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Eriksson H, Koskinen S, Nuotio K, Heikkilä H, Vikatmaa P, Silvennoinen H, Valanne L, Mäyränpää M, Kovanen P, Soinne L, Lindsberg P, Ijäs P. Predictive Factors for Pre-operative Recurrence of Cerebrovascular Symptoms in Symptomatic Carotid Stenosis. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jadhav AP, Desai SM, Panczykowski DM, Rangaraju S, Campbell D, Ritvonen JK, Schreiner M, Silvennoinen H, Gerber J, Puetz V, Raza SA, Haussen DC, Nogueira RG, Strbian D, Jovin TG, Lindsberg PJ. Predicting outcomes after acute reperfusion therapy for basilar artery occlusion. Eur J Neurol 2020; 27:2176-2184. [PMID: 32558040 DOI: 10.1111/ene.14406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long-term functional status clouds clinical decision-making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3-month favorable outcome after acute reperfusion therapy for BAO. METHODS This retrospective, multicenter, observational study was conducted at four high-volume stroke centers in the USA and Europe. Multivariate regression analysis was performed to identify predictors of favorable outcome (90-day modified Rankin scale scores 0-2) and derive a clinically applicable prognostic model (the Pittsburgh Outcomes after Stroke Thrombectomy-Vertebrobasilar (POST-VB) score). The POST-VB score was evaluated and internally validated with regard to calibration and discriminatory ability. External validity was assessed in patient cohorts at three separate centers. RESULTS In the derivation cohort of 59 patients, independent predictors of favorable outcome included smaller brainstem infarct volume on post-procedure magnetic resonance imaging (P < 0.01) and younger age (P = 0.01). POST-VB score was calculated as: age + (10 × brainstem infarct volume). POST-VB score demonstrated excellent discriminatory ability [area under the receiver-operating characteristic curve (AUC) = 0.91] and adequate calibration (P = 0.88) in the derivation cohort (Center A). It performed equally well across the three external validation cohorts (Center B, AUC = 0.89; Center C, AUC = 0.78; Center D, AUC = 0.80). Overall, a POST-VB score < 49 was associated with an 88% likelihood of favorable outcome, as compared to 4% with a score ≥ 125. CONCLUSIONS The POST-VB score effectively predicts 3-month functional outcome following acute reperfusion therapy for BAO and may aid in guiding post-procedural care.
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Affiliation(s)
- A P Jadhav
- Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - S M Desai
- Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - D M Panczykowski
- Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Rangaraju
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - D Campbell
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - J K Ritvonen
- Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - M Schreiner
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Department of Neurology, Dresden, Germany
| | - H Silvennoinen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - J Gerber
- Institute of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - V Puetz
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Department of Neurology, Dresden Neurovascular Center, Dresden, Germany
| | - S A Raza
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - D C Haussen
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - R G Nogueira
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - D Strbian
- Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - T G Jovin
- Department of Neurology, Cooper University Hospital, Camden, NJ, USA
| | - P J Lindsberg
- Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, University of Helsinki, Helsinki, Finland
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Ritvonen J, Strbian D, Silvennoinen H, Virtanen P, Salonen O, Lindsberg PJ, Sairanen T. Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion. Eur J Neurol 2018; 26:128-135. [DOI: 10.1111/ene.13781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/02/2018] [Indexed: 12/23/2022]
Affiliation(s)
- J. Ritvonen
- Molecular Neurology Research Program Unit Biomedicum Helsinki Department of Clinical Neurosciences University of Helsinki Helsinki
| | - D. Strbian
- Molecular Neurology Research Program Unit Biomedicum Helsinki Department of Clinical Neurosciences University of Helsinki Helsinki
- Department of Neurology Helsinki University Hospital Helsinki
| | - H. Silvennoinen
- Helsinki Medical Imaging Center Helsinki University Hospital University of Helsinki Helsinki Finland
| | - P. Virtanen
- Helsinki Medical Imaging Center Helsinki University Hospital University of Helsinki Helsinki Finland
| | - O. Salonen
- Helsinki Medical Imaging Center Helsinki University Hospital University of Helsinki Helsinki Finland
| | - P. J. Lindsberg
- Molecular Neurology Research Program Unit Biomedicum Helsinki Department of Clinical Neurosciences University of Helsinki Helsinki
- Department of Neurology Helsinki University Hospital Helsinki
| | - T. Sairanen
- Department of Neurology Helsinki University Hospital Helsinki
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Ala-Kauhaluoma M, Vikatmaa P, Vikatmaa L, Ijäs P, Nuotio K, Koskinen S, Silvennoinen H, Lindsberg P, Soinne L, Summanen P. Ophthalmic findings before carotid endarterectomy in the ipsilateral and contralateral eye. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heikkinen T, Silvennoinen H, Heinonen S, Vuorinen T. Clinical and socioeconomic impact of moderate-to-severe versus mild influenza in children. Eur J Clin Microbiol Infect Dis 2016; 35:1107-13. [PMID: 27086364 DOI: 10.1007/s10096-016-2641-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/28/2016] [Indexed: 01/05/2023]
Abstract
Some studies have assessed the efficacy of influenza vaccination in children separately for moderate-to-severe and any influenza, but the definition used for identifying children with moderate-to-severe illness has not been validated. We analyzed clinical and socioeconomic data from two prospective cohort studies of respiratory infections among children aged ≤13 years (four influenza seasons, 3,416 child-seasons of follow-up). We categorized children with laboratory-confirmed influenza into two mutually exclusive groups of moderate-to-severe and mild influenza using the previously proposed criteria. We obtained the data for the analyses from structured medical records filled out by the study physicians and from daily symptom cards filled out by the parents. Of 434 cases of influenza, 217 (50 %) were classified as moderate-to-severe and 217 (50 %) as mild. The mean duration of fever was 4.0 days in children with moderate-to-severe influenza and 3.1 days in those with milder illness (P < 0.0001). Antibiotics were prescribed to 111 (51 %) children with moderate-to-severe and to ten (5 %) children with mild influenza (P < 0.0001). The rates of parental work absenteeism were 184 days per 100 children with moderate-to-severe influenza and 135 days per 100 children with mild influenza (P = 0.02). The corresponding rates of children's own absenteeism from day care or school were 297 and 233 days respectively per 100 children (P = 0.006). Categorization of children into groups with moderate-to-severe and mild influenza is meaningful, and it identifies children in whom the clinical and socioeconomic impact of influenza is highest. Illness severity should be considered when assessing influenza vaccine effectiveness in children.
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Affiliation(s)
- T Heikkinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
- Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland.
| | - H Silvennoinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - S Heinonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Pediatrics, Helsinki University Hospital, Helsinki, Finland
| | - T Vuorinen
- Department of Clinical Virology, Division of Microbiology and Genetics, Turku University Hospital, Turku, Finland
- Department of Virology, University of Turku, Turku, Finland
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Sairanen T, Strbian D, Ruuskanen R, Silvennoinen H, Salonen O, Lindsberg PJ. Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion. Eur J Neurol 2014; 22:493-9. [PMID: 25482105 DOI: 10.1111/ene.12597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to determine factors associated with symptomatic intracranial haemorrhage (sICH) in basilar artery occlusion patients treated with intravenous thrombolysis (IVT) and adjuvant anticoagulant therapy. METHODS A registry of 176 consecutive patients with angiography-proven basilar artery occlusion who received IVT with alteplase and heparin between 1995 to 2013 was assessed. Post-treatment sICH was evaluated with the European Cooperative Acute Stroke Study II criteria. Unfavourable outcome was defined as a modified Rankin Scale score of 3-6 at 3 months. RESULTS Twenty-four patients developed sICH (13.6%, sICH+), all of whom had unfavourable outcome and only two (8.3%) sICH+ patients survived. On admission, sICH+ patients more frequently had extensive ischaemic changes defined as posterior circulation Acute Stroke Prognosis Early CT Score (PC-ASPECTS) < 8 (50% vs. 27% in sICH-, P = 0.031) and lower platelet counts (183 vs. 218 E9/l; P = 0.011). They also had higher systolic blood pressure (SBP) (median 160 vs. 147 mmHg, P = 0.034) immediately after IVT. In multivariable regression analysis, lower platelet values [odds ratio (OR) 0.99, 95% confidence interval (CI) 0.97-0.996; P = 0.006], PC-ASPECTS < 8 on admission (OR 3.6, 95% CI 1.3-10.3; P = 0.017) and higher SBP after treatment (OR 1.03, 95% CI 1.01-1.05; P = 0.017) were independently associated with sICH. Ninety per cent of the sICHs occurred within 48 h from IVT/anticoagulation treatment. No differences in activated partial thrompoplastin times prior to or after the treatment were observed between sICH+ and sICH- patients. CONCLUSIONS The risk of sICH was largely determined by extension of ischaemic changes on admission computed tomography. Clinically relevantly, also higher post-thrombolytic SBP as described earlier and lower perithrombolytic platelet counts do increase the risk, a finding requiring confirmation in other patient series.
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Affiliation(s)
- T Sairanen
- Department of Neurology, University of Helsinki, Helsinki, Finland
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Curtze S, Strbian D, Meretoja A, Putaala J, Eriksson H, Haapaniemi E, Mustanoja S, Sairanen T, Satopää J, Silvennoinen H, Niemelä M, Kaste M, Tatlisumak T. Higher baseline international normalized ratio value correlates with higher mortality in intracerebral hemorrhage during warfarin use. Eur J Neurol 2014; 21:616-22. [DOI: 10.1111/ene.12352] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S. Curtze
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - D. Strbian
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - A. Meretoja
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
- Department of Medicine and the Florey Institute; University of Melbourne; Melbourne Victoria Australia
| | - J. Putaala
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - H. Eriksson
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - E. Haapaniemi
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - S. Mustanoja
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - T. Sairanen
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - J. Satopää
- Department of Neurosurgery; Helsinki University Central Hospital; Helsinki Finland
| | - H. Silvennoinen
- Department of Radiology; Helsinki University Central Hospital; Helsinki Finland
| | - M. Niemelä
- Department of Neurosurgery; Helsinki University Central Hospital; Helsinki Finland
| | - M. Kaste
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - T. Tatlisumak
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
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Silvennoinen H, Peltola V, Vainionpää R, Ruuskanen O, Heikkinen T. Admission diagnoses of children 0-16 years of age hospitalized with influenza. Eur J Clin Microbiol Infect Dis 2011; 31:225-31. [PMID: 21643867 DOI: 10.1007/s10096-011-1297-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/11/2011] [Indexed: 12/30/2022]
Abstract
The prompt diagnosis of influenza enables the institution of antiviral therapy and adequate cohorting of patients, but scarce data are available to help clinicians correctly suspect influenza in children at the time of admission. This 16-year retrospective study assessed the main admission diagnoses of 401 children aged ≤16 years hospitalized with virologically confirmed influenza. The clinical data were derived from a systematic review of the medical records of the children. Sepsis-like illness was the main reason for admission in 52% of infants aged <6 months and in 7-16% of the older children. Respiratory symptoms accounted for 38% of admissions, and 15% of children were hospitalized due to acute neurologic conditions, primarily febrile convulsions. Wheezing or exacerbation of asthma was the primary reason for admission in 14% of children aged <3 years. No differences were observed in the admission diagnoses between children with influenza A and B infections. The main admission diagnoses vary widely in different age groups of children with influenza, and only a minority of children are hospitalized for respiratory symptoms. The leading role of sepsis-like illness in infants aged <6 months calls for increased efforts to find protective measures against influenza in this age group.
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Affiliation(s)
- H Silvennoinen
- Department of Pediatrics, Turku University Hospital, 20520, Turku, Finland.
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