Dataset Information

Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients.

ABSTRACT:

Background

Etiology is unknown in approximately one-quarter of stroke patients after evaluation, which is termed cryptogenic stroke (CS). The prognosis of CS patients is largely undetermined. We created a novel index from transcranial Doppler parameters including mean flow velocity (MV) and pulsatility index (PI) and investigated whether the calculation of asymmetry in the novel parameter can predict functional outcomes in CS patients.

Methods

We made the middle cerebral artery (MCA) index (%) as a novel parameter, which was calculated as 100 X (MCA MV + MCA PI X 10) / (MCA MV-MCA PI X 10). The MCA asymmetry index (%) was also calculated as 100 X (|Rt MCA index-Lt MCA index|) / (Rt MCA index + Lt MCA index) / 2. Poor functional outcomes were defined as modified Rankin Scale score (mRS) ?3 at 3 months after stroke onset.

Results

A total of 377 CS patients were included. Among them, 52 (13.8%) patients had a poor outcome. The overall MCA asymmetry index was two-fold higher in CS patients with a poor outcome (10.26%) compared to those with a good outcome (5.41%, p = 0.002). In multivariable analysis, the overall MCA asymmetry index (OR, 1.054, 95% CI, 1.013-1.096, p = 0.009) and the cutoff value of the overall MCA asymmetry index >9 were associated with poor outcomes at 3 months (OR, 3.737, 95% CI, 1.530-9.128, p = 0.004).

Conclusion

We demonstrated that the novel asymmetric MCA index can predict short-term functional outcomes in CS patients.

SUBMITTER: Han M

PROVIDER: S-EPMC6314577 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients.

Han Minho M Kim Young Dae YD Park Hyung Jong HJ Hwang In Gun IG Choi Junghye J Ha Jimin J Heo Ji Hoe JH Nam Hyo Suk HS

PloS one 20190102 1

<h4>Background</h4>Etiology is unknown in approximately one-quarter of stroke patients after evaluation, which is termed cryptogenic stroke (CS). The prognosis of CS patients is largely undetermined. We created a novel index from transcranial Doppler parameters including mean flow velocity (MV) and pulsatility index (PI) and investigated whether the calculation of asymmetry in the novel parameter can predict functional outcomes in CS patients.<h4>Methods</h4>We made the middle cerebral artery (M ...[more]

PMID: 30601840

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Project description:BackgroundMiddle Cerebral Artery (MCA) territory strokes can be disabling and may leave patients unable to swallow safely. Decisions regarding artificial nutrition and goals of care often arise in patients with severe strokes leading to dysphagia. This study determined some predictors of early transition to palliative level of care among patients with acute ischemic MCA stroke with dysphagia.MethodsThis is a retrospective cohort study. Demographic and clinical data of patients presenting to Hartford Hospital with an acute ischemic stroke between January 2005-December 2010 were gathered utilizing the Stroke Center at Hartford Hospital Database. The 236 patients included were divided into "early transition" and "not transitioned" to palliative care cohorts. Primary outcome was transition to palliative care. Factors that were significantly associated with an early transition to palliative level of care in univariate analysis were then entered into a multivariate logistic regression analysis to identify potential independent predictors of early transition to palliative level of care. The significance level was set at p?<?0.05.Results79 patients (34%) were transitioned to palliative level of care after failing the first swallow evaluation within a median of 3 days. Factors predictive of an early transition to palliative level of care after multivariate logistic regression analysis included advancing age (p?<?0.001; OR: 1.10; 95% CI :1.056-1.155) , left MCA infarct (p?=?0.039; OR: 0.417; 95% CI:0.182-0.956), a high NIHSS score on admission (p?=?0.017; OR: 3.038; 95% CI: 1.22-7.555), administration of intra-arterial tPA (p?<?0.001; OR: 7.106; 955 CI 2.541-19.873) and the inability to be assessed on the 1(st) swallow evaluation (p?<?0.001; OR 0.053; 95% CI 0.022-0.131).ConclusionsThe severity of dysphagia influences early transition to palliative level of care in acute stroke patients. Independent predictors of an early transition to palliative level of care among patients with an acute MCA territory stroke and dysphagia included advancing age, a left MCA infarct, a high NIHSS score on admission, administration of intra-arterial tPA and the inability to be assessed on the 1(st) swallow evaluation. This information may guide discussions with families of patients with MCA territory strokes regarding artificial nutrition and goals of care.

Dataset Information

Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients.

Background

Methods

Results

Conclusion

Publications

Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients.

Similar Datasets

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