24-h NIHSS score is the strongest prognostic predictor of 90-day outcome in cardioembolic stroke patients with anterior circulation occlusion after endovascular thrombectomy

 

You're supposed to solve problems, NOT just predict them you blithering idiots. Hoping comeuppance hits you really hard when you are the 1 in 4 per WHO that has a stroke! 

Why are you incompetently? predicting failure to recover than delivering recovery?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!

Had you been thinking at all you would be solving the  5 causes of the neuronal cascade of death in the first week saving hundreds of million to billions of neurons! Thus, preventing unfavorable functional outcome. Or don't you have two functioning neurons to rub together for a spark of intelligence?

24-h NIHSS score is the strongest prognostic predictor of 90-day outcome in cardioembolic stroke patients with anterior circulation occlusion after endovascular thrombectomy

• 

  Chen Yang 1†

• Y

  Yangxi Chen 1,2†

• Q

  Qingyan Liu 3

• G

  Ge Gong 1

• L

  Lei Guo 1

• Y

  Yu Liu 1*

• 

  Xinghu Zhang 1*

• 1. Department of Geriatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China

• 2. Department of Geriatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Southern Medical University, Nanjing, Jiangsu, China

Abstract

Background: 

This study aimed to evaluate and compare the predictive performance of the National Institutes of Health Stroke Scale (NIHSS) assessed at baseline, at 24 h, and derived change metrics for 90-day unfavorable functional outcome (modified Rankin Scale 3–6) in cardioembolic stroke patients with Anterior Circulation Occlusion (ACO) post-endovascular thrombectomy (EVT).

Methods: 

A retrospective analysis of 103 eligible patients was performed. Univariate and multivariate logistic regression identified predictors. Receiver operating characteristic (ROC) curve analysis and DeLong’s test compared the predictive performance of baseline NIHSS, 24-h NIHSS, ΔNIHSS (baseline NIHSS − 24-h NIHSS) and the percent ΔNIHSS (ΔNIHSS × 100/baseline NIHSS).

Results: 

Multivariate analysis confirmed 24-h NIHSS, baseline NIHSS, ΔNIHSS, and percent ΔNIHSS as independent predictors. ROC analysis showed that 24-h NIHSS had the highest predictive power (AUC = 0.850), significantly outperforming baseline NIHSS (AUC = 0.702), ΔNIHSS (AUC = 0.735), and percent ΔNIHSS (AUC = 0.780). The optimal cut-off value was ≥12, with 82.2% sensitivity and 75.6% specificity. Combining 24-h NIHSS with other NIHSS-based metrics did not improve predictive performance compared to 24-h NIHSS alone.

Conclusion: 

The 24-h NIHSS score is the strongest prognostic predictor of 90-day unfavorable functional outcome in cardioembolic stroke patients post-EVT, superior to baseline scores, ΔNIHSS and percent ΔNIHSS. It serves as an early and effective tool for prognostic stratification.

Relationship between relevant inflammatory markers and short-term functional outcomes of acute ischemic stroke treated with mechanical thrombectomy: a retrospective cohort study

 Predicting failure to recover DOES NOTHING FOR SURVIVORS! You're fired!

Relationship between relevant inflammatory markers and short-term functional outcomes of acute ischemic stroke treated with mechanical thrombectomy: a retrospective cohort study

• 

  Jin-Cheng Liu 1,2†

• J

  Jie Wen 2†

• S

  Shi-Xiong Peng 2

• H

  Hao Ren 2

• Y

  Yiran Liu 2

• C

  Cui Zhou 2

• 

  Xiao Hu 1

• 

  Qi Li 1*

• 1. Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

• 2. Department of Neurology, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang, Hubei, China

Abstract

Background and purpose: 

Perioperative inflammatory markers are considered critical factors influencing long-term postoperative survival. This study evaluated the neutrophil-to-high-density lipoprotein ratio (NHR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory response index (SII), and systemic inflammatory response index (SIRI) in relation to functional outcomes in patients with acute ischemic stroke who underwent mechanical thrombectomy (MT). Our objective is to determine the prognostic value of inflammatory composite indices for 90-day functional outcomes in patients with acute ischemic stroke undergoing mechanical thrombectomy and to develop a multivariable prediction model integrating these indices for individualized outcome risk stratification.

Method: 

A total of 112 patients who underwent MT were enrolled between April 2021 and December 2023. Blood tests were performed at admission. Logistic regression analysis was used to evaluate the relationship between NHR, NLR, PLR, LMR, SII, SIRI and poor functional outcomes at 3 months (mRS Score 3–6). Receiver operating characteristic (ROC) curve analysis was conducted to assess the ability of NHR, NLR, PLR, LMR, SII, and SIRI to predict 90-day functional outcomes.

Results: 

A total of 54 patients (48%) had poor functional outcomes at 3 months. The median stroke onset to admission time was [6.7] hours (IQR, [3.45]–[8.05]) for poor functional outcome and [9.0] hours (IQR, [7.45]–[14.15]) for good functional outcome. Mean age of the study cohort was 67.5 years, and 64.3% were male. Multivariate logistic regression analysis revealed that NHR (odds ratio [OR], 1.150; 95% confidence interval [CI] 1.002–1.320, p = 0.046) was an independent predictor for poor functional outcome after adjusting for other clinical and imaging parameters.

Conclusion: 

NHR was independently associated with poor functional outcomes at 3 months in patients with acute ischemic stroke who underwent MT. These findings need to be confirmed in larger samples.(The research you should be doing is PREVNTING THAT POOR FUNCTIONAL OUTCOME! And you're so blitheringly stupid you can't figure that out?

Causal Association of Iron Status With Functional Outcome After Ischemic Stroke

Well, what the fuck is the solution to prevent this problem? No solution, you need to be FIRED FOR INCOMPETENCE! I take no prisoners in trying to get stroke solved, a fucking hell of a lot of dead wood needs to be removed in stroke!

Causal Association of Iron Status With Functional Outcome After Ischemic Stroke

Qiang He,

Wenjing Wang,

Dingkang Xu,

Yang Xiong,

Chao You,

Chuanyuan Tao and

Lu Ma

Originally published14 Dec 2023https://doi.org/10.1161/STROKEAHA.123.044930Stroke. 2023;0

Abstract

BACKGROUND:

Iron status has been associated with functional outcomes after ischemic stroke (IS). Nonetheless, this association may be affected by confounders. We perform Mendelian randomization to clarify the causal association between iron status and functional outcome after IS.

METHODS:

We obtained summary-level statistics related to iron status biomarkers from a meta-analysis of a gene-wide association study conducted by the Genetics of Iron Status Consortium, which included 11 discovery cohorts and 8 replication cohorts. We also took genetic variants related to 4 biomarkers of iron status from combining gene-wide association study results of Iceland, the United Kingdom, and Denmark to perform a replicate Mendelian randomization analysis. This data set included 4 iron status biomarkers, namely, ferritin, total iron binding capacity, iron, and transferrin saturation (TSAT). The confounders in these data sets have been adjusted to mitigate the collider bias. We acquired summary statistics data sets for functional outcomes following IS from the gene-wide association study meta-analysis conducted by the Genetics of Ischemic Stroke Functional Outcome Consortium. The genetic estimates for functional outcomes at 90 days after IS were evaluated by the modified Rankin Scale score, including 3741 cases with good functional outcomes (modified Rankin Scale score, 0–2) and 2280 subjects with poor functional outcomes post-stroke (modified Rankin Scale score, 3–6). Inverse variance weighting was used as the primary method, complemented by sensitivity analyses for pleiotropy and increasing robustness.

RESULTS:

Reported with odds ratios (ORs) of stroke outcome with per SD unit increase in genetically determined iron status biomarker, TSAT and iron were associated with poor functional outcome after IS (TSAT: OR, 1.36 [95% CI, 1.23–1.50]; P=2.27×10⁻⁹; iron: OR, 1.44 [95% CI, 1.13–1.85]; P=0.0033). In replicate Mendelian randomization analysis, the detrimental effects of iron on poor functional outcome after IS remained stable (OR, 1.60 [95% CI, 1.24–2.08]; P=0.0003). In the meta-analysis, iron and TSAT were associated with poor functional outcomes after IS (TSAT: OR_meta, 1.35 [95% CI, 1.23–1.48]; iron: OR_meta, 1.51 [95% CI, 1.27–1.81]). Through sensitivity analyses and reverse Mendelian randomization analyses, we confirmed the robustness of the results.

CONCLUSIONS:

Our study provides evidence suggesting a potential causal relationship between iron status and poor functional outcomes after IS. Future studies are required to illuminate the underlying mechanism.

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Association of Perfusion Lesion Variables With Functional Outcome in Patients With Mild Stroke and Large Vessel Occlusion Managed Medically

 Why are you predicting poor functional outcome rather than delivering research that results in great functional outcome? I'd fire you all for missing the whole point of stroke research. SURVIVOR RECOVERY!

Association of Perfusion Lesion Variables With Functional Outcome in Patients With Mild Stroke and Large Vessel Occlusion Managed Medically

Peng Wang, Wenhuo Chen, View ORCID ProfileChushuang Chen, View ORCID ProfileAndrew Bivard, Geng Yu, Mark W. Parsons, View ORCID ProfileLongting Lin, on behalf of INSPIRE

First published October 28, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201498

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Abstract

Background and Objectives The best management of patients with mild stroke and large vessel occlusion (LVO) remains unclear. This study aimed to identify perfusion imaging predictors of poor functional outcome in such patients.

Methods This cohort study retrospectively selected patients enrolled in the International Stroke Perfusion Imaging Registry between August 2011 and April 2022. The registry enrolled patients with acute ischemic stroke and with baseline CT perfusion scanned within 24 hours of stroke onset. This study identified patients with mild symptoms, defined by an NIH Stroke Scale score of ≤5. Patients with LVO of anterior circulation were selected. This study further selected patients who received medical management and excluded patients who received endovascular treatment. The primary outcome was poor functional outcome defined as a modified Rankin Scale of 3–6 at 3 months. Perfusion lesion was defined by delay time > 3 seconds on CTP. Regression analyses were used to identify clinical and imaging variables that predicted poor functional outcome.

Results A total of 139 patients with mild stroke were included, of whom 27 (19%) had poor functional outcome. Patients with poor outcome, compared with those with good outcome, had much larger perfusion lesion volume (median 80 mL vs 41 mL, p < 0.001). Perfusion lesion was a significant predictor of poor outcome in either univariable regression (crude OR = 1.02, 95% CI = [1.01–1.03]) or multivariable regression model (adjusted OR = 1.01, 95% CI = [1.01–1.02]), adjusting for occlusion site, good collaterals, baseline stroke severity, age, IV thrombolysis (IVT), and onset to scan time. A perfusion lesion of 65 mL was the optimal cutpoint to identify poor functional outcome (sensitivity = 59%, specificity = 77%). Patients with perfusion lesion ≥65 mL, compared with patients with perfusion lesion <65 mL, showed a much higher rate of poor functional outcome (38% vs 11%, p < 0.001). Of the 139 patients in this study, 95 received IVT. Patients treated with or without IVT did not influence their outcomes (crude OR = 0.74, 95% CI = [0.31–1.78]).

Discussion A perfusion lesion of ≥65 mL predicted poor functional outcome in mild stroke patients with LVO.

Glossary

ASPECTS=

Alberta Stroke Program Early CT Score;

CBF=

cerebral blood flow;

CTP=

CT perfusion;

DT=

delay time;

EVT=

endovascular thrombectomy;

INSPIRE=

International Stroke Perfusion Imaging Registry;

IVT=

IV thrombolysis;

LVO=

large vessel occlusion;

NCCT=

noncontrast CT;

NIHSS=

NIH Stroke Scale;

PH=

parenchymal hemorrhage;

sICH=

symptomatic intracerebral hemorrhage

Footnotes

• Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

• ↵* These authors contributed equally to this work as first authors.

• ↵† These authors contributed equally to this work as senior authors.

• Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil, FAAN.

• CME Course: NPub.org/cmelist

• Received February 20, 2022.
• Accepted in final form September 15, 2022.