Predicting Domain-Specific Health-Related Quality of Life Using Acute Infarct Volume

Lin, Chen; Lee, Jung Hwa; Chatterjee, Neil; Corado, Carlos; Carroll, Timothy J.; Naidech, Andrew M.

doi:10.1161/strokeaha.117.017094

Cited by 18 publications

(26 citation statements)

References 28 publications

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“…This observation adds to the notion that reducing the overall stroke burden such as through systemic thrombolysis or mechanical thrombectomy may reduce the risk for poststroke cognitive impairment. 38,39 In addition to infarct volume, location is another important predictor of outcome as suggested by earlier studies. Infarct in cortical location tend to predict poor outcomes.…”

Section: Discussionmentioning

confidence: 87%

Leukoaraiosis Predicts Short-term Cognitive But not Motor Recovery in Ischemic Stroke Patients During Rehabilitation

Khan

Heiser

Bernicchi

et al. 2019

Journal of Stroke and Cerebrovascular Diseases

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Background: Leukoaraiosis has been shown to impact functional outcomes after acute ischemic stroke. However, its association with domain specific recovery after ischemic stroke is uncertain. We sought to determine whether preexisting leukoaraiosis is associated with short term motor and cognitive recovery after stroke. Methods: We retrospectively studied ischemic stroke patients admitted to acute inpatient rehabilitation (AIR) between January 2013 and September 2015. Patient baseline characteristics, infarct volume, prestroke modified Rankin Scale, stroke cause, rehabilitation length of stay, and Functional Independence Measure (FIM) scores were recorded. Leukoaraiosis severity was graded on brain MRI using the Fazekas scale. Multiple linear regression was used to determine factors independently associated with the total, cognitive, and motor FIM scores at AIR discharge, respectively. Results: Of 1,600 ischemic stroke patients screened, 109 patients were included in the final analysis. After adjustment, the initial NIHSS (β −0.541, CI −0.993-−0.888; p=0.020) and preexisting leukoaraiosis severity (β −1.448, CI −2.861-−0.034; p=0.045) independently predicted the total FIM score. Domain specific analysis showed that infarct volume (β −0.012, CI −0.019-−0.005; p=0.002) and leukoaraiosis severity (β −0.822, CI −1.223-−0.410; p=0.0001) independently predicted FIM cognitive scores at discharge from AIR. Leukoaraiosis did not predict FIM motor score (p=0.17).

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Section: Discussionmentioning

confidence: 87%

Leukoaraiosis Predicts Short-term Cognitive But not Motor Recovery in Ischemic Stroke Patients During Rehabilitation

Khan

Heiser

Bernicchi

et al. 2019

Journal of Stroke and Cerebrovascular Diseases

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“…Of note, the size and locations of acute infarct was significantly associated with one or more domains of HRQoL in this study. Consistently, the acute infarcts’ volume was recently found to contribute modestly to the prediction of domains of applied cognition–general concerns of HRQoL, however, this study did not explore the locations of acute infarct (Lin et al, 2017 ). Our study showed that the infratentorial acute infarct could negatively affect several domains of SSQoL, implicating a necessity of incorporation of the locations of infarcts or other brain lesions when investigating their impacts on HRQoL after stroke.…”

Section: Discussionmentioning

confidence: 69%

“…Multivariate linear regression analyses were used to investigate the associations between SVD burden and overall SSQoL and its domains adjusting for age, sex, education, history of stroke, hypertension, diabetes mellitus and hyperlipidemia, scores of NIHSS on admission, BI, HADS-AS, GDS, MMSE, acute infarcts’ volume, acute infarcts’ locations (cortical, subcortical and infratentorial), presence of old infarcts with a forward selection method. Due to the skewness of acute infarcts’ volume, they were categorized into four degrees based on the quartile (Degree 1: = 0 mL; Degree 2: 0.01–0.50 mL; Degree 3: 0.51–1.76 mL; Degree 4: >1.76 mL; Lin et al, 2017 ) and then made them enter all the regression models. The models did not involve any multicollinearity since all predictors showed a variance inflation factor of <10.…”

Section: Methodsmentioning

confidence: 99%

Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke

Liang

Chen

Deng

et al. 2017

Front. Aging Neurosci.

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Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke.Methods: Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by the presence of any of the SVD markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS) in the basal ganglia or their combinations on brain magnetic resonance imaging (MRI). The presence of each individual marker scored 1 point and was summed up to generate an ordinal “SVD score” (0–4) capturing total SVD burden. Linear regression was used to determine the associations between SVD burden and HRQoL.Results: Of the743 acute ischemic stroke patients that formed he study sample (mean age: 66.3 ± 10.6 years; 41.7% women), 49.3%, 22.5%, 16.0%, 9.2% and 3.1% had SVD scores of 0, 1, 2, 3 and 4, respectively. After adjusting for demographic, clinical and imaging variables, the SVD score was independently associated with lower overall score of SSQoL (B = −1.39, SE = 0.56, p = 0.01), and its domains of mobility (B = −0.41, SE = 0.10, p < 0.001) and vision (B = −0.12, SE = 0.06, p = 0.03). Acute infract volume (B = −1.44, SE = 0.54, p = 0.01), functional independence (B = 5.69, SE = 0.34, p < 0.001) and anxious (B = −1.13, SE = 0.23, p < 0.001) and depressive symptoms (B = −3.41, SE = 0.22, p < 0.001) were also the significant predictors of the overall score of SSQoL.Conclusion: The brain’s SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies.

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“…18 While prior studies on sex and outcomes after stroke have focused on disability and functional outcomes, our group has not observed differences between men and women in HRQOL after stroke. 3,6 Further work should be done to elucidate why sex impacts on functional outcomes but HRQOL after stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, we reported that acute infarct volume, a valuable biomarker in predicting disability, was a poor predictor of HRQOL after acute ischemic stroke. 3…”

Section: Introductionmentioning

confidence: 99%

Infarct location is associated with quality of life after mild ischemic stroke

Lin

Sangha

Lee

et al. 2018

International Journal of Stroke

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Background In patients with mild ischemic stroke, small but eloquent infarcts may have devastating effects, particularly on health-related quality of life. Aim This study investigates the association between acute infarct location and three-month health-related quality of life in patients with mild ischemic stroke. Methods We evaluated consecutively enrolled patients from a single center between August 2012 and July 2013. Our primary outcome at three months was impairment in any health-related quality of life domain (upper extremity, lower extremity, executive function, and general concerns) defined by a T-score <45. We analyzed the association between acute infarct locations and impaired health-related quality of life at three months in univariate and multivariable analysis. Results Among 229 patients (mean age 64.9 years, 55% male, 29.7% black, and median initial NIHSS score 1), impaired health-related quality of life was noted in 84 (36.2%) patients at three months. In univariate analysis, patients with subcortical infarcts (56.0% vs. 39.3%, p = 0.02) and brainstem infarcts (21.4% vs. 10.3%, p = 0.02) were more likely to have impaired health-related quality of life. In multivariable analysis, patients with subcortical and/or brainstem infarcts had increased odds of impaired health-related quality of life (adjusted OR 2.54, 95% CI 1.29-5.01, p = 0.01). Conclusions After mild ischemic stroke, subcortical and brainstem infarct locations predict impairment in health-related quality of life.

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Predicting Domain-Specific Health-Related Quality of Life Using Acute Infarct Volume

Cited by 18 publications

References 28 publications

Leukoaraiosis Predicts Short-term Cognitive But not Motor Recovery in Ischemic Stroke Patients During Rehabilitation

Leukoaraiosis Predicts Short-term Cognitive But not Motor Recovery in Ischemic Stroke Patients During Rehabilitation

Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke

Infarct location is associated with quality of life after mild ischemic stroke

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