C-reactive protein/albumin ratio predicting early death in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of C-reactive protein/albumin ratio (CAR) for 30 d survival status in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Neurological Intensive Care Unit (NICU),Nanfang Hospital,Southern Medical University were selected from 2013 to 2016.They were divided into a survival group and a death group according to the 30 d survival status.The clinical data of both groups were compared and analyzed.Multivariate logistic regression analysis was used to determine the independent risk factors for 30 d survival status.The predictive value of the variables was analyzed using the receiver operating characteristic (ROC) curve.Results A total of 236 patients were enrolled in the study,including 64 (27.12％) in the death group and 172 (72.88％) in the survival group.The baseline National Institutes of Health Stroke Scale score,procalcitonin,C-reactive protein,CAR,and onset to NICU time in patients of the survival group were significantly lower or shorter than those of the death group,and the serum albumin level of the survival group was higher than that of the death group (all P ＜0.05).Pearson's correlation analysis showed that C-reactive protein (r =0.647,P ＜ 0.001),CAR (r =0.632,P ＜ 0.001),and onset to NICU time (r =0.596,P ＜ 0.001) were closely associated with the 30 d survival status in patients with acute ischemic stroke.Multivariate logistic regression analysis showed that CAR was an independent risk factor for 30 d mortality in patients with acute ischemic stroke (odds ratio 1.895,95％ confidence interval 1.573-2.282;P ＜ 0.001).ROC curve analysis showed that the area under the curve of CAR was 0.873 (95％ confidence interval 0.815-0.931),the optimal cut-off value was 2.197,the sensitivity of predicting 30 d death risk was 82.8％,and the specificity was 87.8％.Conclusion CAR is an independent risk factor for 30 d death in patients with acute ischemic stroke and can be used for 30 d survival assessment in patients with acute ischemic stroke.

Predictive value of serum procalcitonin for acute stroke patients with bacterial pneumonia:a retrospective case series study / 国际脑血管病杂志

Objective To investigate the risk factors for bacterial pneumonia and the predictive value of early serum procalcitonin (PCT) level for bacterial pneumonia and sepsis classification in patients with acute stroke. Methods The patients with acute stroke in neurological intensive care unit were enroled retrospectively and divided into either a bacterial pneumonia group or a non-infection group according to whether they had bacterial pneumonia or not. The former was redivided into a non-severe sepsis subgroup and a severe sepsis subgroup according to the sepsis classification. The demographics, baseline clinical data, and PCT level (the bacterial pneumonia group was the PCT level when infection occurred, the non-infection group was the PCT level within 24 h of admission) were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for bacterial pneumonia. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum PCT level for bacterial pneumonia and sepsis classification. Results A total of 164 patients with acute stroke were enroled in the study, including 114 in the bacterial pneumonia group (66 in the non-severe sepsis subgroup and 48 in the severe sepsis subgroup) and 50 in the non-infection group. There were significant differences in age, fasting blood glucose level, Glasgow coma scale (GCS) score, and PCT level between the bacterial pneumonia group and the non-infection group (P < 0. 05 ). Multivariate logistic regression analysis showed that fasting blood glucose level ≥7 mmol/L (odds ratio [ OR] 8. 488, 95% confidence interval [ CI] 2. 739 - 26. 300; P < 0. 01), GCS score ≤8 (OR 11. 361, 95% CI 2. 175 - 59. 352; P < 0. 01), and PCT level ≥0. 050 ng/ml (OR 16. 715, CI 5. 075 - 55. 049; P < 0. 01) were the independent risk factors for bacterial pneumonia. In the bacterial pneumonia group, the PCT level (median; interquartile range) in the severe sepsis subgroup was significantly higher than that in the non-severe sepsis subgroup (0. 835 [ 0. 164 - 1. 715 ] ng/ml vs. 0. 114 [0. 073 - 0. 275 ] ng/ml; Z = 4. 818, P < 0. 01 ). ROC curve analysis showed that PCT ≥0. 070 ng/ml could better predict the occurrence of bacterial pneumonia in patients with acute stroke, with sensitivity of 84. 2% , specificity of 74. 0% and the area under the ROC curve of 0. 865 (CI 0. 806 - 0. 924, P < 0. 01); PCT 0. 669 ng/mlcould better predict the occurrence of severe sepsis in acute stroke patients with bacterial pneumonia, with sensitivity of 56. 3% , specificity of 92. 4% and the area under the ROC curve of 0. 765 (CI 0. 672 - 0. 858; P < 0. 01). Conclusions The early PCT level ≥0. 050 ng/ml was an independent risk factor for occurring bacterial pneumonia in patients with acute stroke, its level had certaln predictive value for bacterial pneumonia and the severity of infection.

Spontaneous cough in extubation of non-comatose neurocritical patients / 中华神经医学杂志

Objective To explore the relationship between spontaneous cough and extubation outcome (EO) in non-comatose neurocritical patients.Methods A retrospective study was performed in patients admitted to the neurocritical care unit (NICU) from September 2011 to September 2012; the extubation decisions in these patients had been made by physicians based on an existing extubation protocol of NICU.We compared the baseline information,traditional weaning parameters (TWPs),Glasgow coma scale (GCS) scores,eye response scores,motor response scores,ability to follow four commands (closing eyes,showing two fingers,wiggling toes,coughing according to command) and existence of spontaneous cough between extubation failure (EF) and extubation success (ES) the patients.Results A total of 145 patients experienced episodes with artificial airway,resulting in 27 extubation attempts with 70.4％ (19/27) of ES and 29.6％ (8/27) of EF.There were no differences in baseline information and TWPs (P＞0.05),while significant differences in scores of GCS,eye response and motor response between ES and EF patients (P＜0.05).The cut-off value of GCS scores at the time of extubation was 10.5 (P=0.009).The ability to follow the four commands was not associated with extubation outcome (P=0.206).The existence of spontaneous cough strongly predicted ES (P=0.000),and when subgroup analysis was done for patients who could not follow four commands,the association was still remarkable (P=0.002).Conclusion Spontaneous cough could be a predictor of ES in non-comatose NICU patients,even in those who could not follow commands.

Dynamic changes of procalcitonin within 72 hours of acute stroke without infection / 中华神经医学杂志

Objective To investigate the dynamic changes ofprocalcitonin (PCT) within 72 h of acute stroke without infection and explore the value of PCT in diagnosis of bacterial infection in the early stage of acute stroke.Methods Forty-one patients with acute stroke within 24 hours of symptom onset,admitted to our hospital from July 2012 to January 2013,were enrolled in our study.The concentrations of PCT and C-reactive protein (CRP) in the serum were measured,respectively,at 24,48 and 72 h after symptom onset.At each time point,the PCT and CRP values were compared with the upper value of normal ranges of PCT and CRP,respectively.Results The median (quartiles) PCT concentrations at 24,48 and 72 h after stroke onset were,respectively,(0.050 [0.040,0.080]) ng/mL,(0.060 [0.036,0.095]) ng/mL and [0.051 (0.040,0.079)] ng/mL,which were significantly different as compared with that of the upper value of normal range (0.05 ng/mL,P＜0.05).The median (quartiles) CRP concentrations at 24 and 48 h after stroke onset were,respectively,[3.200 (1.100,5.000)] mg/L and [4.300(1.700,9.900)] mg/L,showing no significant difference with the upper value of normal range (5.0 mg/L,P＞0.05); however,the mean CRP concentration at 72 after stroke onset was [5.300 (2.500,15.550) mg/L],enjoying significant difference as compared with the upper value of normal range (P＜0.05).Most of the patients (22 patients,53.67％) had a peak level of PCT at 24 h,while most of them (26,63.41％) had a peak level of CRP at 72 h.The concentration of PCT increased within 24 h after symptom onset,but declined in the following 72 h; in contrast,the concentration of CRP continuously increased in the first 72 h of symptom onset.Conclusions PCT concentrations may increase in the first 72 h after acute stroke,therefore,when using PCT in diagnosis of bacterial infection in the early stage of acute stroke,the influence of elevating PCT concentrations by stroke itself should be considered.But PCT usually reaches its peak level earlier than CRP and returns to normal range faster than CRP,which may be more valuable than CRP in diagnosis of bacterial infection in the early stage of acute stroke.

Prognostic predictive value of quantitative electroencephalography for patients with large middle cerebral artery infarction / 国际脑血管病杂志

Objective To study the prognostic predictive value of quantitative dectroencephalography (qEEG)for patients with large middle cerebral artery infarction (LMCAI).Methods The scores of routine electroencephalography (EEG),qEEG and the Glasgow Coma Scale (GCS) of the patients within 72 hours after symptom onset were recorded.The short-term prognosis (death or survival) was evaluated at 1 month after the onset.The long-term prognosis (good or poor) was evaluated at 3 months after the onset.All the observed data in each prognostic group were compared.Results A total of 105 patients were included in the study.There were significant differences in the margin of amplitude integrated electroencephalogram (aEEG) (upper margin:19.11 ± 7.80 μV vs.11.87 ±6.41 μV;t =2.392,P =0.019; lower margin:11.90 ± 4.78 μV vs.7.58 ± 4.15 μV; t =3.327,P =0.022),Synek-classification (x2 =48.114,P =0.000) between the short-term survival group and the death group; in patients with left LMCAI,there were significant differences in the absolute energy of the β-activity (13.16 ±12.66 μV2 vs.19.20 ±17.96 μV2;t =-2.781,P =0.039),spectral edge frequency 95％ (SEF95％) (9.17 ± 3.24 Hz vs.10.36 ± 3.76 Hz; t =-5.614,P =0.002) between the short-term survival group and the death group.There were significant differences in the age (59.33 ±13.67 years vs.68.87± 10.473 years; t =-3.215,P =0.002),GCS scores (10.86±2.80 vs.9.21 ±2.51;t =2.511,P =0.015),SEF95％ (13.80 ±5.40 Hz vs.10.93 ±4.68 Hz; t ＝2.311,P =0.024) and sides of infarction (x2 =4.737,P =0.030) between the long-term good prognosis group and the poor prognosis group.Conclusion qEEG can be used as an effective means of monitoring for evaluating the prognosis of patients with LMCAI.

The 40 Hz auditory steady-state response predicting the malignant process of middle cerebral artery territory infarction: a retrospective case series study / 国际脑血管病杂志

Objcctive To investigate the predictive value of the 40 Hz auditory steady-state response (ASSR) in patients with the malignant process of middle cerebral artery territory infarction.Methods The40 Hz ASSR and brainstem auditory evoked potential (BAEP) were performed within 72 hours after patients with middle cerebral artery terrtory infarction admitted in the neuro-intensive care unite (NICU).At the same time,the National Institutes of Health Stroke Scale (NIHSS) scores were assessed.Multivariable logistic regression analysis was used to deterrmine the influencing factors of the malignant process.The relevant indicators of the malignant process were analyzed by the receiver operating characteristic(ROC) curve in order to clear the predictive value of 40 Hz ASSR in the malignant process of middle cerebral artery territory infarction.Results A total of 104 patients with supratentorial middle cerebral artery territory infarction were included.They were divided into the malignant process group (n=59) or the non-malignant process group (n=45).There were significant differences in the baseline NIHSS scores (17.25 ± 7.23 vs.20.40 ± 8.09; t =- 2.055,P =0.043),infarct volume (105.85 ± 73.37 mm3 us.179.15 ± 144.38 mm3; t =-3.011,P =0.004),leukocyte count ([ 10.26 ±3.14] × 109/L vs.[ 13.45 ±5.42] × 109/L; t =-3.336,P =0.001),40 Hz ASSR (Z =-3.237,P =0.001),and short-latency somatosensory evoked potentials (Z =-3.130,P =0.002) grade between the malignant process group and the non-malignant process group.Multivariate logistic regression analysis showed that the40 Hz ASSR (odds ratio [OR] 3.347,95％ confidence interval [CI] 1.630 -6.872; P=0.014),infarct volume (OR 1.006,95％ CI 1.001 - 1.012,P=0.003),and leukocyte count (OR 1.277,95％ CI 1.074 - 1.402; P =0.001) were the independent predictors in patients with the malignant process of middle cerebral artery territory infarction.When the 40 Hz ASSR was grade 3,the sensitivity and specificity of predicting malignant process were 39.5％ and 94.4％.Conclusions The 40 Hz ASSR has an important predictive value in patients with the malignant process of middle cerebral artery territory infarction.