Clinical and molecular correlates of the ASPECTS in the acute phase of stroke.

BACKGROUND: The Alberta Stroke Program Early CT Score (ASPECTS) scale was developed for monitoring early ischemic changes on CT, being associated with clinical outcomes. The ASPECTS can also associate with peripheral biomarkers that reflect the pathophysiological response of the brain to the ischemic stroke. OBJECTIVE: To investigate the association between peripheral biomarkers with the Alberta Stroke Program Early CT Score (ASPECTS) in individuals after ischemic stroke. METHODS: Patients over 18 years old with acute ischemic stroke were enrolled in this study. No patient was eligible for thrombolysis. The patients were submitted to non-contrast CT in the first 24 hours of admission, being the Alberta Stroke Program Early CT Score and clinical and molecular evaluations applied on the same day. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale and the Mini-Mental State Examination for clinical evaluation were also applied to all subjects. Plasma levels of BDNF, VCAM-1, VEGF, IL-1ß, sTNFRs and adiponectin were determined by ELISA. RESULTS: Worse neurological impairment (NIHSS), cognitive (MEEM) and functional (Rankin) performance was observed in the group with changes in the NCTT. Patients with NCTT changes also exhibited higher levels of IL-1ß and adiponectin. In the linear multivariate regression, an adjusted R coefficient of 0.515 was found, indicating adiponectin and NIHSS as independent predictors of ASPECTS. CONCLUSION: Plasma levels of adiponectin are associated with the ASPECTS scores.

Clinical and molecular correlates of the ASPECTS in the acute phase of stroke / Correlação clínica e molecular com a ASPECTS na fase aguda do acidente vascular cerebral

ABSTRACT Background: The Alberta Stroke Program Early CT Score (ASPECTS) scale was developed for monitoring early ischemic changes on CT, being associated with clinical outcomes. The ASPECTS can also associate with peripheral biomarkers that reflect the pathophysiological response of the brain to the ischemic stroke. Objective: To investigate the association between peripheral biomarkers with the Alberta Stroke Program Early CT Score (ASPECTS) in individuals after ischemic stroke. Methods: Patients over 18 years old with acute ischemic stroke were enrolled in this study. No patient was eligible for thrombolysis. The patients were submitted to non-contrast CT in the first 24 hours of admission, being the Alberta Stroke Program Early CT Score and clinical and molecular evaluations applied on the same day. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale and the Mini-Mental State Examination for clinical evaluation were also applied to all subjects. Plasma levels of BDNF, VCAM-1, VEGF, IL-1β, sTNFRs and adiponectin were determined by ELISA. Results: Worse neurological impairment (NIHSS), cognitive (MEEM) and functional (Rankin) performance was observed in the group with changes in the NCTT. Patients with NCTT changes also exhibited higher levels of IL-1β and adiponectin. In the linear multivariate regression, an adjusted R coefficient of 0.515 was found, indicating adiponectin and NIHSS as independent predictors of ASPECTS. Conclusion: Plasma levels of adiponectin are associated with the ASPECTS scores.

RESUMO Introdução: A Alberta Stroke Early Score (ASPECTS) foi desenvolvida para monitorização de alterações isquêmicas precoces na tomografia computadorizada de crânio, estando associada a desfechos clínicos. A ASPECTS também pode se associar aos biomarcadores periféricos que refletem a resposta fisiopatológica do cérebro ao AVC isquêmico. Objetivo: Investigar à associação entre os parâmetros periféricos com a Alberta Stroke Early Score (ASPECTS) em indivíduos após acidente vascular cerebral isquêmico. Métodos: Pacientes acima de 18 anos com AVC isquêmico agudo foram incluídos neste estudo. Nenhum paciente foi elegível para trombólise. Os pacientes foram submetidos à tomografia computadorizada sem contraste nas primeiras 24 horas da admissão, a ASPECTS e as avaliações clínicas e moleculares aplicadas no mesmo dia. O National Institutes of Health Stroke Scale (NIHSS), a escala de Rankin modificada e o Mini Exame do Estado Mental para avaliação clínica também foram aplicados a todos os indivíduos. Os níveis plasmáticos de BDNF, VCAM-1, VEGF, IL-1β, sTNFRs e adiponectina foram determinados por ELISA. Resultados: Pior desempenho neurológico (NIHSS), cognitivo (MEEM) e funcional (Rankin) foram observados no grupo com alterações na ASPECTS. Pacientes com alterações na ASPECTS também exibiram níveis mais altos de IL-1β e adiponectina. Na regressão multivariada linear, foi encontrado um coeficiente R ajustado de 0,515, indicando adiponectina e NIHSS como preditores independentes para a ASPECTS. Conclusão: Os níveis plasmáticos de adiponectina estão associados aos escores da ASPECTS.

Perfil dos pacientes com diagnóstico de AVC atendidos em um hospital de Minas Gerais credenciado na linha de cuidados / Profile of patients with a diagnosis of stroke attended at a hospital in Minas Gerais accredited in the care line

Introdução: Acidente Vascular Cerebral é um problema de saúde pública em que estudos epidemiológicos evidenciam a importância da prevenção, promoção e tratamento da doença no Brasil. Objetivo: descrever a distribuição de pacientes com Acidente Vascular Cerebral nos diferentes setores de internação de um hospital da rede pública credenciado pelo Ministério da Saúde na linha de cuidados. Métodos: Estudo transversal em que foram avaliados pacientes com Acidente Vascular Cerebral admitidos no Hospital Risoleta Tolentino Neves de Belo Horizonte no período de janeiro a junho de 2015. Dados sócio-demográficos e clínicos foram extraídos dos prontuários e/ ou por meio de entrevistas, sendo analisadas as informações: sexo; idade; mecanismo fisiopatológico; tempo de ictus; fatores de risco para o AVC; setor de internação; tempo de internação e complicações clínicas. Resultados: Dos 223 pacientes internados, 55% eram sexo masculino e idade média de 64,3 anos. Em relação aos setores hospitalares, 169 foram alocados para a Unidade de Acidente Vascular Cerebral (82% isquêmico), 24 no Centro de Tratamento Intensivo (79% hemorrágico), 23 no Pronto Atendimento (74% Ataque Isquêmico Transitório) e sete na Enfermaria Geral. A média do tempo de ictus foi de 13,2 horas. O tempo médio de internação foi de 12,4 ± 9,8 dias, entretanto a Enfermaria Geral e o Centro de Tratamento Intensivo apresentaram maiores tempos de internação e número de complicações clínicas. Conclusão: A linha de cuidado em Acidente Vascular Cerebral nos hospitais pode reduzir complicações clínicas, mortalidade e tempo de internação, contribuindo para organização de setores de internação e utilização de recursos hospitalares.(AU)

Background: Stroke is a public health problem in which epidemiological studies evidence the importance of the prevention, promotion and treatment of the disease in Brazil. Purpose: To describe the distribution of patients with Stroke in different hospital sectors of a public hospital accredited by the Ministry of Health in care line. Methods: Cross-sectional study which evaluated patients with Stroke admitted to the Hospital Risoleta Tolentino Neves Belo Horizonte in the period January-June 2015. socio-demographic and clinical data were extracted from medical records and / or through interviews, and analyzed information: gender; age; Pathophysiological mechanism; Stroke time; Risk factors for stroke; Hospitalization; Length of hospital stay and clinical complications. Results: Of the 223 hospitalized patients, 55% were male and mean age was 64.3 years. In the hospital sectors, 169 were allocated to the Stroke Unit (82% ischemic), 24 in the Intensive Care Center (79% hemorrhagic), 23 in the Emergency Care Unit (74% Transient Ischemic Attack) and 7 in the General Nursing. The mean stroke time was 13.2 hours. The mean length of hospital stay was 12.4 ± 9.8 days, although the General Nursing and Intensive Care had longer hospitalization times and number of clinical complications. Conclusion: The line of care in stroke in hospitals can reduce clinical complications, mortality and length of stay, contributing to the organization of hospitalization sectors and use of hospital resources. (AU)