Dataset Information

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

ABSTRACT:

Background

Three months is the standard timepoint for assessing final functional status after acute ischemic stroke in phase 3 clinical trials. Earlier reliable timepoints for outcome ascertainment would facilitate care quality improvement programs that employ administrative datasets and reduce the loss to follow-up observed in many stroke clinical trials. We assessed whether day 30 global disability status reliably predicts final 3-month disability outcome among acute stroke patients.

Methods

Data of 5,997 subjects in acute stroke trials conducted between 1998 and 2006 from the Virtual International Stroke Trials Archive dataset were partitioned into a derivation cohort (n = 4,051) and a validation cohort (n = 1,946). Global disability was assessed with modified Rankin Scale (mRS). To evaluate the association of day 30 vs day 90 mRS, weighted kappa agreement was computed and then adjusted using multivariable ordinal logistic modeling.

Results

Overall, mean age was 67.6 +/- 12.4 years; 2,541 (45.2%) were women. Day 30 mRS score correlated strongly with day 90 (r = 0.87, p < 0.001); weighted kappa agreement was 0.86 (95% confidence interval 0.85-0.87, p < 0.001). In multivariable logistic regression analysis, day 30 mRS was the dominant variable associated with day 90 mRS, accounting for 65.6% of the variance. Nine other baseline variables were associated with outcome, but collectively explained only an additional 1.8% of the variance.

Conclusions

After an index ischemic stroke, global disability status at 1 month reliably estimates final 3-month disability outcomes. One-month disability status alone may be dependable and efficient as an outcome measure in stroke quality improvement programs and select clinical trials.

SUBMITTER: Ovbiagele B

PROVIDER: S-EPMC2931650 | biostudies-literature | 2010 Aug

REPOSITORIES: biostudies-literature

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Publications

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

Ovbiagele Bruce B Lyden Patrick D PD Saver Jeffrey L JL

Neurology 20100801 8

<h4>Background</h4>Three months is the standard timepoint for assessing final functional status after acute ischemic stroke in phase 3 clinical trials. Earlier reliable timepoints for outcome ascertainment would facilitate care quality improvement programs that employ administrative datasets and reduce the loss to follow-up observed in many stroke clinical trials. We assessed whether day 30 global disability status reliably predicts final 3-month disability outcome among acute stroke patients.<h ...[more]

PMID: 20733143

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Project description:BACKGROUND:Although adiponectin is a major adipocytokine that affects the pathogenesis of various cardiovascular diseases, its clinical significance in stroke remains controversial. The purpose of this study was to assess the impact of serum adiponectin levels on functional prognosis in patients with ischemic stroke. METHODS:This was a prospective, observational cohort study. Consecutive first-ever ischemic stroke patients without any pre-morbid handicap admitted to our hospital were identified from December 2017 to December 2018. Serum concentration of adiponectin was routinely measured within the first 24 h after admission by a commercially available sandwich ELISA. Associations between adiponectin and either clinical severity at admission, poor outcomes or mortality at 3-month after admission were analyzed using logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI). RESULTS:The serum level of adiponectin was obtained in 227 patients with a median value of 7.0 ?g/ml, which was significantly higher (P?<?0.001) than in those heathy control. Adiponectin levels were associated with moderate-to-high stroke, and risk increased by 12% (OR?=?1.12; 95% CI 1.03-1.25; P?=?0.002). Patients with a poor outcome and nonsurvivors had significantly increased adiponectin levels on admission (P?<?0.001, all). In multivariate logistic regression analysis, adiponectin was an independent predictor of functional outcome and mortality, and risk increased by 24% (OR?=?1.24, 95% CI 1.13-1.37; P?<?0.001) and 31% (1.31 [1.18-1.46], P?<?0.001), respectively. Kaplan-Meier analysis suggested that the patients with high serum adiponectin levels had a higher risk of death than those patients with low levels (log-rank test P?<?0.001). CONCLUSIONS:Our results show that high adiponectin is associated with stroke severity and support the hypothesis that adiponectin can be serve as a biomarker of poor outcome after stroke, independent of baseline variables. Trial registration ChiCTR-OPC-17013501. Retrospectively Registered 21 September 2017.

Project description:BackgroundMixed data exist regarding the association between hyperglycemia and functional outcome after acute ischemic stroke when accounting for the impact of leptomeningeal collateral flow. We sought to determine whether collateral status modifies the association between treatment group and functional outcome in a subset of patients with large vessel occlusion enrolled in the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial.MethodsIn this post-hoc analysis, we analyzed patients enrolled into the SHINE trial with anterior circulation large vessel occlusion who underwent imaging with CT angiography prior to glucose control treatment group assignment. The primary analysis assessed the degree to which collateral status modified the effect between treatment group and functional outcome as defined by the 90-day modified Rankin Scale score. Logistic regression was used to model the data, with adjustments made for thrombectomy status, age, post-perfusion thrombolysis in cerebral infarction (TICI) score, tissue plasminogen activator (tPA) use, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Five SHINE trial centers contributed data for this analysis. Statistical significance was defined as a p-value < 0.05.ResultsAmong the 1151 patients in the SHINE trial, 57 with angiographic data were included in this sub-analysis, of whom 19 had poor collaterals and 38 had good collaterals. While collateral status had no effect (p = 0.855) on the association between glucose control treatment group and functional outcome, patients with good collaterals were more likely to have a favorable functional outcome (p = 0.001, OR 5.02; 95% CI 1.37-16.0).ConclusionsIn a post-hoc analysis using a subset of patients with angiographic data enrolled in the SHINE trial, collateral status did not modify the association between glucose control treatment group and functional outcome. However, consistent with prior studies, there was a significant association between good collateral status and favorable outcome in patients with large vessel occlusion stroke.Trial registrationClinicalTrials.gov Identifier is NCT01369069. Registration date is June 8, 2011.

Dataset Information

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

Background

Methods

Results

Conclusions

Publications

Disability status at 1 month is a reliable proxy for final ischemic stroke outcome.

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