto-logistic regression model. METHODS In this historical cohort study, we included patients with symptoms of stroke transferred to Ghaem Hospital of Mashhad, as the referral center for stroke patients, from April 2018 to March 2019. The auto-logistic regression model was applied to examine the possible geographical variations of in-hospital mortality and its related factors. All analysis was performed using the Statistical Package for the Social Sciences (SPSS, v. 16) and R 4.0.0 software at the significance level of 0.05. RESULTS In this study, a total of 1,170 patients with stroke symptoms were included. The overall mortality rate in the hospital was 14.2% and there was an uneven geographical distribution. The results of auto-logistic regression model showed that in-hospital stroke mortality was associated with age (OR = 1.03, 95% CI: 1.01-1.04), accessibility rate of ambulance vehicle (OR = 0.97, 95% CI: 0.94-0.99), final stroke diagnosis (OR = 1.60, 95% CI: 1.07-2.39), triage level (OR = 2.11, 95% CI: 1.31-3.54), and length of stay (LOS) in hospital (OR = 1.02, 95% CI: 1.01-1.04). CONCLUSION Our results showed considerable geographical variations in the odds of in-hospital stroke mortality in Mashhad neighborhoods. Also, the age- and sex-adjusted results highlighted the direct association between such variables as accessibility rate of an ambulance, screening time, and LOS in hospital with in-hospital stroke mortality. Thus, the prognosis of in-hospital stroke mortality could be improved by reducing delay time and increasing the EMS access rate.
Collapse
Affiliation(s)
- Ali Hadianfar
- Student Research Committee, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Payam Sasannezhad
- Department of Neurology, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Eisa Nazar
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Razieh Yousefi
- Student Research Committee, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Mohammadtaghi Shakeri
- Department of Biostatistics, School of Public Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.
| | - Zahra Jafari
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Soheil Hashtarkhani
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, USA
| |
Collapse
|
3
|
Aminu AQ, Wondergem R, Van Zaalen Y, Pisters M. Self-Efficacy Is a Modifiable Factor Associated with Frailty in Those with Minor Stroke: Secondary Analysis of 200 Cohort Respondents. Cerebrovasc Dis Extra 2021; 11:99-105. [PMID: 34628411 PMCID: PMC8543288 DOI: 10.1159/000519311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Owing to the improvement in acute care, there has been an increase in the number of people surviving stroke and living with its impairments. Frailty is common in people with stroke and has a significant impact on the prognosis after stroke. To reduce frailty progression, potentially modifiable factors should be identified. Increasing levels of self-efficacy influence both behaviour and physical functioning, and therefore it could be a potential target to prevent frailty. METHODS This is a prospective cohort study that involved the secondary analysis of the RISE data to examine the relationship between self-efficacy and frailty. The RISE study is a longitudinal study that consists of 200 adults aged 18+ years after their first stroke event. Data were collected from the respondents at 3 weeks, 6 months, 12 months, and 24 months after their discharge from the hospital. Frailty was assessed using the multidimensional frailty index with scores ranging from 0 to 1, and self-efficacy was assessed using the SESx scale, which was dichotomized as low/moderate or high. Frailty trajectories were examined using the repeated linear model. The generalized estimating equation was used to examine the relationship between self-efficacy and frailty at baseline and in the future (6-24 months). The B coefficients were reported at 95% CI before and after adjusting for potential confounders (age, gender, stroke severity, education, and social support). RESULTS A total of 200 responses were analysed, and the mean age of the respondents was 67.78 ± 11.53. Females made up 64% of the sample, and the mean frailty score at baseline was 0.17 ± 0.09. After adjusting for confounders, respondents with low self-efficacy had an approximately 5% increase in their frailty scores at baseline and in the 24-month follow-up period compared to those with high self-efficacy. CONCLUSION The result from this study showed that self-efficacy was significantly associated with frailty after stroke. Our findings suggest that self-efficacy may play a role in frailty progression among stroke survivors.
Collapse
Affiliation(s)
- Abodunrin Quadri Aminu
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
| | - Roderick Wondergem
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne Van Zaalen
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn Pisters
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
4
|
Variations in Rates of Discharges to Nursing Homes after Acute Hospitalization for Stroke and the Influence of Service Heterogeneity: An Anglia Stroke Clinical Network Evaluation Study. Healthcare (Basel) 2020; 8:healthcare8040390. [PMID: 33050219 PMCID: PMC7712187 DOI: 10.3390/healthcare8040390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Nursing home placement after stroke indicates a poor outcome but numbers placed vary between hospitals. The aim of this study is to determine whether between-hospital variations in new nursing home placements post-stroke are reliant solely on case-mix differences or whether service heterogeneity plays a role. A prospective, multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospitals within the Anglia Stroke and Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospitals (as a fixed-effect) and rates of new discharges to nursing homes using multiple logistic regression, adjusting for important patient risk factors. Descriptive and graphical data analyses were undertaken to explore the role of hospital characteristics. Of 1335 stroke admissions, 135 (10%) were discharged to a nursing home but rates varied considerably from 6% to 19% between hospitals. The hospital with the highest adjusted odds ratio of nursing home discharges (OR 4.26; 95% CI 1.69 to 10.73), was the only hospital that did not provide rehabilitation beds in the stroke unit. Increasing hospital size appeared to be related to an increased odds of nursing home placement, although attenuated by the number of hospital stroke admissions. Our results highlight the potential influence of hospital characteristics on this important outcome, independently of patient-level factors.
Collapse
|
5
|
Fekadu G, Chelkeba L, Melaku T, Tegene E, Kebede A. 30-day and 60-day rates and predictors of mortality among adult stroke patients: Prospective cohort study. Ann Med Surg (Lond) 2020; 53:1-11. [PMID: 32274016 PMCID: PMC7132118 DOI: 10.1016/j.amsu.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/03/2020] [Accepted: 03/15/2020] [Indexed: 01/01/2023] Open
Abstract
Stroke is one of the most common medical emergencies and the leading cause of preventable death and long-term disability worldwide. A prospective cohort study was conducted at the stroke unit of Jimma university medical center for four consecutive months (from March 10 to July 10, 2017). Of the total 116 study patients, 60 (51.7%) had an ischemic stroke. At 30-day follow-up, 81 (69.8%) patients were alive, 34 (29.3%) were died, and one patient (0.9%) was lost to follow-up. Elevated alanine aminotransferase (ALT) level (AHR: 3.77, 95% CI: 1.34-10.57), diagnosis of stroke clinically alone (AHR: 3.90, 95 CI: 1.49-10.26), brain edema (AHR: 4.28, 95% CI: 1.61-11.37), and National Institute of Health Stroke Scale (NIHSS) ≥ 13 during hospital arrival (AHR: 6.49, 95% CI: 1.90-22.22) were the independent predictors of 30-day mortality. At 60-day follow-up, 68 (58.6%) patients were alive, 46 (39.7%) were died, and 2 (1.7%) were lost to follow-up. Discharge against medical advice (AHR: 6.40, 95% CI: 2.31-17.73) and severe modified Rankin score/mRS (4-5) at discharge (AHR: 3.64, 95% CI: 1.01-13.16) were the independent predictors of 60-day mortality. The median (IQR) length of survival after hospital admission for patients died within 30 and 60 days were 4.65 (2.34-11.80) and 9.3 (3.93-33) days, respectively. Stroke significantly affects the morbidity and mortality in Ethiopia. There is a need to provide better care and future planning for stroke patients as an emergency diagnosis and treatment to minimize mortality and disability.
Collapse
Affiliation(s)
- Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Legese Chelkeba
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene
- School of Medicine, Institute of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Ayantu Kebede
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
6
|
Walpitage DL, Garcia A, Harper E, Sharma NK, Waitman LR. Using Electronic Health Record Activity to Represent Interdisciplinary Care Teams and Examining their Contribution to Hospital Length of Stay. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2020; 2019:883-892. [PMID: 32308885 PMCID: PMC7153122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Modeling variance in patient outcomes using medical claims and other forms of aggregated administrative data may ignore significant contributions associated with providers who are not recorded in billing transactions. We examined the association between interdisciplinary provider factors and length of stay (LOS) for 1,099 lumbar spine surgery patients. Interdisciplinary provider "dose" (number of providers/case), "workload" (care of other patients), and "activity" factors were defined and generated. Hierarchical Regression models were used to test the impact of these provider factors controlling for the effect of socio-demographic and clinical factors. Interdisciplinary provider factors explained 12% of additional variance in LOS. EHR-based interdisciplinary care team representations hold promise in contributing to our understanding of health care delivery and quality. Keywords: interdisciplinary care, nursing documentation, workload, length of stay, electronic health records (EHR).
Collapse
Affiliation(s)
| | | | | | - Neena K Sharma
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center
| | - Lemuel R Waitman
- Division of Medical Informatics, Department of Internal Medicine
| |
Collapse
|
7
|
Shojima Y, Ueno Y, Tanaka R, Yamashiro K, Miyamoto N, Hira K, Kurita N, Nakajima S, Urabe T, Hattori N. Eicosapentaenoic-to-Arachidonic Acid Ratio Predicts Mortality and Recurrent Vascular Events in Ischemic Stroke Patients. J Atheroscler Thromb 2020; 27:969-977. [PMID: 31969533 PMCID: PMC7508728 DOI: 10.5551/jat.52373] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims: The ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) is related to major adverse events and death in cardiovascular diseases. The association between long-term prognosis of ischemic stroke and EPA/AA ratio has not been clarified. Methods: Acute ischemic stroke patients who had undergone blood examinations for polyunsaturated fatty acids were enrolled. Major cardiovascular events, including recurrence of ischemic stroke, occurrence of cardiovascular and peripheral artery diseases and hemorrhagic stroke, and death, were analyzed, retrospectively. Cox proportional hazards regression analysis was used to explore factors, including clinical characteristics, laboratory data including EPA/AA ratio, and treatments associated with major cardiovascular events and death. Results: A total of 269 patients (mean age, 70 ± 13 years; 179 men) were enrolled. During follow-up (mean, 2.3 ± 1.0 years), 64 patients exhibited major cardiovascular events and death (annualized rate, 10.5% per person-year). Multivariate Cox analysis revealed that EPA/AA ratio (hazard ratio, 0.26; 95% confidence interval, 0.07–0.99; p = 0.048) and statin therapy (hazard ratio, 0.43; 95% confidence interval, 0.25–0.73; p = 0.002) correlated inversely with major cardiovascular events and death. In the Kaplan–Meier analysis, cumulative event-free rates were significantly lower among patients with EPA/AA ratio < 0.33 and patients without statin therapy (p = 0.006). Conclusions: Low EPA/AA ratio at baseline and treatment without statins could predict mortality, recurrent ischemic stroke, cardiovascular and peripheral artery diseases, and hemorrhagic stroke among patients with acute ischemic stroke. The combination of baseline EPA/AA ratio and statin therapy could be critical in predicting the long-term prognosis of ischemic stroke patients.
Collapse
Affiliation(s)
- Yuri Shojima
- Department of Neurology, Juntendo University School of Medicine
| | - Yuji Ueno
- Department of Neurology, Juntendo University School of Medicine
| | - Ryota Tanaka
- Department of Neurology, Juntendo University School of Medicine.,Stroke Center and Division of Neurology, Department of Medicine, Jichi Medical University
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University School of Medicine
| | | | - Kenichiro Hira
- Department of Neurology, Juntendo University School of Medicine
| | - Naohide Kurita
- Department of Neurology, Juntendo University School of Medicine
| | - Sho Nakajima
- Department of Neurology, Juntendo University School of Medicine
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital
| | | |
Collapse
|
8
|
Tørnes M, McLernon DJ, Bachmann MO, Musgrave SD, Warburton EA, Potter JF, Myint PK. Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke. Front Neurol 2019; 10:827. [PMID: 31447761 PMCID: PMC6691802 DOI: 10.3389/fneur.2019.00827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals. Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service (NHS) acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics. Results: We included 2,241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3 to 11%. The hospital that had the lowest odds of UTI [odds ratio (OR) = 0.50 (95% confidence interval (CI) 0.22–.11)] in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate [OR=2.69 (1.56–4.64)] was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner. Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to be addressed to improve the ultimate stroke outcome.
Collapse
Affiliation(s)
- Michelle Tørnes
- Ageing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - David J McLernon
- Medical Statistics Team, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stanley D Musgrave
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | | | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| |
Collapse
|
9
|
Chen CM, Lee M, Yang YH, Huang SS, Lin CH. Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke. Sci Rep 2019; 9:11521. [PMID: 31395912 PMCID: PMC6687732 DOI: 10.1038/s41598-019-47975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/m2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson–Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
Collapse
Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
10
|
The Factors Associated with the Fatal Outcome of Stroke. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study is to determine the risk factors associated with the fatal outcome of stroke. The research was designed as observational, non-interventional study, conducted by the type of case series, and it included 290 patients hospitalized with a diagnosis of stroke at Neurology Clinic of the Clinical Center Kragujevac during the observed period from 01/02/2013 to 31/01/2014. The data used for the research were: documentation of Neurology Clinic of the Clinical Center Kragujevac, documentation of the Institute of Public Health Kragujevac and patients’ questionnaires. The results of univariate binary logistic regression pointed out a relevant connection between the fatal outcome of stroke and age (p˂ 0.0001), gender (p˂ 0.0001), the severity of the disease (p = 0.002), smoking (p = 0.021), care for the parents’ health (p = 0.018), the concern about business problems (p = 0.018), while the influence of antidepressants was indicative (p = 0.066), whereas using the multivariate binary logistic regression, it was concluded that age (OR=1.096; 95% CI=1.059-1.134; p<0.001), the severity of the disease (OR=4.324; 95% CI=1.256-14.885; p=0.020) and the use of antidepressants (OR=5.578; 95% CI=1.178-26.423; p=0.030) were factors independently associated with the mortality rate. These findings suggest that it would be useful to carry out additional comprehensive research about all potential risk factors for the occurrence of stroke, and also to establish all the steps that can be taken in order to identify and detect risk factors, their elimination or reduction, and, accordingly, to take aggressive measures of primary and secondary prevention.
Collapse
|
11
|
Tørnes M, McLernon D, Bachmann M, Musgrave S, Warburton EA, Potter JF, Myint PK. Does service heterogeneity have an impact on acute hospital length of stay in stroke? A UK-based multicentre prospective cohort study. BMJ Open 2019; 9:e024506. [PMID: 30948571 PMCID: PMC6500188 DOI: 10.1136/bmjopen-2018-024506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To determine whether stroke patients' acute hospital length of stay (AHLOS) varies between hospitals, over and above case mix differences and to investigate the hospital-level explanatory factors. DESIGN A multicentre prospective cohort study. SETTING Eight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network in the East of England, UK. PARTICIPANTS The study sample was systematically selected to include all consecutive patients admitted within a month to any of the eight hospitals, diagnosed with stroke by an accredited stroke physician every third month between October 2009 and September 2011. PRIMARY AND SECONDARY OUTCOME MEASURES AHLOS was defined as the number of days between date of hospital admission and discharge or death, whichever came first. We used a multiple linear regression model to investigate the association between hospital (as a fixed-effect) and AHLOS, adjusting for several important patient covariates, such as age, sex, stroke type, modified Rankin Scale score (mRS), comorbidities and inpatient complications. Exploratory data analysis was used to examine the hospital-level characteristics which may contribute to variance between hospitals. These included hospital type, stroke monthly case volume, service provisions (ie, onsite rehabilitation) and staffing levels. RESULTS A total of 2233 stroke admissions (52% female, median age (IQR) 79 (70 to 86) years, 83% ischaemic stroke) were included. The overall median AHLOS (IQR) was 9 (4 to 21) days. After adjusting for patient covariates, AHLOS still differed significantly between hospitals (p<0.001). Furthermore, hospitals with the longest adjusted AHLOS's had predominantly smaller stroke volumes. CONCLUSIONS We have clearly demonstrated that AHLOS varies between different hospitals, and that the most important patient-level explanatory variables are discharge mRS, dementia and inpatient complications. We highlight the potential importance of stroke volume in influencing these differences but cannot discount the potential effect of unmeasured confounders.
Collapse
Affiliation(s)
- Michelle Tørnes
- Ageing Clinical and Experimental Research Group, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - David McLernon
- Medical Statistics Team, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Max Bachmann
- Norwich Medical School, Univeristy of East Anglia, Norwich, UK
| | | | | | - John F Potter
- Norwich Medical School, Univeristy of East Anglia, Norwich, UK
- Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, UK
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research Group, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
- Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
12
|
Chimatiro GL, Rhoda AJ, De Wit L. Stroke patients' outcomes and satisfaction with care at discharge from four referral hospitals in Malawi: A cross-sectional descriptive study in limited resource. Malawi Med J 2019; 30:152-158. [PMID: 30627348 PMCID: PMC6307053 DOI: 10.4314/mmj.v30i3.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Stroke is the fourth leading cause of mortality and disability in Malawi. There is paucity of studies reporting on acute stroke functional outcomes, quality of life and satisfaction with care among patients with stroke. This study aimed to determine stroke outcomes and satisfaction with care in the country's central hospitals. Methods A descriptive cross-sectional study, recruiting 114 adult patients with stroke and their caregivers, was done. FIM, EQ-5D-5L, SASC and C-SASC were used to collect data. Univariate associations were assessed using the Kruskal-Wallis Test for categorical variables and the Wilcoxon Rank Sum Test for continuous variables. Results With 79% of the original study sample taking part, there was improvement in patients' functional status at discharge compared to on admission with notable improvement in self-care (p<0.001), sphincter control (p<0.001), locomotion (p<0.001), and social cognition (p<0.001), but no significant improvement in transfers (p=1.000), and communication (p=0.865). Satisfaction with care was high, with no significant differences between males and females (p=0.415), age in years (p=0.397), and distance to the clinic (p=0.615). Satisfaction ratings were also high from caregivers' responses and their scores were not associated with age (p=0.663) or distance to the hospital (p=0.872). Quality of life was poor, most patients were either unable or had severe limitation in functional dimensions of mobility (22(28%), self-care (19(25%) and performance of usual activities (25(33%). Every additional year in age was associated with average of 0.36 decrease in quality of life score coefficient, −0.36 (95% CI: −0.63; −0.10); p=0.008. Conclusion Patients with stroke experience improvement in functional outcomes on discharge compared to on admission. Patients and caregivers were satisfied with care provision despite having poor quality of life post stroke treatment. There is need to focus proven interventions on areas of stroke care that can impact patients' quality of life in resource limited settings.
Collapse
Affiliation(s)
- George Lameck Chimatiro
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, South Africa
| | - Anthea J Rhoda
- Deputy Dean Teaching and Learning, Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, South Africa
| | - Liesbet De Wit
- Vrije Universiteit Brussel, Department of Public Health, Belgium
| |
Collapse
|
13
|
Aigner A, Becher H, Jacobs S, Wilkens LR, Boushey CJ, Le Marchand L, Haiman CA, Maskarinec G. Low diet quality and the risk of stroke mortality: the multiethnic cohort study. Eur J Clin Nutr 2018; 72:1035-1045. [PMID: 29426930 PMCID: PMC6555553 DOI: 10.1038/s41430-018-0103-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 09/18/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Several diets, e.g., those low in fruits/vegetables, high in sodium, and red/processed meat, have been related to a higher stroke risk. We investigated stroke mortality associated with a priori diet-quality indices in the Multiethnic Cohort study. SUBJECTS/METHODS Based on 172,043 observations including 3548 stroke deaths, we investigated the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010, the alternate Mediterranean diet score, and the Dietary Approaches to Stop Hypertension index in relation to stroke mortality. Using Cox regression, we estimated adjusted population attributable risks (PAR) and hazard ratios (HR) for tertiles of the indices while adjusting for relevant confounders. RESULTS The associations between all diet-quality indices and stroke mortality were consistent in direction; a low-quality diet was associated with a greater risk of stroke death, but the HEI-2010 was the strongest predictor. The PAR for stroke death based on HEI-2010 was 7.9% (95%-CI: 3.7-12.2%), indicating the preventable percentage of deaths if the total population had the same diet quality as those in the highest tertile for this diet-quality index. The lowest as compared to the highest tertile of the HEI-2010 was associated with a 1.23-fold (95%-CI: 1.13-1.34) risk. The PARs for low and medium adherence to the indices were similar by sex and follow-up time, but varied by ethnicity, with the highest PAR in Whites (15.4%) and no association in Latinos. CONCLUSIONS Findings for four diet-quality indices, in particular the HEI-2010, indicated that diet quality acts as an independent risk factor for stroke mortality. Promotion of a high diet quality could have a substantial impact on the prevention of stroke deaths.
Collapse
Affiliation(s)
- Annette Aigner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Jacobs
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Lynne R Wilkens
- Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Carol J Boushey
- Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Loic Le Marchand
- Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Norris Cancer Center, University of Southern California, Los Angeles, CA, USA
| | | |
Collapse
|
14
|
Alhazzani AA, Mahfouz AA, Abolyazid AY, Awadalla NJ, Katramiz K, Faraheen A, Khalil SN, Aftab R. In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E927. [PMID: 29735898 PMCID: PMC5981966 DOI: 10.3390/ijerph15050927] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 11/18/2022]
Abstract
Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016) were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness (HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.
Collapse
Affiliation(s)
- Adel A Alhazzani
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia.
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt.
| | - Ahmed Y Abolyazid
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine Mansoura University, Mansoura 35516, Egypt.
| | - Nabil J Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine Mansoura University, Mansoura 35516, Egypt.
| | - Khaled Katramiz
- Department of Neurology Section, Aseer Central Hospital, Saudi Arabia, Abha 21411, Saudi Arabia.
| | - Aesha Faraheen
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Shamsun Nahar Khalil
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Razia Aftab
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| |
Collapse
|