Enhancing stroke-associated pneumonia prediction in ischemic stroke: An interpretable Bayesian network approach.

Transcription factor EB (TFEB) is an endogenous protective protein. Serum TFEB levels were measured after acute intracerebral hemorrhage (ICH), in addition to determining their connection to the severity and neurological outcomes of patients. Serum TFEB levels were measured in a prospective cohort study of 186 ICH patients and 100 controls. Severity was estimated using the National Institutes of Health Stroke Scale (NIHSS) and hematoma volume. Poor neurological status mirrored by the post-ICH six-month modified Rankin Scale (mRS), along with stroke-associated pneumonia (SAP), was considered as the two outcome variables. Patients showed a marked decline in serum TFEB levels compared with controls. Serum TFEB levels were significantly inversely correlated with both NIHSS scores and hematoma volume; had a linear relationship with likelihoods of both SAP and poor prognosis (mRS scores 3-6), were independent of ordinal mRS scores, SAP, and poor prognosis; and were efficiently predictive of SAP and poor prognosis with analogous areas under the receiver operating characteristic curve as NIHSS scores and hematoma volume. The association between serum TFEB levels and poor prognosis is partly mediated by SAP. Reduced serum TFEB levels post-ICH of evident relevance to bleeding intensity are powerfully linked to poor neurological prognosis, wherein there is a partial mediative effect by SAP, thereby reinforcing TFEB as a serological prognostic indicator of good prospect in ICH.

Association of Serum Bilirubin with Ischemic Stroke Outcomes

Early Neurologic Improvement Based on the National Institutes of Health Stroke Scale Score Predicts Favorable Outcome within 30 Minutes after Undergoing Intravenous Recombinant Tissue Plasminogen Activator Therapy

ObjectiveThis study aims to identify relevant risk factors, assess the interactions between variables, and establish a predictive model for ischemic stroke (IS) in patients with cardiac myxoma (CM) using the Bayesian network (BN) approach.MethodsData of patients with CM were collected from three tertiary comprehensive hospitals in Beijing from January 2002 to January 2022. Age, sex, medical history, and information related to CM were extracted from the electronic medical record system. The BN model was constructed using the tabu search algorithm, and the conditional probability of each node was calculated using the maximum likelihood estimation method. The probability of each node of the network and the interrelationship between IS and its related factors were qualitatively and quantitatively analyzed. A receiver operating characteristic (ROC) curve was also plotted. Sensitivity, specificity, and area under the curve (AUC) values were calculated and compared between the BN and logistic regression models to evaluate the efficiency of the predictive model.ResultsA total of 416 patients with CM were enrolled in this study, including 61 with and 355 without IS. The BN model found that cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility were directly associated with the occurrence of IS in patients with CM. The BN model for predicting CM-IS achieved higher scores on AUC {0.706 [95% confidence interval (CI), 0.639–0.773]} vs. [0.697 (95% CI, 0.629–0.766)] and sensitivity (99.44% vs. 98.87%), but lower scores on accuracies (85.82% vs. 86.06%) and specificity (6.56% vs. 11.48%) than the logistic regression model.ConclusionCardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility are candidate predictors of IS in patients with CM. The BN model was superior or at least non-inferior to the traditional logistic regression model, and hence is potentially useful for early IS detection, diagnosis, and prevention in clinical practice.

BackgroundPost-stroke depression (PSD) refers to a depressive state that appears after stroke onset and is one of the most common complications in ischemic stroke patients. The occurrence of PSD exacerbates the risk of disability and increases the mortality of patients. Current diagnosis of PSD is severely underdiagnosed.MethodsPatients hospitalized for acute ischemic stroke between December 2019 and November 2022 in the Department of Neurology of Sinopharm Gezhouba Central Hospital were retrospectively collected. Patients’ basic clinical information, test data and related questionnaire scores were collected. They were divided into PSD group and NPSD group. Multivariate regression was used to analyze the risk factors of post-stroke depression and establish a risk prediction model to draw nomograms. Receiver Operating Characteristic Curve (ROC), Calibration curve and Decision Curve Analysis (DCA) decision curve were drawn using R language to assess the clinical efficacy and clinical utility of the model.ResultsPost-stroke depression in Acute Ischemic Stroke (AIS) patients was associated with single factors such as hypertension, living alone, education level, homocysteine level, National Institute of Health Stroke Scale (NIHSS) score, lymphocyte count, neutrophil count (P < 0.05). Among them, living alone, CRP level, hypertension, homocysteine level, education level, systemic immune inflammation index (SII), and NIHSS score were independent risk factors for post-stroke depression in AIS patients (P < 0.05). The seven selected variables were used to construct a risk prediction model, nomograms were drawn, and ROC curves were used to assess model discrimination, AUROC = 0.881. Calibration curve is used to evaluate the consistency of the model, DCA decision curve is used to evaluate the practicability of the model, and this model has good discrimination ability, calibration and clinical practicability.ConclusionThe probability of PSD in AIS patients in this study was 26.51%. Independent risk factors for developing PSD, including CRP level, living alone, history of hypertension, homocysteine level, education level, SII, NIHSS score to establish risk prediction model and draw nomograms. The model was demonstrated to have good discrimination, calibration and clinical utility by internal validation.

Purpose: The National Institutes of Health Stroke Scale (NIHSS) was developed to measure neurologic outcome and recovery in patients with stroke. The aim of our study was to establish the validity of the NIHSS on short-term (30-day) mortality in patients with ischemic stroke.&#x0D; Methods: All 402 patients (216 males) with acute ischemic stroke hospitalized over 1 year were included in the study. Information on the presence of diabetes mellitus and smoking habits was obtained by a questionnaire. Systolic and diastolic blood pressure was measured upon hospital admission. The body mass index was calculated. Laboratory data were assessed in the first 24h after stroke onset. The National Institutes of Health Stroke Scale (NIHSS) was employed upon hospital admission. Patients were then followed up for 30 days.&#x0D; Results: The mean age of patients was 70.89 years (range, 36–96 years). Women were older than men (P&lt;0.0001). There were 49 (12.2%) deaths in the first 30 days. Patients who died had a higher NIHSS score upon hospital admission (P=0.0001), were older (P=0.013), had higher high-sensitivity C-reactive protein (hsCRP) levels (P=0.0001) and lower albumin levels (P=0.016). With Cox multivariable regression analyses, NIHSS score (P=0.0001) as well as levels of total cholesterol (TC) (P=0.004) and low-density lipoproteincholesterol (LDL-C) (P=0.016) were predictors of 30-day mortality. After the addition of age as a variable, NIHSS score (P=0.0001) as well as levels of TC (P=0.006) and LDL-C (P=0.025) remained predictors of mortality.&#x0D; Conclusion: The NIHSS is a good predictor of outcome in short-term (30-day) mortality in patients with ischemic stroke.

Background Hemorrhagic transformation (HT) is a challenging complication of thrombolytic therapy that can lead to increased morbidity and mortality in recurrent ischemic stroke. Aim The study aimed to identify predictors of HT in recurrent symptomatic acute ischemic stroke (AIS) patients treated with intravenous thrombolysis. Patients and methods Forty-three patients with recurrent symptomatic AIS were recruited, and 10 of them developed HT. All patients underwent history taking and clinical examination, including Glasgow Coma Score and National Institute of Health Stroke Scale (NIHSS), Fazekas score, and modified Rankin scale, as well as radiological investigations, cardiac evaluation, and laboratory investigation [routine laboratories, neutrophil–lymphocyte ratio (NLR), C-reactive protein (CRP)-to-albumin ratio (CAR), international normalized ratio (INR), prothrombin time (PT), and fibrinogen level]. Outcome was assessed via clinical examination, NIHSS, and modified Rankin scale. Results Recurrent AIS patients with HT represented 23.2% of our sample of patients while symptomatic intracranial hemorrhage represented 13.9%. HT group had significant rates of atrial fibrillation, diabetes mellitus, hypertension, valvular heart disease, higher blood pressure, random blood sugar, Fazekas score, and NIHSS score. Most of HT patients were on anticoagulants for previous stroke. Most cases in the HT group received i.v. thrombolytic as treatment for their previous stroke. They also had increased NLR, high CAR, INR, PT, and low fibrinogen level, previous thrombolytic therapy, and low Alberta stroke program early non-contrast CT score. Conclusion HT in recurrent AIS patients receiving recombinant tissue plasminogen activator was associated with higher INR, NLR, PT, NIHSS, Fazekas score, CAR, lower fibrinogen, previous thrombolytic therapy, and low Alberta stroke program early non-contrast CT score.

Cerebral microbleeds (CMBs) are an important risk factor for stroke recurrence and prognosis. However, there is no consensus on the safety of antiplatelet therapy in patients with ischemic stroke and CMBs. This study aimed to observe the effects of dual antiplatelet therapy with aspirin and clopidogrel on bleeding conversion in patients with different degrees of CMBs. An observational retrospective study was conducted on 160 patients with acute mild ischemic stroke admitted to the Stroke Center, Affiliated Hospital of Beihua University between March 2021 and December 2022. Patients were divided into the CMBs and non-CMB groups. The CMB group was then divided into the low, medium and high-risk groups. In two groups, all patients were administered dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg orally once a day for 21 days according to the Chinese Stroke Guidelines of 2018), and no other anticoagulant or antiplatelet drugs were administered during the treatment period. Head CT, National Institutes of Health Stroke Scale(NIHSS) and modified Rankin Scale (mRS) score were re-checked, and the number of bleeding conversions was calculated at 21 days. Five patients in the CMB group had intracranial hemorrhage (5/116, 4.3%), while no intracranial hemorrhage was observed in the non-CMB group. There were no differences in the conversion rate of cerebral hemorrhage, NIHSS score, or mRS score between two groups after dual antiplatelet therapy (p>0.05). The conversion rate of cerebral hemorrhage in the high-risk group was higher than that in the non-CMB group (p<0.05), but the NIHSS and mRS score showed no difference between the high-risk and non-CMB groups (p>0.05). Dual antiplatelet therapy with aspirin and clopidogrel does not significantly increase the risk of bleeding transformation; however, it improves neurological recovery or long-term prognosis in patients with acute ischemic cerebral stroke complicated by low-risk and middle-risk CMBs.

Introduction: The Joint Commission recommends all acute stroke patients undergo swallow screening prior to any oral intake to decrease risk of aspiration pneumonia. In a 2009 study, a nursing swallow screening tool was compared to the National Institutes of Health Stroke Scale (NIHSS) to identify dysphagia in acute stroke patients. They found the NIHSS was a better predictor for identifying dysphagia. This IRB-approved study replicated and expanded the 2009 study in a community hospital with stroke patients using a facility-based nursing Stroke Swallow Screen (SSS). Hypothesis: The investigators hypothesized that the results would corroborate the 2009 study for the purpose of streamlining acute stroke assessment in the Emergency Department (ED). Methods: SSS results, NIHSS scores and speech-language pathology (SLP) swallowing evaluations of adult ischemic and hemorrhagic stroke patients were collected retrospectively via medical chart review. SSS results and NIHSS scores were compared against the “gold standard” for dysphagia diagnosis, the SLP evaluation. Convenience sampling, based on diagnosis within a 24-month time interval, determined the study sample. Results: Dysphagia prevalence among subjects (N=240) was 45%. The SSS demonstrated 95.4% sensitivity compared to 80.6% for the NIHSS. Conclusion: The SSS was a better predictor for presence of dysphagia in acute stroke patients than the NIHSS. Our findings stand in contrast to the 2009 report, in which dysphagia sensitivities of their screening tool and the NIHSS were 29% and 79%, respectively. Therefore, streamlining these ED stroke assessments would not be efficacious in our facility.

Preclusion of Ischemic Stroke Patients from Intravenous Tissue Plasminogen Activator Treatment for Mild Symptoms Should Not be Based on Low National Institutes of Health Stroke Scale Scores

ABSTRACTBackground:Cerebrovascular disease is the second most common cause of death in people more than 60 years of age. Predicting the outcome of the stroke is a great challenge for physicians. Various risk factors such as age, sex, co-morbidities, smoking and alcohol habits, type of stroke, National Institute of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), and others play the role in the outcome of stoke.Aim:To assess the degree of impact of NIHSS score in comparison to the other traditional risk factors on the functional outcome and 30-day mortality by mRS in the patients with acute ischemic stroke.Materials and Methods:Patients with acute ischemic stroke and age more than 18 years were included. Their admission NIHSS score and the 30-day mRS were analyzed. Patients were divided into two groups as survivors and non-survivors.Results:The mean age of survivors and non-survivors was 59.77 ± 10.99 and 65.58 ± 6.67 years, respectively. The NIHSS score on day 1 for non-survivors was 21.21 ± 8.21, and almost half of this score was seen in survivors. The NIHSS score on day 1 had a significant association with mortality with a relative risk of 0.79 (95% CI = 0.70–0.89). The NIHSS score has 73.7% sensitivity and 74.1% specificity with cutoff value of 15.5 for discriminating the outcome of ischemic stroke.Conclusion:The NIHSS and mRS scales are simple, validated, easily applicable, and reliable tools for assessing the mortality and the functional outcome of ischemic stroke patients.

The aim of this study was to assess the value of nitric oxide (NO) and endothelin-1 (ET-1) serum concentrations as potential biomarkers for predicting the functional outcome in patients with acute ischemic stroke. Material and methods. A total of 37 patients diagnosed with ischemic stroke and admitted to a multidisciplinary vascular center were included in the study. The patients were divided into two groups based on the severity of neurological deficits as determined by the National Institutes of Health Stroke Scale (NIHSS): Group 1 consisted of 20 patients with NIHSS scores 15, and Group 2 consisted of 17 patients with NIHSS scores 15. The functional outcome was assessed using the NIHSS absolute values and the degree of disability measured by the Modified Rankin Scale (mRS) by comparing the values before and after baseline treatment. Lab evaluation included quantitative assessment of stable NO and ET-1 metabolites in patient’s serum at admission and on day 10 of hospital stay. The SPSS Statistics V23.0 for Windows software package, Python programming language, and Pandas and SciPy libraries were used for statistical data processing. Results. Group 1 patients demonstrated a statistically significant decrease in NIHSS (P=0.0013) and mRS (P0.0001) scores, which was indicative of a favorable functional outcome. Group 2 patients showed some recovery of only neurological deficit measured by NIHSS scale (P=0.0012), changes in degree of disability by mRS were statistically insignificant. On Day10 of hospital stay, both groups showed a clinically significant increase in ET-1 content, and slight change in NO concentration. NIHSS score demonstrated a significant negative correlation with baseline ET-1 concentrations: R=–0.82, P=0.00023 — in Group 1; R=–0.55, P=0.00075 — in Group 2. Modified RS scores showed negative correlation with NO (R=–0.50, P=0.00044) and ET-1 (R=–1.0, P=0.0074) concentrations in Group 1, and positive correlation with NO (R=0.55, P=0.0023) and ET-1 (R=0.33, P=0.04) concentrations in Group 2. Conclusion. Monitoring of NO and ET-1 serum concentrations provides valuable insights for personalized assessment of the anticipated functional outcome in patients with cerebral ischemia. Further research and the development of prognostic mathematical models are needed to validate the use of endothelial function markers as predictive indicators of patients' recovery potential during the acute phase of ischemic stroke.

Normalized wall index, intraplaque hemorrhage and ulceration of carotid plaques correlate with the severity of ischemic stroke

A simple risk score for early ischemic stroke mortality derived from National Institutes of Health Stroke Scale: A discriminant analysis

BackgroundOmentin-1 is a novel adipocytokine that is related to atherosclerosis-based ischaemic cardiovascular disease and stroke. Previous studies have linked its lower levels with poor stroke outcomes. We aimed to assess the level of serum omentin-1 as a prognostic marker in patients with large artery ischaemic stroke.MethodsFifty ischaemic stroke patients suffering large artery ischaemic stroke and another 50 subjects without a prior history of strokes were recruited. All participants were subjected to neurological examinations, echocardiography and laboratory investigations including a lipid profile and HBA1c. Carotid intima-media thickness (IMT) was measured for all participants. Stroke patients were evaluated by the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Infarction volume was measured by magnetic resonance image (MRI) and serum level of omentin-1 was gauged for all participants.ResultsCarotid IMT significantly increased in stroke patients compared to control subjects. While serum omentin-1 levels were higher in control non-diabetic subjects, they were lower in diabetic patients with ischaemic stroke. Serum omentin-1 levels were inversely correlated with NIHSS, carotid IMT, infarction volume and mRS scores in all stroke patients. Serum omentin-1 level less than 24.5 ng/ml showed 93.7%sensitivity and 44.4% specificity in prediction of poor stroke outcome while values less than 27.8 ng/ml in non-diabetic stroke patients had sensitivity and specificity with 87.5% and 55.6% respectively.ConclusionLower levels of serum omentin-1 are associated with increased ischaemic stroke severity and poor functional outcome.