Table 1 - uploaded by Tan Xu
Content may be subject to copyright.
Characteristics of stroke patients at hospital admission
Source publication
There are currently no data on the relationship between admission pulse pressure (PP) level and short term clinical outcome among acute stroke patients in the Chinese population. We studied the association between admission PP and in-hospital death or dependency among acute stroke patients in Inner Mongolia, China.
A total of 2,178 acute ischemic s...
Context in source publication
Context 1
... median time from onset of symptom to admission was 9.3 h (11.1 h for ischemic, 8.9 h for intracerebral hemor- rhage, 8.6 h for subarachnoid hemorrhage). Table 1 presents the demographic and clinical characteristics of stroke patients at admission by stroke subtypes. Those with acute ischemic stroke were more likely to be older, smoke and have a history of diabetes or dyslipidemia compared with those with intracerebral hemorrhage ; whereas those with acute intracerebral hemorrhage were more likely to be of Mongol ethnicity, have a profession involving manual labor, have both a personal and family history of hyper - tension, and have higher systolic BP, diastolic BP and PP levels compared with those with ischemic stroke. ...
Similar publications
The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China.
109 grade III class A ho...
Citations
... Notably, a recent systematic review and meta-analysis of 11 studies revealed that a high PP level was associated with an increased risk of stroke (6); Furthermore, there is mounting evidence that PP level was strongly related to mortality in patients with acute intracerebral hemorrhage and ischemic stroke, as well as increasing stroke recurrence (5,(7)(8)(9)(10)(11)(12). A previous study including 156 patients with SAH demonstrated no statistically significant association between admission PP and hospital mortality (13). However, evidence of associations between PP level and the risk of mortality remains unknown in non-traumatic subarachnoid hemorrhage (SAH) patients. ...
... However, there are few studies on the association between PP level and mortality in SAH patients. A previous study including 156 patients with SAH demonstrated no statistically significant association between admission PP and hospital mortality (13). Contrary to these results, our study demonstrated that a higher or lower PP upon admission was associated with an increased risk of hospital mortality. ...
Background and purpose
Previous studies have described an association between pulse pressure (PP) level and mortality in stroke patients. Evidence of associations between PP level and the risk of mortality remains unknown in non-traumatic subarachnoid hemorrhage (SAH) patients. We aimed to explore the relationship between the baseline PP level and hospital mortality.
Methods
This cohort study of 693 non-traumatic SAH adults used Medical Information Mart for Intensive Care (MIMIC-IV) data from 2008–2019 admissions to Intensive Care Unit (ICU). PP level was calculated as the first value after admission to the ICU. The endpoint of the study was in-hospital mortality. Cox proportional hazards models were utilized to analyze the association between baseline PP level and hospital mortality. Restricted Cubic Splines (RCS) analysis was utilized to determine the relationship curve between hospital mortality and PP level and examine the threshold saturation effect. We further applied Kaplan–Meier survival curve analysis to examine the consistency of these correlations. The interaction test was used to identify subgroups with differences.
Results
The mean age of the study population was 58.8 ± 14.6 years, and 304 (43.9%) of participants were female. When baseline PP level was assessed in quartiles, compared to the reference group (Q1 ≤ 56 mmHg), the adjusted hazard ratio (HR) in Q2 (57–68 mmHg), Q3(69–82 mmHg), Q4 (≥83 mmHg) were 0.55 (95% CI: 0.33–0.93, p = 0.026), 0.99 (95% CI, 0.62–1.59, p = 0.966), and 0.99 (95% CI: 0.62–1.59, p = 0.954), respectively. In the threshold analysis, for every 5 mmHg increase in PP level, there was an 18.2% decrease in hospital mortality (adjusted HR, 0.818; 95% CI, 0.738–0.907; p = 0.0001) in those with PP level less than 60 mmHg, and a 7.7% increase in hospital mortality (adjusted HR, 1.077; 95% CI, 1.018–1.139; p = 0.0096) in those with PP level was 60 mmHg or higher.
Conclusion
For patients with non-traumatic SAH, the association between baseline PP and risk of hospital mortality was non-linear, with an inflection point at 60 mmHg and a minimal risk at 57 to 68 mmHg (Q2) of baseline PP level.
... Algunos estudios sugieren que podría considerarse incluso un mes desde el inicio de los síntomas (2). En la mayoría de los estudios se concluye que las cifras elevadas de PA se asocian a un mal pronóstico, aunque suelen ser estudios a largo plazo (entre 3 y 6 meses) y que utilizan la medida clínica aislada de la PA (15)(16)(17)(18). Aunque también existen estudios que sugieren por el contrario, que la inducción de hipertensión durante la fase aguda podría mejorar el pronóstico (19)(20)(21)(22). ...
... 3 An assessment of clinical prognosis is useful for prioritizing (and rationalizing) healthcare resources, particularly for costly diseases such as stroke. However, although there have been many studies of the predictors of mortality and functional outcome for stroke using a plethora of outcome measures, including research in Asia 4 -6 and in China, [7][8][9][10][11][12][13][14][15][16][17] these are often limited by sample size, geographic location, and stroke type. The aims of our study were therefore to compare recovery patterns and determine factors associated with a poor outcome for the major stroke types of ischemic stroke (IS) and intracerebral hemorrhage (ICH) in a broad range of hospitalized patients in China. ...
Limited data exist on the comparative recovery patterns and outcomes of patients with ischemic stroke and intracerebral hemorrhage in China.
Data on baseline characteristics and outcomes of 6354 patients at 3 and 12 months poststroke are from ChinaQUEST (QUality Evaluation of Stroke Care and Treatment), a multicenter, prospective, 62-hospital registry study in China. Logistic regression was used to determine factors associated with a poor outcome defined by death/dependency (modified Rankin Scale score of 3 to 5) on follow-up. Generalized estimating equations were used to assess variations in recovery pattern by stroke type.
Baseline severity and rate of functional recovery in the early phase were significantly greater for intracerebral hemorrhage. However, patients with ischemic stroke were on average twice as likely to experience a good outcome (modified Rankin Scale score <3) by 12 months poststroke (OR: 1.98, CI: 1.76 to 2.24). In patients with ischemic stroke, diabetes and atrial fibrillation were strongly associated with a poor outcome at 12 months poststroke even after adjustment for confounding factors such as age, prior stroke/dependency, time to presentation, and stroke severity, whereas use of antiplatelets and lipid-lowering therapy after stroke were associated with improved outcome. For patients with intracerebral hemorrhage, low education and atrial fibrillation were associated with a poor outcome after adjustment for potential confounders and antihypertensive use was strongly associated with improved outcome.
Patients with intracerebral hemorrhage and ischemic stroke have different recovery patterns in China. However, they share similar prognostic factors and in the use of evidence-based secondary prevention therapies to maximize chances of a good outcome.
Background:
Management of hypertension in subarachnoid hemorrhage patients within the preaneurysmal treatment period remains ambiguous, in part due to the lack of high-level, evidence-based guidelines. Despite this, current recommendations offer guidance regarding certain parameters (e.g., mean arterial pressure, systolic blood pressure). However, managing hypertension within this critical period is difficult because a fine balance must be achieved between lowering blood pressure enough to minimize the risk of rebleeding and preventing reduced cerebral perfusion and subsequent ischemic damage. Furthermore, the different causes of hypertension within the preaneurysmal treatment period are polyfactorial and include pathophysiologic responses, sympathetic nervous system activation, and iatrogenic from hyperdynamic therapy and vasopressors, which requires consideration for these patients to receive optimal management. Other factors including loss of autoregulation and concomitant conditions must also be considered when deciding whether to start antihypertensive therapy.
Methods:
We review the literature and provide a comprehensive update on management of hypertension within the preaneurysmal treatment period, which we hope stresses the need for better evidence-based guidelines that will in turn help manage this cohort.
Results:
Thorough review revealed no high-grade, evidence-based guidelines to manage these patients, which results in variation in clinical practice among different clinicians and institutions. Despite this, current recommendations seem reasonable until such guidelines are established.
Conclusions:
It is clear that further, larger studies are warranted in order to clarify the effect of antihypertensive therapy on patient outcome and what the BP thresholds are, along with establishing the best treatment, for commencing antihypertensive therapy.
Asia, which holds 60% of the world’s population, comprises some developing countries which are in economic transition. This paper reviews the epidemiology of stroke in South, East and South-East Asia. Data on the epidemiology of stroke in South, East, and South-East Asia were derived from the Global Burden of Disease study (mortality, disability-adjusted life-years [DALYs] lost because of stroke), World Health Organization (vascular risk factors in the community), and publications in PubMed (incidence, prevalence, subtypes, vascular risk factors among hospitalized stroke patients). Age- and sex-standardized mortality is the lowest in Japan, and highest in Mongolia. Community-based incidence data of only a few countries are available, with the lowest rates being observed in Malaysia, and the highest in Japan and Taiwan. The availability of prevalence data is higher than incidence data, but different study methods were used for case-finding, with different age bands. For DALYs, Japan has the lowest rates, and Mongolia the highest. For community, a high prevalence of hypertension is seen in Mongolia and Pakistan; diabetes mellitus in Papua New Guinea, Pakistan, and Mongolia; hypercholesterolemia in Japan, Singapore, and Brunei; inactivity in Malaysia; obesity in Brunei, Papua New Guinea, and Mongolia; tobacco smoking in Indonesia. Hypertension is the most frequent risk factor, followed by diabetes mellitus and smoking. Ischemic stroke occurs more frequently than hemorrhagic stroke, and subarachnoid hemorrhages are uncommon. There are variations in the stroke epidemiology between countries in South, East, and South-East Asia. Further research on stroke burden is required.
Background
Pulse pressure (PP) is related to cardiac function, arterial stiffness, fluid status, and vascular events. This study aimed to explore the prognostic role of PP upon admission in patients with acute ischemic stroke (AIS) based on a nation‐wide stroke registry.
Methods and Results
We evaluated the association between PP upon admission and outcomes 3 months after a stroke in patients who had an AIS registered in the Taiwan Stroke Registry, including 56 academic and community hospitals between 2006 and 2013. Three months after the stroke, unfavorable outcomes were defined using a modified Rankin scale of 3 to 6. Of 33 530 patients (female, 40.6%; mean age, 68.8±13.3 years) who had an AIS, PP upon admission had a reverse J‐curve association with an unfavorable outcome. After adjusting for clinical variables, including AIS subtypes, initial National Institutes of Health Stroke Scale, and systolic and diastolic blood pressure upon admission, a PP of <50 mm Hg was associated with unfavorable outcomes (P<0.0001). Compared with patients with a PP of 50 to 69 mm Hg, the odds ratios for unfavorable outcomes were 1.24 (95% CI, 1.14–1.36) with a PP of 30 to 49 mm Hg and 1.85 (95% CI, 1.50–2.28) with a PP of <30 mm Hg. Moreover, the prognostic impact of PP upon admission was similar across all AIS subtypes.
Conclusions
Low PP upon admission was associated with unfavorable patient outcomes in AIS.
