International Journal of Stroke

Low estimated glomerular filtration rate explains the association between hyperhomocysteinemia and in-hospital mortality among patients with ischemic stroke/transient ischemic attack or intracerebral hemorrhage: Results from the Chinese Stroke Center Alliance

International Journal of Stroke, Ahead of Print. Objectives:To investigate the association between hyperhomocysteinemia (HHcy) and in-hospital mortality following ischemic stroke (IS), transient ischemic attack (TIA), or intracerebral hemorrhage (ICH)….

By Wei Liu, ago

Predictors of post-stroke delirium incidence and duration: Results of a prospective observational study using high-frequency delirium screening

International Journal of Stroke, Ahead of Print.
Background:Post-stroke delirium (PSD) is a modifiable predictor for worse outcome in stroke. Knowledge of its risk factors would facilitate clinical management of affected patients, but recently updated national guidelines consider available evidence insufficient.Aims:The study aimed to establish risk factors for PSD incidence and duration using high-frequency screening.Methods:We prospectively investigated patients with ischemic stroke admitted within 24 h. Patients were screened twice daily for the presence of PSD throughout the treatment period. Sociodemographic, treatment-related, and neuroimaging characteristics were evaluated as predictors of either PSD incidence (odds ratios (OR)) or duration (PSD days/unit of the predictor, b), using logistic and linear regression models, respectively.Results:PSD occurred in 55/141 patients (age = 73.8 ± 10.4 years, 61 female, National Institutes of Health Stroke Scale (NIHSS) = 6.4 ± 6.5). Age (odds ratio (OR) = 1.06 (95% confidence interval (CI): 1.02–1.10), b = 0.08 (95% CI = 0.04–0.13)), and male gender (b = 0.99 (95% CI = 0.05–1.93)) were significant non-modifiable risk factors. In a multivariable model adjusted for age and gender, presence of pain (OR  mvar  >= 1.75 (95% CI = 1.12–2.74)), urinary catheter (OR  mvar  > = 3.16 (95% CI = 1.10–9.14)) and post-stroke infection (PSI; OR  mvar  > = 4.43 (95% CI = 1.09–18.01)) were predictors of PSD incidence. PSD duration was impacted by presence of pain (b  mvar  >= 0.49 (95% CI = 0.19–0.81)), urinary catheter (b  mvar  > = 1.03 (95% CI = 0.01–2.07)), intravenous line (b  mvar  >= 0.36 (95% CI = 0.16–0.57)), and PSI (b  mvar  >= 1.60 (95% CI = 0.42–2.78)). PSD (OR = 3.53 (95% CI = 1.48–5.57)) and PSI (OR = 5.29 (95% CI = 2.92–7.66)) independently predicted inferior NIHSS at discharge. Insular and basal ganglia lesions increased the PSD risk about four- to eight-fold.Discussion/Conclusion:This study identified modifiable risk factors, the management of which might reduce the negative impact PSD has on outcome.

By Robert Fleischmann, ago

Predictors of post-stroke delirium incidence and duration: Results of a prospective observational study using high-frequency delirium screening

International Journal of Stroke, Ahead of Print.
Background:Post-stroke delirium (PSD) is a modifiable predictor for worse outcome in stroke. Knowledge of its risk factors would facilitate clinical management of affected patients, but recently updated national guidelines consider available evidence insufficient.Aims:The study aimed to establish risk factors for PSD incidence and duration using high-frequency screening.Methods:We prospectively investigated patients with ischemic stroke admitted within 24 h. Patients were screened twice daily for the presence of PSD throughout the treatment period. Sociodemographic, treatment-related, and neuroimaging characteristics were evaluated as predictors of either PSD incidence (odds ratios (OR)) or duration (PSD days/unit of the predictor, b), using logistic and linear regression models, respectively.Results:PSD occurred in 55/141 patients (age = 73.8 ± 10.4 years, 61 female, National Institutes of Health Stroke Scale (NIHSS) = 6.4 ± 6.5). Age (odds ratio (OR) = 1.06 (95% confidence interval (CI): 1.02–1.10), b = 0.08 (95% CI = 0.04–0.13)), and male gender (b = 0.99 (95% CI = 0.05–1.93)) were significant non-modifiable risk factors. In a multivariable model adjusted for age and gender, presence of pain (OR  mvar  >= 1.75 (95% CI = 1.12–2.74)), urinary catheter (OR  mvar  > = 3.16 (95% CI = 1.10–9.14)) and post-stroke infection (PSI; OR  mvar  > = 4.43 (95% CI = 1.09–18.01)) were predictors of PSD incidence. PSD duration was impacted by presence of pain (b  mvar  >= 0.49 (95% CI = 0.19–0.81)), urinary catheter (b  mvar  > = 1.03 (95% CI = 0.01–2.07)), intravenous line (b  mvar  >= 0.36 (95% CI = 0.16–0.57)), and PSI (b  mvar  >= 1.60 (95% CI = 0.42–2.78)). PSD (OR = 3.53 (95% CI = 1.48–5.57)) and PSI (OR = 5.29 (95% CI = 2.92–7.66)) independently predicted inferior NIHSS at discharge. Insular and basal ganglia lesions increased the PSD risk about four- to eight-fold.Discussion/Conclusion:This study identified modifiable risk factors, the management of which might reduce the negative impact PSD has on outcome.

By Robert Fleischmann, ago