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Ischemic stroke in critically ill patients with malignancy
840
Abstracts
Abstract Intensive medical therapy with therapeutic hypothermia for malignant middle cerebral artery infarction Kyu sun Lee, Jin soo Lee, Ji man Hong Ajou University Medical Center, Republic of Korea Background/Purpose: Malignant middle cerebral artery (MCA) infarction is a large hemispheric infarct caused by proximal MCA or internal carotid artery occlusion with deteriorating progress. Decompressive hemicraniectomy has been regarded effective for increased intracranial pressure. However, it might not be available in elderly or medically unstable patients. Therefore, we compared clinical findings and prognosis between intensive medical therapy with hypothermia (best medical therapy group) and decompressive hemicraniectomy (surgery group) for malignant MCA infarction. Methods: We collected acute MCA infarction patients who underwent brain MRI within 6 hours since onset in a stroke center over 4 years. Malignant MCA infarction was defined as greater than 82 mL on DWI within 6 hours or greater than 145 mL on follow-up DWI or CT. Results: Among total 46 cases, best medical therapy group were 18, and surgery group were 16. Initial National Institutes of Health Stroke Scale (NIHSS) did not differ between the groups. Initial infarct volume on DWI within 6 hours significantly differs between the groups: mean 254.0 ± 107.0 mL in surgery vs 127.2 ± 44.0 mL in best medical therapy (P b .001). NIHSS at discharge, prevalence of good outcome (mRS 0-2), and mortality at 3 months did not differ between the groups. The prevalence of poor outcome (mRS 5-6) at 3 months significantly differ between the groups: 14 (87.5%) in surgery and 16 (53.3%) in best medical therapy (P = .020). Conclusions: This study suggests that intensive medical therapy with hypothermia has lower prevalence of poor outcome than decompressive hemicraniectomy despite relatively similar clinical severity on baseline. Therefore, systematized medical therapy with therapeutic hypothermia might be a feasible strategy to avoid invasive hemicraniectomy in malignant MCA infarction. Keywords: Malignant middle cerebral artery infarction, Decompressive hemicraniectomy, Therapeutic hypothermia http://dx.doi.org/10.1016/j.jcrc.2015.04.058
Abstract Ischemic stroke in critically ill patients with malignancy Jeong-am Ryu, Jeong hoon Yang, Daesang Lee, Gee young Suh, Joongbum Cho, Chi ryang Chung, Chi-min Park, Oh. young Bang, Kyeongman Jeon Samsung Medical Center (Samsung Seoul Hospital), Republic of Korea Background/Purpose: Ischemic stroke (IS) in the critically ill cancer patients is associated with significant morbidity and mortality. We investigated the clinical characteristics and predictors of IS in critically ill cancer patients. Methods: All consecutive patients were retrospectively evaluated who underwent brain magnetic resonance imaging (B-MRI) for suspicion of IS with acute abnormal neurologic symptoms or signs developed in the oncology medical intensive care unit of Samsung Medical Center from March 2010 to February 2014. A multiple logistic regression analysis was used to identify independent predictors of IS. Results: Over the study period, a total of 88 cancer patients underwent B-MRI scanning for suspicion of IS, with altered
mentality in 55 (63%), hemiparesis in 28 (32%), and seizure in 20 (23%) patients. Forty-three patients (49%) had a final diagnosis of IS. Multiple territorial lesions were most common stroke subtype (81%). Only 8 nonstroke patients (18%) had brain metastasis. Most nonstroke patients (29%) had normal B-MRI findings. After adjusting for potential confounding factors, seizure (adjusted OR, 0.141; 95% CI, 0.027-0.736) was inversely associated with IS. Neurologic sign of hemiparesis (adjusted OR, 5.339; 95% CI, 1.521-19.163) was significantly associated with IS in critically ill cancer patients. Conclusions: Approximately half of critically ill cancer patients diagnosed with IS underwent B-MRI scanning for suspicion of IS during their ICU stay. However, brain metastasis was relatively rare. Generally, it is difficult to determine stroke by symptom alone, but hemiparesis may be a helpful neurologic sign to distinguish IS in critically ill cancer patients. Keywords: Ischemic stroke, Cancer, Brain magnetic resonance
http://dx.doi.org/10.1016/j.jcrc.2015.04.059
Abstract Outcomes after spinal cord injury in patients with previous anemia: A nationwide population-based study Yi-chun Choua, Chien-chang Liaob, Ta-liang Chenb a
Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan b Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
Background/Purpose: Factors associated with complications and mortality after spinal cord injury (SCI) was not completely understood. The purpose of this study is to evaluated post-SCI complications and mortality in patients with and without previous anemia. Methods: Using Taiwanese National Health Insurance Research Database, a nationwide population-based study was conducted of 9049 patients who suffered from SCI with hospitalization between 2008 and 2012. Outcomes after SCI were compared between people with and without previous anemia within 24-month period before SCI. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of 30-day complications and mortality after SCI associated with previous anemia were calculated in the multivariate logistic regressions. Results: The incidences of post-SCI acute renal failure for people with (n = 399) and without (n = 8650) previous anemia were 1.8% and 0.6%, respectively (P = .0081). Patients with previous anemia had higher post-SCI mortality than those without anemia (2.5% vs 0.7%, P b .0001). Among patients with SCI, previous anemia was associated with post-SCI acute renal failure (OR, 2.42; 95% CI, 1.02-5.73) and mortality (OR, 2.82; 95% CI, 1.27-6.23) after adjusted for sociodemographics and coexisting medical conditions. Conclusions: In this nationwide population-based study, we investigated that previous anemia was associated with acute renal failure and 30-day mortality after SCI. Keywords: Anemia, Spinal cord injury, Complications, Mortality
http://dx.doi.org/10.1016/j.jcrc.2015.04.060
Abstracts
Abstract Intensive medical therapy with therapeutic hypothermia for malignant middle cerebral artery infarction Kyu sun Lee, Jin soo Lee, Ji man Hong Ajou University Medical Center, Republic of Korea Background/Purpose: Malignant middle cerebral artery (MCA) infarction is a large hemispheric infarct caused by proximal MCA or internal carotid artery occlusion with deteriorating progress. Decompressive hemicraniectomy has been regarded effective for increased intracranial pressure. However, it might not be available in elderly or medically unstable patients. Therefore, we compared clinical findings and prognosis between intensive medical therapy with hypothermia (best medical therapy group) and decompressive hemicraniectomy (surgery group) for malignant MCA infarction. Methods: We collected acute MCA infarction patients who underwent brain MRI within 6 hours since onset in a stroke center over 4 years. Malignant MCA infarction was defined as greater than 82 mL on DWI within 6 hours or greater than 145 mL on follow-up DWI or CT. Results: Among total 46 cases, best medical therapy group were 18, and surgery group were 16. Initial National Institutes of Health Stroke Scale (NIHSS) did not differ between the groups. Initial infarct volume on DWI within 6 hours significantly differs between the groups: mean 254.0 ± 107.0 mL in surgery vs 127.2 ± 44.0 mL in best medical therapy (P b .001). NIHSS at discharge, prevalence of good outcome (mRS 0-2), and mortality at 3 months did not differ between the groups. The prevalence of poor outcome (mRS 5-6) at 3 months significantly differ between the groups: 14 (87.5%) in surgery and 16 (53.3%) in best medical therapy (P = .020). Conclusions: This study suggests that intensive medical therapy with hypothermia has lower prevalence of poor outcome than decompressive hemicraniectomy despite relatively similar clinical severity on baseline. Therefore, systematized medical therapy with therapeutic hypothermia might be a feasible strategy to avoid invasive hemicraniectomy in malignant MCA infarction. Keywords: Malignant middle cerebral artery infarction, Decompressive hemicraniectomy, Therapeutic hypothermia http://dx.doi.org/10.1016/j.jcrc.2015.04.058
Abstract Ischemic stroke in critically ill patients with malignancy Jeong-am Ryu, Jeong hoon Yang, Daesang Lee, Gee young Suh, Joongbum Cho, Chi ryang Chung, Chi-min Park, Oh. young Bang, Kyeongman Jeon Samsung Medical Center (Samsung Seoul Hospital), Republic of Korea Background/Purpose: Ischemic stroke (IS) in the critically ill cancer patients is associated with significant morbidity and mortality. We investigated the clinical characteristics and predictors of IS in critically ill cancer patients. Methods: All consecutive patients were retrospectively evaluated who underwent brain magnetic resonance imaging (B-MRI) for suspicion of IS with acute abnormal neurologic symptoms or signs developed in the oncology medical intensive care unit of Samsung Medical Center from March 2010 to February 2014. A multiple logistic regression analysis was used to identify independent predictors of IS. Results: Over the study period, a total of 88 cancer patients underwent B-MRI scanning for suspicion of IS, with altered
mentality in 55 (63%), hemiparesis in 28 (32%), and seizure in 20 (23%) patients. Forty-three patients (49%) had a final diagnosis of IS. Multiple territorial lesions were most common stroke subtype (81%). Only 8 nonstroke patients (18%) had brain metastasis. Most nonstroke patients (29%) had normal B-MRI findings. After adjusting for potential confounding factors, seizure (adjusted OR, 0.141; 95% CI, 0.027-0.736) was inversely associated with IS. Neurologic sign of hemiparesis (adjusted OR, 5.339; 95% CI, 1.521-19.163) was significantly associated with IS in critically ill cancer patients. Conclusions: Approximately half of critically ill cancer patients diagnosed with IS underwent B-MRI scanning for suspicion of IS during their ICU stay. However, brain metastasis was relatively rare. Generally, it is difficult to determine stroke by symptom alone, but hemiparesis may be a helpful neurologic sign to distinguish IS in critically ill cancer patients. Keywords: Ischemic stroke, Cancer, Brain magnetic resonance
http://dx.doi.org/10.1016/j.jcrc.2015.04.059
Abstract Outcomes after spinal cord injury in patients with previous anemia: A nationwide population-based study Yi-chun Choua, Chien-chang Liaob, Ta-liang Chenb a
Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan b Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
Background/Purpose: Factors associated with complications and mortality after spinal cord injury (SCI) was not completely understood. The purpose of this study is to evaluated post-SCI complications and mortality in patients with and without previous anemia. Methods: Using Taiwanese National Health Insurance Research Database, a nationwide population-based study was conducted of 9049 patients who suffered from SCI with hospitalization between 2008 and 2012. Outcomes after SCI were compared between people with and without previous anemia within 24-month period before SCI. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of 30-day complications and mortality after SCI associated with previous anemia were calculated in the multivariate logistic regressions. Results: The incidences of post-SCI acute renal failure for people with (n = 399) and without (n = 8650) previous anemia were 1.8% and 0.6%, respectively (P = .0081). Patients with previous anemia had higher post-SCI mortality than those without anemia (2.5% vs 0.7%, P b .0001). Among patients with SCI, previous anemia was associated with post-SCI acute renal failure (OR, 2.42; 95% CI, 1.02-5.73) and mortality (OR, 2.82; 95% CI, 1.27-6.23) after adjusted for sociodemographics and coexisting medical conditions. Conclusions: In this nationwide population-based study, we investigated that previous anemia was associated with acute renal failure and 30-day mortality after SCI. Keywords: Anemia, Spinal cord injury, Complications, Mortality
http://dx.doi.org/10.1016/j.jcrc.2015.04.060