Albuminuria predicts early neurological deterioration in patients with acute ischemic stroke

Kanamaru, Takuya; Suda, Satoshi; Muraga, Kanako; Okubo, Seiji; Watanabe, Yozo; Tsuruoka, Syuichi; Kimura, Kazumi

doi:10.1016/j.jns.2016.11.007

Cited by 30 publications

(26 citation statements)

References 25 publications

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“…A number of studies have, for the definition of END, used an increase of ≥2 points in the total NIHSS score within 7 days [18], as modified from a previous study. We have incorporated such sensitive criteria to define END for such subtle changes call for action in clinical practice.…”

Section: Methodsmentioning

confidence: 99%

Association of fibrinogen level with early neurological deterioration among acute ischemic stroke patients with diabetes

Lee

Kang

et al. 2017

BMC Neurol

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BackgroundDiabetes mellitus (DM) is a risk factor for early neurological deterioration (END) in acute ischemic stroke. The prothrombotic protein fibrinogen is frequently elevated in patients with diabetes, and may be associated with poorer prognoses. We evaluated whether fibrinogen is associated with END in patients with diabetes after acute ischemic stroke.MethodsWe included 3814 patients from a single hospital database admitted within 72 h of onset of ischemic stroke. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥2 within 7 days post-admission. In the total population (END, n = 661; non-END, n = 3153), univariate and multivariate analyses were performed to assess fibrinogen as an independent predictor for END. We then performed propensity score matching and univariate analyses for DM (END, n = 261; non-END, n = 522) and non-DM populations (END, n = 399; non-END, n = 798). Multiple logistic analyses were performed after matching for fibrinogen as a risk factor in each subgroup.ResultsFibrinogen levels were higher in the END group than in the non-END group (367 ± 156 mg/dL vs. 347 ± 122 mg/dL, p = 0.002), though they were not associated with END in logistic regression analyses. Fibrinogen levels were found to be an independent predictor for END, but only in the DM population (fibrinogen levels 300–599 mg/dL, odds ratio: 1.618, 95% confidence interval: 1.037–2.525, p = 0.034, fibrinogen levels ≥600 mg/dL, 2.575, 1.018–6.514, p = 0.046; non-DM population, p = 0.393). The diabetes-fibrinogen interaction for the entire cohort was p = 0.101.ConclusionsElevated fibrinogen is dose-dependently associated with END in patients with diabetes following acute ischemic stroke.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-017-0865-7) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Association of fibrinogen level with early neurological deterioration among acute ischemic stroke patients with diabetes

Lee

Kang

et al. 2017

BMC Neurol

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“…In the case of disagreement about the NIHSS score evaluation, a third neurologist in this centre was invited for a final decision. END was defined as an increment in the total NIHSS score of ≥2 points within 7 days after admission [9][10][11][12]21,[29][30][31][32].…”

Section: Definition Of Early Neurological Deteriorationmentioning

confidence: 99%

“…Numerous clinical and animal studies have confirmed the efficacy of antiplatelets and statins in patients with acute ischaemic stroke (AIS) [3][4][5][6][7]. However, early neurological deterioration (END) may occur to a fraction of patients with AIS, even though they take antiplatelet agents and statins regularly [8][9][10]. Previous studies showed that the incidence of END in AIS patients ranges from 5% to 40%, which might depend on different inclusion criteria and evaluation methods [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…However, early neurological deterioration (END) may occur to a fraction of patients with AIS, even though they take antiplatelet agents and statins regularly [8][9][10]. Previous studies showed that the incidence of END in AIS patients ranges from 5% to 40%, which might depend on different inclusion criteria and evaluation methods [8][9][10][11][12]. It is reported that END could lead to elevated probability of death and disability in AIS patients [13,14].…”

Section: Introductionmentioning

confidence: 99%

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A novel nomogram to predict early neurological deterioration in patients with acute ischaemic stroke

Gong

Zhang

Gong

et al. 2020

Euro J of Neurology

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Background and purpose Acute ischaemic stroke (AIS) is a vital cause of mortality and morbidity in China. Many AIS patients develop early neurological deterioration (END). This study aimed to construct a nomogram to predict END in AIS patients. Methods Acute ischaemic stroke patients in Nanjing First Hospital were recruited as the training cohort. Additional patients in Nantong Third People’s Hospital were enrolled as the validation cohort. Multivariate logistic regression was utilized to establish the nomogram. Discrimination and calibration performance of the nomogram were tested by concordance index and calibration plots. Decision curve analysis was employed to assess the utility of the nomogram. Results In all, 1889 and 818 patients were recruited in the training and validation cohorts, respectively. Age [odds ratio (OR) 1.075; 95% confidence interval (CI) 1.059–1.091], diabetes mellitus (OR 1.673; 95% CI 1.181–2.370), atrial fibrillation (OR 3.297; 95% CI 2.005–5.421), previous antiplatelet medication (OR 0.473; 95% CI 0.301–0.744), hyper‐sensitive C‐reactive protein (OR 1.049; 95% CI 1.036–1.063) and baseline National Institutes of Health Stroke Scale (OR 1.071; 95% CI 1.045–1.098) were associated with END and incorporated in the nomogram. The concordance index was 0.826 (95% CI 0.785–0.885) and 0.798 (95% CI 0.749–0.847) in the training and validation cohorts. By decision curve analysis, the model was relevant between thresholds of 0.06 and 0.90 in the training cohort and 0.08 and 0.77 in the validation cohort. Conclusions The nomogram composed of hyper‐sensitive C‐reactive protein, age, diabetes mellitus, atrial fibrillation, previous antiplatelet medication and baseline National Institutes of Health Stroke Scale may predict the risk of END in AIS patients.

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“…Adiponectin [9,22,29], potassium [9,22,29], creatinine [9,22,26,29], estimated glomerular filtration rate [10,18,29] [5J] and UA [12,25,26] showed no association with END.…”

Section: Metabolic Biomarkersmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke

Martin

Price

2018

Cerebrovasc Dis

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Background: Early neurological deterioration (END) following acute stroke is associated with poorer long-term outcomes. Identification of patients at risk could assist early monitoring and treatment decisions. This review summarised the evidence describing non-radiological biomarkers for END. Summary: Electronic searches from January 1990 to March 2017 identified studies reporting a blood/cerebrospinal fluid (CSF)/urine biomarker measurement within 24 h of acute stroke and at least 2 serial assessments of clinical neurological status (< 24 h and < 7 days). Out of 12,895 citations, 82 studies were included, mostly focusing on ischaemic stroke. Using higher neurological thresholds, the n-weighted END incidence for ischaemic stroke was 11.9% (95% CI 11.4–12.4%) and 18.6% (17.9–19.2%) for lower thresholds. Incidence decreased with advancing study publication year (Pearson r-squared 0.23 and 0.15 for higher and lower threshold studies). After classification into 3 broad categories, meta-analysis showed that biomarkers associated with increased END risk (n; fixed-effects mean difference; 95% CI) were “metabolic” (glucose [n = 9,481; 0.90 mmol/L; 0.74–1.06], glycosylated haemoglobin [n = 3,146; 0.33%; 0.19–0.46], low-density lipoprotein [n = 4,839; 0.13 mmol/L; 0.06–0.21], total cholesterol [n = 4,762; 0.21 mmol/L; 0.11–0.31], triglycerides [n = 4,820; 0.11 mmol/L; 0.06–0.17], urea [n = 1,351; 0.55 mmol/L; 0.14–0.96], decreasing albumin [n = 513; 0.33 g/dL; 0.05–0.61]); “inflammatory and excitotoxic” (plasma glutamate [n = 688; 60.13 µmol/L; 50.04–70.22], CSF glutamate [n = 369; 7.50 µmol/L; 6.76–8.23], homocysteine [n = 824; 2.15 µmol/L; 0.68–3.61], leucocytes [n = 3,766; 0.54 × 10⁹/L; 0.34–0.74], high-sensitivity C-reactive protein [n = 1,707; 3.79 mg/L; 1.23–6.35]); and “coagulation/haematological” (fibrinogen [n = 3,132; 0.32 g/L; 0.25–0.40]; decreasing haemoglobin [n = 3,586; 2.38 g/L; 0.15–4.60]). Key Messages: Declining incidence of END may represent improving care standards; however, it remains a frequent occurrence. Although statistical associations exist between biomarkers and an increased risk of END, the most promising still need prospective evaluation to determine their additional value relative to baseline radiological and clinical characteristics.

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Albuminuria predicts early neurological deterioration in patients with acute ischemic stroke

Cited by 30 publications

References 25 publications

Association of fibrinogen level with early neurological deterioration among acute ischemic stroke patients with diabetes

Association of fibrinogen level with early neurological deterioration among acute ischemic stroke patients with diabetes

A novel nomogram to predict early neurological deterioration in patients with acute ischaemic stroke

A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke

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