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1.
Exp Gerontol ; 61: 8-14, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25449856

ABSTRACT

Blood thyroid function tests (TFT) are routinely used to screen for thyroid disorders in several clinical settings. TFT on hospital admission may also be useful prognostic predictors of acute IS: according to recent evidence, poststroke outcome is better in patients with lower thyroid function and worse in those with higher thyroid function. However, previous reports are few and mostly compared patients with thyroid disorders to euthyroid patients. Thyroid disorders are known risk factors for cerebrovascular disease. However, hyperthyroidism is related to cardioembolic IS whereas hypothyroidism is related to atherosclerotic risk factors. Therefore, findings from available studies of TFT might just reflect the worse prognosis of cardioembolic IS compared to other IS subtypes. Another limitation of previous studies is the lack of information for older persons, who represent three quarters of all IS patients. In this paper, we investigated whether serum thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) measured on Stroke Unit (SU) admission are associated with early outcomes of acute IS in 775 euthyroid patients aged ≥65 years (mean age 80.1±8.7 years). Two composite outcomes were investigated: poor functional outcome (death during SU stay or disability at SU discharge), and unfavorable discharge setting (death during SU stay, transfer from SU to other acute hospital unit or transfer from SU to long-term care-facilities as opposed to direct discharge home). Analyses were performed using logistic regression models. Curvilinear associations were tested including TFT as polynomial terms. Models were adjusted for demographics, prestroke, and IS-related confounders. We found that lower TSH had a complex curvilinear association with poor functional outcome and that the shape of the associations changed with age. At age 65, the curve was U-shaped: outcome risk decreased with increasing TSH, reached its minimum at TSH near 3.00mUI/L and then started to rise. Between ages 70 and 75, however, the shape of the curve straightened and, starting from age 80 took an inverted U-shape: outcome risk rose with increasing TSH, reached its maximum at TSH values that progressively shifted upward with increasing age (from 1.70mU/L at age 80 to about 2.20mUI/L at age 90), then started to decrease. A linear inverse association was found between FT3 and unfavorable discharge setting. Our study suggests that measurement of TFT on SU admission can provide independent prognostic information for early outcomes of acute IS in older euthyroid patients.


Subject(s)
Brain Ischemia/physiopathology , Stroke/physiopathology , Thyroid Gland/physiopathology , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Male , Thyroid Function Tests , Thyrotropin/blood , Thyroxine/blood , Treatment Outcome
2.
Neurology ; 80(1): 29-38, 2013 Jan 01.
Article in English | MEDLINE | ID: mdl-23243075

ABSTRACT

OBJECTIVE: Incidence of ischemic stroke (IS) increases with age. Knowledge of factors associated with IS acute outcomes in the oldest-old (≥80 years) is needed to improve quality of care and resource allocation in this age group. METHODS: Data are for 769 consecutive IS patients aged ≥60 years (436 aged ≥80 years) admitted to an Italian stroke unit in a 4-year period. Demographics, prestroke disability (modified Rankin Scale ≥3) and comorbidities, IS etiology and subtype, NIH Stroke Scale (NIHSS) score, clinical and laboratory admission parameters, and medical complications were prospectively registered. Independent predictors of in-hospital death, incident disability, length of stay, discharge without rehabilitation, and no direct discharge home were identified by multiple logistic regression. Risk profiles before and after age 80 were compared. RESULTS: Poor outcomes were more frequent in the oldest-old compared to the younger patients. NIHSS score, clinical parameters of IS severity (need for oxygen, indwelling catheter, or nasogastric tube), incident disability, and medical complications predicted most of the study outcomes in both age groups. After age 80, IS etiology and subtype proved additional independent determinants for most outcomes along with age, sex, and prestroke functional and health status. CONCLUSIONS: Characteristics related to neurologic impairment on admission were the main predictors of acute outcomes of IS in this cohort. Specific IS etiology and subtype influenced IS outcomes only after age 80. In oldest-old patients, demographics and prestroke functional and health status also influenced IS outcomes with peculiar associations.


Subject(s)
Brain Ischemia/epidemiology , Outcome Assessment, Health Care/statistics & numerical data , Stroke/epidemiology , Age Factors , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/diagnosis , Brain Ischemia/mortality , Comorbidity , Disability Evaluation , Female , Health Status , Humans , Incidence , Italy/epidemiology , Length of Stay/statistics & numerical data , Male , Patient Discharge/statistics & numerical data , Prospective Studies , Risk Factors , Severity of Illness Index , Sex Characteristics , Stroke/complications , Stroke/diagnosis , Stroke/mortality
3.
Neuroepidemiology ; 39(1): 45-50, 2012.
Article in English | MEDLINE | ID: mdl-22777596

ABSTRACT

BACKGROUND AND PURPOSE: Studies on post-stroke seizures have produced conflicting results. Our study aim was to further elucidate the incidence and predictive factors of early post-stroke seizures (ES) and their relationship with outcome. METHODS: relevant clinical data were prospectively collected in 2,053 patients with acute stroke admitted to the Stroke Unit from 2004 to 2008. RESULTS: Sixty-six patients (8 hemorrhagic and 58 ischemic strokes) aged 73-88 years (mean age 82 years) presented seizures in the first week after stroke onset. The type of ischemic stroke was atherothrombotic in 10 patients, cardioembolic in 21, lacunar in 4, undetermined in 19, and of other etiology in 4. Twenty-seven patients had generalized convulsive, 6 had complex partial, and 33 had simple partial seizures. Status epilepticus was observed in 13 patients. The severity of strokes in patients with ES was greater than in those without (National Institutes of Health Stroke Scale >14 in 50 vs. 25%), so mortality (30 days) was higher (29 vs. 14%). Independent seizure predictors were: total anterior circulation infarct, hemorrhagic transformation, hyperglycemia, and the interaction term diabetes × hyperglycemia. CONCLUSIONS: ES may be considered a marker of stroke severity. Cortical location of the lesion, hemorrhagic transformation, and hyperglycemia in patients without diabetes are important predictors of ES.


Subject(s)
Seizures/epidemiology , Stroke/epidemiology , Aged , Aged, 80 and over , Brain Infarction/epidemiology , Brain Ischemia/epidemiology , Female , Humans , Hyperglycemia/epidemiology , Incidence , Intracranial Hemorrhages/epidemiology , Male , Prognosis , Prospective Studies , Risk Factors , Seizures/etiology , Stroke/complications
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