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Prevalence of right-to-left shunt in stroke patients with cancer. 癌症中风患者右左分流的发病率。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-13 DOI: 10.1177/17474930241260589
Fabienne Steinauer, Philipp Bücke, Eric Buffle, Mattia Branca, Jayan Göcmen, Babak B Navi, Ava L Liberman, Anna Boronylo, Leander Clenin, Martina Goeldlin, Julian Lippert, Bastian Volbers, Thomas R Meinel, David Seiffge, Adnan Mujanovic, Johannes Kaesmacher, Urs Fischer, Marcel Arnold, Thomas Pabst, Martin D Berger, Simon Jung, Morin Beyeler

Background and objectives: Cancer is associated with an increased risk of acute ischemic stroke (AIS) and venous thromboembolism. The role of a cardiac right-to-left shunt (RLS) as a surrogate parameter for paradoxical embolism in cancer-related strokes is uncertain. We sought to investigate the relationship between the presence of an RLS and cancer in AIS patients.

Methods: We included consecutive AIS patients hospitalized at our tertiary stroke center between January 2015 and December 2020 with available RLS status as detected on transesophageal echocardiography (TEE). Active cancers were retrospectively identified and the association with RLS was assessed with multivariable logistic regression and inverse probability of treatment weighting to minimize the ascertainment bias of having a TEE obtained.

Results: Of the 2236 AIS patients included, 103 (4.6%) had active cancer, of whom 24 (23%) were diagnosed with RLS. An RLS was present in 774 out of the 2133 AIS patients without active cancer (36%). After adjustment and weighting, the absence of RLS was associated with active cancer (adjusted odds ratio (aOR) 2.29; 95% confidence interval (CI), 1.14-4.58). When analysis was restricted to patients younger than 60 years of age or those with a high-risk RLS (Risk of Paradoxical Embolism Score ⩾ 6), there was no association between RLS and cancer (aOR, 3.07; 95% CI, 0.79-11.88 and aOR, 0.56; 95% CI, 0.10-3.10, respectively).

Conclusion: RLS was diagnosed less frequently in AIS patients with cancer than in cancer-free patients, suggesting that arterial sources may play a larger role in cancer-related strokes than paradoxical venous embolization. Future studies are needed to validate these findings and evaluate potential therapeutic implications, such as the general indication, or lack thereof, for patent foramen ovale (PFO) closure in this patient population.

背景和目的:癌症与急性缺血性脑卒中(AIS)和静脉血栓栓塞风险增加有关。心脏右左分流(RLS)作为矛盾性栓塞的替代指标在癌症相关中风中的作用尚不确定。我们试图研究 AIS 患者出现 RLS 与癌症之间的关系:我们纳入了 2015 年 1 月至 2020 年 12 月期间在我们的三级卒中中心住院的连续 AIS 患者,这些患者经食道超声心动图(TEE)检测出 RLS 状态。对活动性癌症进行了回顾性鉴别,并通过多变量逻辑回归和逆治疗概率加权评估了与RLS的关系,以尽量减少经食道超声心动图检查的确定偏倚:在纳入的 2236 名 AIS 患者中,103 人(4.6%)患有活动性癌症,其中 24 人(23%)被诊断为 RLS。在2133名无活动性癌症的AIS患者中,有774人(36%)患有RLS。经过调整和加权后,无 RLS 与癌症活动有关(调整后的几率比 [aOR],2.29;95% 置信区间 [CI],1.14-4.58)。当分析对象仅限于年龄小于60岁或RLS风险较高的患者(并发栓塞风险评分≥6分)时,RLS与癌症之间没有关联(aOR,3.07;95% CI,0.79-11.88;aOR,0.56;95% CI,0.10-3.10):结论:与未患癌症的患者相比,AIS 癌症患者被诊断出 RLS 的频率较低,这表明动脉源在癌症相关中风中的作用可能大于矛盾性静脉栓塞。未来的研究需要验证这些发现,并评估潜在的治疗意义,如在这一患者群体中关闭 PFO 的一般适应症或缺乏适应症。
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引用次数: 0
Reperfusion therapies for ischemic stroke in dementia and cognitive impairment: A systematic review and meta-analysis. 再灌注治疗缺血性脑卒中痴呆和认知功能障碍:系统回顾和荟萃分析。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2023-12-27 DOI: 10.1177/17474930231220186
Fouzi Bala, William Betzner, Benjamin Beland, Jennifer S McDonald, Aravind Ganesh

Background: Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) have an unclear benefit in those with pre-stroke dementia or cognitive impairment, as these patients were often excluded from landmark stroke trials. We performed a systematic review and meta-analysis to assess the outcomes of IVT and EVT in these populations.

Aims: Our systematic review, conforming to the Meta-Analysis of Observational Studies in Epidemiology guidelines, investigated studies on acute ischemic stroke patients with pre-stroke dementia or cognitive impairment treated with IVT or EVT. Primary outcome was favorable 90-day outcome (mRS 0-2). Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (SICH), and radiographic intracranial hemorrhage (ICH).

Summary of review: Nine articles were identified, with five observational studies of IVT use in patients with (n = 1078) and without dementia (n = 2805) being selected for the meta-analysis. There were no significant differences in favorable outcome (adjusted OR: 0.61, 95% CI 0.24-1.59), mortality (unadjusted OR: 1.19, 95% CI 0.86-1.64), ICH (unadjusted OR: 1.32, 95% CI 0.79-2.19), and symptomatic ICH (unadjusted OR: 0.94, 95% CI 0.70-1.25) for patients undergoing IVT with pre-stroke dementia versus those without. One EVT study (n = 615 with dementia vs n = 9600 without) found no significant differences in outcomes apart from an increased odds of ICH for those with pre-existing dementia (adjusted OR: 1.57, 95% CI 1.03-2.40). A pooled analysis of three IVT studies showed no significant association of cognitive impairment (n = 93 vs n = 211 without) with all assessed outcomes, whereas a study of EVT found that pre-stroke cognitive impairment was associated with poor 90-day outcomes (mRS 3-6).

Conclusion: These results suggest no substantial safety issues in the use of IVT or EVT for patients with pre-existing dementia or cognitive impairment compared to those without. However, the efficacy of these therapies in this demographic remains uncertain. Further rigorous studies that include a more nuanced outcome measurement approach are warranted.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42021240499.

背景:血管内取栓(EVT)和静脉溶栓(IVT)对脑卒中前痴呆或认知障碍患者的益处尚不清楚,因为这些患者通常被排除在具有里程碑意义的脑卒中试验之外。我们进行了系统回顾和荟萃分析,以评估这些人群中IVT和EVT的结果。方法:根据流行病学指南中观察性研究的荟萃分析,我们确定了急性缺血性卒中合并卒中前痴呆或认知障碍患者接受IVT或EVT治疗的研究。主要转归为90天的有利转归(mRS 0-2)。次要结局包括90天死亡率、症状性颅内出血(SICH)和影像学颅内出血(ICH)。结果:纳入了9篇文章,其中5项观察性研究选择了IVT在有(n=1078)和无痴呆(n=2805)患者中的应用进行meta分析。接受IVT合并卒中前痴呆的患者与未接受IVT的患者在有利结局(校正OR:0.61, 95%CI 0.24-1.59)、死亡率(未校正OR: 1.19, 95%CI 0.86-1.64)、脑出血(未校正OR:1.32, 95%CI 0.79- 2.19)和症状性脑出血(未校正OR:0.94, 95%CI 0.70-1.25)方面无显著差异。一项EVT研究(n=615例痴呆患者vs n= 9600例无痴呆患者)发现,除了已存在痴呆患者脑出血的几率增加外,结果无显著差异(调整OR:1.57, 95%CI 1.03-2.40)。三项IVT研究的汇总分析显示,认知障碍与所有评估结果均无显著相关性(n=93 vs n=211),而EVT研究发现卒中前认知障碍与较差的90天预后(mRS 3-6)相关。结论:这些结果一般表明,与没有痴呆或认知障碍的患者相比,IVT或EVT用于已有痴呆或认知障碍的患者没有实质性的安全性问题。然而,这些疗法在这一人群中的疗效仍不确定。进一步严格的研究包括更细致的结果测量方法是有必要的。注册:网址:https://www.crd.york.ac.uk/PROSPERO/;唯一标识符:CRD42021240499。缩写:EVT:血管内血栓切除术,ICH:脑出血,IVT:静脉溶栓,MCI:轻度认知障碍,mRS:改良Rankin评分,MOOSE:流行病学观察性研究荟萃分析,PRISMA:系统评价和荟萃分析的首选报告项目,QUIPS:预后质量研究,SICH:症状性脑出血。
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引用次数: 0
Sensitivity of the Boston criteria version 2.0 in Dutch-type hereditary cerebral amyloid angiopathy. 波士顿标准 2.0 版对荷兰型遗传性脑淀粉样血管病的敏感性
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-03-21 DOI: 10.1177/17474930241239801
Rgj van der Zwet, E A Koemans, S Voigt, R van Dort, I Rasing, K Kaushik, T W van Harten, M R Schipper, G M Terwindt, Mjp van Osch, Maa van Walderveen, E S van Etten, Mjh Wermer

Background and aim: The revised Boston criteria v2.0 for cerebral amyloid angiopathy (CAA) add two radiological markers to the existing criteria: severe visible perivascular spaces in the centrum semiovale and white matter hyperintensities (WMHs) in a multispot pattern. This study aims to determine the sensitivity of the updated criteria in mutation carriers with Dutch-type hereditary CAA (D-CAA) in an early and later disease stage.

Methods: In this cross-sectional study, we included presymptomatic and symptomatic D-CAA mutation carriers from our prospective natural history study (AURORA) at the Leiden University Medical Center between 2018 and 2021. 3-Tesla scans were assessed for CAA-related magnetic resonance imaging (MRI) markers. We compared the sensitivity of the Boston criteria v2.0 to the previously used modified Boston criteria v1.5.

Results: We included 64 D-CAA mutation carriers (mean age 49 years, 55% women, 55% presymptomatic). At least one white matter (WM) feature was seen in 55/64 mutation carriers (86%: 74% presymptomatic, 100% symptomatic). Fifteen (23%) mutation carriers, all presymptomatic, showed only WM features and no hemorrhagic markers. The sensitivity for probable CAA was similar between the new and the previous criteria: 11/35 (31%) in presymptomatic mutation carriers and 29/29 (100%) in symptomatic mutation carriers. The sensitivity for possible CAA in presymptomatic mutation carriers increased from 0/35 (0%) to 15/35 (43%) with the new criteria.

Conclusion: The Boston criteria v2.0 increase the sensitivity for detecting possible CAA in presymptomatic D-CAA mutation carriers and, therefore, improve the detection of the early phase of CAA.

背景和目的:修订后的波士顿脑淀粉样血管病(CAA)标准v2.0在现有标准的基础上增加了两个放射学标志物:半卵圆中心的严重可见血管周围间隙和多点模式的白质高密度(WMH)。本研究旨在确定最新标准在荷兰型遗传性 CAA(D-CAA)突变携带者疾病早期和晚期阶段的敏感性:在这项横断面研究中,我们纳入了2018年至2021年间莱顿大学医学中心前瞻性自然史研究(AURORA)中的无症状和有症状的D-CAA突变携带者。3-Tesla 扫描评估了 CAA 相关的 MRI 标记。我们比较了波士顿标准v2.0与之前使用的修改后波士顿标准v1.5的敏感性:我们纳入了 64 名 D-CAA 基因突变携带者(平均年龄 49 岁,55% 为女性,55% 无症状)。55/64 例突变携带者中至少有一种白质(WM)特征(86%:74%无症状,100%有症状。15名突变携带者(23%)均无症状,仅表现出白质特征,无出血标记物。新标准和旧标准对疑似 CAA 的敏感性相似:在无症状突变携带者中,有11/35(31%)人可能患有CAA;在有症状突变携带者中,有29/29(100%)人可能患有CAA。新标准对无症状突变携带者中可能存在 CAA 的敏感性从 0/35 (0%) 增加到 15/35 (43%):波士顿标准v2.0提高了对无症状D-CAA突变携带者可能患有CAA的检测灵敏度,从而改善了对CAA早期阶段的检测。
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引用次数: 0
Endovascular treatment to improve outcomes for medium vessel occlusions: The ESCAPE-MeVO trial. 改善中血管闭塞预后的血管内治疗:ESCAPE-MeVO试验。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-20 DOI: 10.1177/17474930241262642
Johanna M Ospel, Dar Dowlatshahi, Andrew Demchuk, David Volders, Markus Möhlenbruch, Shahid Nimjee, James Kennedy, Brian Buck, Jai Jai Shankar, Thomas C Booth, Mouhammad A Jumaa, Robert Fahed, Aravind Ganesh, Qiao Zhang, Craig Doram, Karla J Ryckborst, Michael D Hill, Mayank Goyal
<p><strong>Rationale: </strong>Clinical outcomes in acute ischemic stroke due to medium vessel occlusion (MeVO) are often poor when treated with best medical management. Data from non-randomized studies suggest that endovascular treatment (EVT) may improve outcomes in MeVO stroke, but randomized data on potential benefits and risks are hitherto lacking. Thus, there is insufficient evidence to guide EVT decision-making in MeVO stroke.</p><p><strong>Aims: </strong>The primary aim of the ESCAPE-MeVO trial is to demonstrate that acute, rapid EVT in patients with acute ischemic stroke due to MeVO results in better clinical outcomes compared to best medical management. Secondary outcomes are to demonstrate the safety of EVT, its impact on self-reported health-related quality of life, and cost-effectiveness.</p><p><strong>Sample size estimates: </strong>Based on previously published data, we estimate a sample size of 500 subjects to achieve a power of 85% with a two-sided alpha of 0.05. To account for potential loss to follow-up, 530 subjects will be recruited.</p><p><strong>Methods and design: </strong>ESCAPE-MeVO is a multicenter, prospective, randomized, open-label study with blinded endpoint evaluation (PROBE design), clinicaltrials.gov: NCT05151172. Subjects with acute ischemic stroke due to MeVO meeting the trial eligibility criteria will be allocated in a 1:1 ratio to best medical care plus EVT versus best medical care only. Patients will be screened only at comprehensive stroke centers to determine if they are eligible for the trial, regardless of whether they were previously treated at a primary care center. Key eligibility criteria are (1) acute ischemic stroke due to MeVO that is clinically and technically eligible for EVT, (2) last-known well within the last 12 h, (3) National Institutes of Health Stroke Scale > 5 or 3-5 with disabling deficit, (4) high likelihood of salvageable tissue on non-invasive neuroimaging.</p><p><strong>Study outcomes: </strong>The primary outcome is the modified Rankin scale 90 days after randomization (shift analysis), whereby modified Rankin Score 5 and 6 will be collapsed into one category. Secondary outcomes include dichotomizations of the modified Rankin Score at 90 days, 24 h National Institutes of Health Stroke Score, difference between 24 h and baseline National Institutes of Health Stroke Score, mortality at 90 days, health-related quality of life (EQ-5D-5 L), Lawton scale of instrumental activities of daily living score, reperfusion quality (MeVO expanded Thrombolysis in Cerebral Infarction Score) and infarct volume at 24 h, and cost-effectiveness of endovascular recanalization. Safety outcomes include symptomatic and asymptomatic intracranial hemorrhage and procedural complications.</p><p><strong>Discussion: </strong>The ESCAPE-MeVO trial will demonstrate the effect of endovascular thrombectomy in addition to best medical management vis-à-vis best medical management in patients with acute ischemic stroke
理由:中血管闭塞(MeVO)导致的急性缺血性卒中在接受最佳药物治疗后,临床疗效往往不佳。非随机研究数据表明,血管内治疗(EVT)可改善中血管闭塞性卒中的预后,但迄今为止尚缺乏有关潜在益处和风险的随机数据。目的:ESCAPE-MeVO 试验的主要目的是证明对 MeVO 引起的急性缺血性卒中患者进行急性、快速 EVT 与最佳内科治疗相比可获得更好的临床疗效。次要结果是证明 EVT 的安全性、对自我报告的健康相关生活质量的影响以及成本效益:根据之前公布的数据,我们估计样本量为 500 名受试者,双侧α值为 0.05 时的功率为 85%。考虑到可能的随访损失,我们将招募 530 名受试者:ESCAPE-MeVO是一项多中心、前瞻性、随机、开放标签研究,采用盲法终点评估(PROBE设计),clinicaltrials.gov:NCT05151172。符合试验资格标准的 MeVO 急性缺血性脑卒中受试者将按 1:1 的比例分配到最佳医疗加 EVT 与仅最佳医疗中。患者将只在综合卒中中心接受筛查,以确定其是否符合试验条件,无论其之前是否在初级医疗中心接受过治疗。主要资格标准为:1)因MeVO导致的急性缺血性卒中,临床和技术上均符合EVT治疗条件;2)在过去12小时内最后一次获知病情;3)美国国立卫生研究院卒中量表>5或3-5,伴有致残性缺损;4)在非侵入性神经影像学检查中发现可挽救组织的可能性很高:主要结果是随机分组 90 天后的改良 Rankin 评分(移位分析),其中改良 Rankin 评分 5 分和 6 分将合并为一类。次要结果包括:90天时的改良Rankin评分的二分法、24小时美国国立卫生研究院卒中评分、24小时美国国立卫生研究院卒中评分与基线美国国立卫生研究院卒中评分之间的差异、90天时的死亡率、健康相关生活质量(EQ-5D-5L)、Lawton日常生活工具活动评分、24小时时的再灌注质量(MeVO扩大脑梗塞溶栓评分)和梗塞体积,以及血管内再通的成本效益。安全性结果包括无症状和无症状颅内出血以及手术并发症:ESCAPE-MeVO试验将证明在最佳内科治疗的基础上进行血管内血栓切除术与最佳内科治疗相比,对MeVO引起的急性缺血性卒中患者的效果,并为急性MeVO卒中的循证治疗决策提供数据。
{"title":"Endovascular treatment to improve outcomes for medium vessel occlusions: The ESCAPE-MeVO trial.","authors":"Johanna M Ospel, Dar Dowlatshahi, Andrew Demchuk, David Volders, Markus Möhlenbruch, Shahid Nimjee, James Kennedy, Brian Buck, Jai Jai Shankar, Thomas C Booth, Mouhammad A Jumaa, Robert Fahed, Aravind Ganesh, Qiao Zhang, Craig Doram, Karla J Ryckborst, Michael D Hill, Mayank Goyal","doi":"10.1177/17474930241262642","DOIUrl":"10.1177/17474930241262642","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Clinical outcomes in acute ischemic stroke due to medium vessel occlusion (MeVO) are often poor when treated with best medical management. Data from non-randomized studies suggest that endovascular treatment (EVT) may improve outcomes in MeVO stroke, but randomized data on potential benefits and risks are hitherto lacking. Thus, there is insufficient evidence to guide EVT decision-making in MeVO stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The primary aim of the ESCAPE-MeVO trial is to demonstrate that acute, rapid EVT in patients with acute ischemic stroke due to MeVO results in better clinical outcomes compared to best medical management. Secondary outcomes are to demonstrate the safety of EVT, its impact on self-reported health-related quality of life, and cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sample size estimates: &lt;/strong&gt;Based on previously published data, we estimate a sample size of 500 subjects to achieve a power of 85% with a two-sided alpha of 0.05. To account for potential loss to follow-up, 530 subjects will be recruited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and design: &lt;/strong&gt;ESCAPE-MeVO is a multicenter, prospective, randomized, open-label study with blinded endpoint evaluation (PROBE design), clinicaltrials.gov: NCT05151172. Subjects with acute ischemic stroke due to MeVO meeting the trial eligibility criteria will be allocated in a 1:1 ratio to best medical care plus EVT versus best medical care only. Patients will be screened only at comprehensive stroke centers to determine if they are eligible for the trial, regardless of whether they were previously treated at a primary care center. Key eligibility criteria are (1) acute ischemic stroke due to MeVO that is clinically and technically eligible for EVT, (2) last-known well within the last 12 h, (3) National Institutes of Health Stroke Scale &gt; 5 or 3-5 with disabling deficit, (4) high likelihood of salvageable tissue on non-invasive neuroimaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study outcomes: &lt;/strong&gt;The primary outcome is the modified Rankin scale 90 days after randomization (shift analysis), whereby modified Rankin Score 5 and 6 will be collapsed into one category. Secondary outcomes include dichotomizations of the modified Rankin Score at 90 days, 24 h National Institutes of Health Stroke Score, difference between 24 h and baseline National Institutes of Health Stroke Score, mortality at 90 days, health-related quality of life (EQ-5D-5 L), Lawton scale of instrumental activities of daily living score, reperfusion quality (MeVO expanded Thrombolysis in Cerebral Infarction Score) and infarct volume at 24 h, and cost-effectiveness of endovascular recanalization. Safety outcomes include symptomatic and asymptomatic intracranial hemorrhage and procedural complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The ESCAPE-MeVO trial will demonstrate the effect of endovascular thrombectomy in addition to best medical management vis-à-vis best medical management in patients with acute ischemic stroke","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1064-1070"},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Modification effects of immigration status and comorbidities on associations of heat and heatwave with stroke morbidity. 移民身份和合并症对高温和热浪与中风发病率相关性的修正效应。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1177/17474930241263725
Chenlu Yang, Yike Li, Cunrui Huang, Yonglin Hou, Dandan Chu, Junzhe Bao

Background: Heat and heatwave have been associated with stroke morbidity, but it is still unclear whether immigrants from different geographic regions and patients with comorbidity are more vulnerable to heat and heatwave.

Methods: Time-stratified case-crossover design combined with generalized additive quasi-Poisson models were used to quantify the relative risks (RRs) of heat and heatwave on first-ever stroke morbidity during 0-7 lag days. Attributable fractions (AFs) were estimated to assess the first-ever stroke morbidity burden due to heat and heatwave. Stratified analyses for sex, age, disease subtypes, resident characteristics, and comorbidity type were performed to identify potential modification effects.

Results: Heat and heatwave were associated with first-ever stroke morbidity, with the AF of 2.535% (95% empirical confidence interval (eCI) = 0.748, 4.205) and 2.409% (95% confidence interval (CI) = 1.228, 3.400), respectively. Among northern and southern immigrants, the AF for heat was 2.806% (0.031, 5.069) and 2.798% (0.757, 4.428), respectively, and the AF for heatwave was 2.918% (0.561, 4.618) and 2.387% (1.174, 3.398), respectively, but the effects of both on natives were statistically insignificant. Among patients with hypertension, dyslipidemia, or diabetes, the AF for heat was 3.318% (1.225, 5.007), 4.237% (1.037, 6.770), and 4.860% (1.171, 7.827), respectively, and the AF for heatwave was 2.960% (1.701, 3.993), 2.771% (0.704, 4.308), and 2.652% (0.653, 4.185), respectively. However, the effects of both on patients without comorbidity were statistically insignificant.

Conclusion: Heat and heatwave are associated with an increased risk of first-ever stroke morbidity among immigrants and those with comorbid hypertension, dyslipidemia, or diabetes, with the effects primarily due to non-native individuals.

Data access statement: The author(s) are not authorized to share the data.

背景:高温和热浪与中风发病率有关:高温和热浪与中风发病率有关,但来自不同地理区域的移民和合并症患者是否更容易受到高温和热浪的影响仍不清楚:方法:采用时间分层病例交叉设计结合广义加性准泊松模型来量化高温和热浪对 0-7 滞后天首次发病中风的相对风险(RR)。估算了可归因分数(AF),以评估高温和热浪导致的首次发病中风负担。对性别、年龄、疾病亚型、居民特征和合并症类型进行了分层分析,以确定潜在的修正效应:结果:炎热和热浪与首次中风发病率相关,其AF值分别为2.535%(95% eCI:0.748, 4.205)和2.409%(95% CI:1.228, 3.400)。在北方和南方移民中,高温的自动平均血脂指数分别为 2.806% (0.031, 5.069) 和 2.798% (0.757, 4.428),热浪的自动平均血脂指数分别为 2.918% (0.561, 4.618) 和 2.387% (1.174, 3.398),但两者对本地人的影响在统计学上并不显著。在高血压、血脂异常或糖尿病患者中,热量的 AF 为 3.318%(1.225,5.007)、4.237%(1.037,6.770)和 4.860%(1.171,7.827),热浪的AF分别为2.960%(1.701,3.993)、2.771%(0.704,4.308)和2.652%(0.653,4.185)。然而,两者对无合并症患者的影响在统计学上并不显著:结论:高温和热浪与移民及合并高血压、血脂异常或糖尿病的人群首次中风发病风险增加有关,其影响主要来自非本地人。
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引用次数: 0
Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes. 体重指数对缺血性和出血性脑卒中预后的临床影响。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-06 DOI: 10.1177/17474930241249370
Kaori Miwa, Michikazu Nakai, Sohei Yoshimura, Yusuke Sasahara, Shinichi Wada, Junpei Koge, Akiko Ishigami, Yoshiki Yagita, Kenji Kamiyama, Yoshihiro Miyamoto, Shotai Kobayashi, Kazuo Minematsu, Kazunori Toyoda, Masatoshi Koga

Background and aim: To investigate the prognostic implication of body mass index (BMI) on clinical outcomes after acute ischemic and hemorrhagic stroke.

Methods: The subjects of the study included adult patients with available baseline body weight and height data who had suffered an acute stroke and were registered in the Japan Stroke Data Bank-a hospital-based, multicenter stroke registration database-between January 2006 and December 2020. The outcome measures included unfavorable outcomes defined as a modified Rankin Scale (mRS) score of 5-6 and favorable outcomes (mRS 0-2) at discharge, and in-hospital mortality. Mixed effects logistic regression analysis was conducted to determine the relationship between BMI categories (underweight, normal weight, overweight, class I obesity, class II obesity; <18.5, 18.5-23.0, 23.0-25.0, 25-30, ⩾30 kg/m2) and the outcomes, after adjustment for covariates.

Results: A total of 56,230 patients were assigned to one of the following groups: ischemic stroke (IS, n = 43,668), intracerebral hemorrhage (ICH, n = 9741), and subarachnoid hemorrhage (SAH, n = 2821). In the IS group, being underweight was associated with an increased likelihood of unfavorable outcomes (odds ratio, 1.47 (95% confidence interval (CI):1.31-1.65)) and in-hospital mortality (1.55 (1.31-1.83)) compared to outcomes in those with normal weight. Being overweight was associated with an increased likelihood of favorable outcomes (1.09 (1.01-1.18)). Similar associations were observed between underweight and these outcomes in specific IS subtypes (cardioembolic stroke, large artery stroke, and small-vessel occlusion). Patients with a BMI ⩾30.0 kg/m2 was associated with an increased likelihood of unfavorable outcomes (1.44 (1.01-2.17)) and in-hospital mortality (2.42 (1.26-4.65)) in large artery stroke. In patients with ICH, but not those with SAH, being underweight was associated with an increased likelihood of unfavorable outcomes (1.41 (1.01-1.99)).

Conclusions: BMI substantially impacts functional outcomes following IS and ICH. Lower BMI consistently affected post-stroke disability and mortality, while higher BMI values similarly affected these outcomes after large artery stroke.

背景和目的:研究体重指数(BMI)对急性缺血性和出血性脑卒中临床预后的影响:研究对象包括 2006 年 1 月至 2020 年 12 月期间在日本脑卒中数据库(Japan Stroke Data Bank)--一个基于医院的多中心脑卒中登记数据库--登记的急性脑卒中成年患者,这些患者均有体重和身高基线数据。结果测量包括出院时的不利结果(定义为改良Rankin量表(mRS)5-6分)、有利结果(mRS 0-2)和院内死亡率。在对协变量进行调整后,进行了混合效应逻辑回归分析,以确定体重指数类别(体重不足、正常体重、超重、I 级肥胖、II 级肥胖;2)与结果之间的关系:共有 56230 名患者被分配到以下组别:缺血性中风(IS,n = 43668)、脑内出血(ICH,n = 9741)和蛛网膜下腔出血(SAH,n = 2821)。在IS组中,与体重正常者的结果相比,体重过轻与不利结果(几率比1.47(95%置信区间(CI):1.31-1.65))和院内死亡率(1.55(1.31-1.83))的可能性增加有关。超重与有利结果的可能性增加有关(1.09 (1.01-1.18))。在特定的 IS 亚型(心栓塞性中风、大动脉中风和小血管闭塞)中,也观察到体重不足与这些结果之间存在类似的关联。在大动脉卒中中,BMI ⩾30.0 kg/m2 的患者出现不良预后(1.44 (1.01-2.17))和院内死亡率(2.42 (1.26-4.65))的可能性增加。在 ICH 患者中,体重过轻与不良预后的可能性增加(1.41 (1.01-1.99))相关,但与 SAH 患者无关:结论:体重指数对IS和ICH后的功能预后有很大影响。结论:体重指数对 IS 和 ICH 后的功能预后有很大影响。体重指数越低,中风后的残疾率和死亡率越高,而体重指数越高,大动脉中风后的这些预后也会受到类似影响。
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引用次数: 0
Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis. 全国感染性心内膜炎队列中的中风患病率和预后影响。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-26 DOI: 10.1177/17474930241255560
Sara Álvarez-Zaballos, Pilar Vázquez-Alen, Patricia Muñoz, Arístides de Alarcón, Encarnación Gutiérrez Carretero, Ana Álvarez-Uría, Mª Carmen Fariñas, Raquel Rodríguez-García, Miguel Ángel Goenaga, Guillermo Cuervo, Antonio Plata-Ciezar, Carmen Hidalgo-Tenorio, Gonzalo Aldamiz-Echevarría, Manuel Martínez-Sellés

Background: Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE.

Methods: Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021.

Results: Out of 5667 IE cases, 1125 had acute stroke (19.8%): 818 ischemic strokes (811 cardioembolic strokes (193 with hemorrhagic transformation), 4 transient ischemic attacks, 3 lacunar infarctions), 127 intracranial hemorrhages, and 27 other neurological complications (cerebral abscesses, encephalitis, and meningitis). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs 63.7%, p = 0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p = 0.01), surgical indication (69.9% vs 65.9%, p = 0.001), in-hospital mortality (40.9% vs 22.0%, p < 0.001), and 1-year mortality (46.2% vs 27.9%, p < 0.001). The following variables were independently associated with stroke: mitral location (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.34-1.8, p < 0.001), vascular phenomenon (OR = 2.9, 95% CI = 2.4-3.6, p = 0.0001), acute renal failure (OR = 1.2, 95% CI = 1.0-1.4, p = 0.021), septic shock (OR = 1.3, 95% CI = 1.1-1.6, p = 0.007), sepsis (OR = 1.3, 95% CI = 1.1-1.6, p = 0.005), surgery indicated but not performed (OR = 1.4, 95% CI = 1.2-1.7, p < 0.001), community-acquired IE (OR = 1.2, 95% CI = 1-1.4, p = 0.017), and peripheral embolization (OR = 1.6, 95% CI = 1.4-1.9, p < 0.001). Stroke was an independent predictor of in-hospital (OR = 2.1, 95% CI = 1.78-2.51, p < 0.001) and 1-year mortality (hazard ratio = 1.9, 95% CI = 1.6-2.5).

Conclusion: One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.

背景:中风是感染性心内膜炎(IE)的常见并发症:中风是感染性心内膜炎(IE)的常见并发症。我们的目的是在全国前瞻性 IE 队列中描述中风的发病率和预后影响:方法:2008年至2021年期间连续纳入46家西班牙医院:结果:在5667例IE病例中,1125例患有急性中风(19.8%):811例缺血性中风(618例心肌栓塞性中风、193例心肌栓塞性中风伴出血性转变、4例短暂性脑缺血发作、3例腔隙性脑梗塞)、125例颅内出血和29例其他神经系统并发症(脑脓肿、脑炎、脑膜炎、癫痫发作)。与无中风的患者相比,中风患者的平均年龄(69 岁)相似,但女性患者较多(68.2% 对 63.7%,P=0.04),心内并发症(35% 对 30%,P=0.01)、手术指征(69.9% 对 65.9%,P=0.001)、院内死亡率(40.9% 对 22.0%,P=0.001)的发生率较高:五分之一的 IE 患者合并中风。中风与死亡率相关。
{"title":"Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis.","authors":"Sara Álvarez-Zaballos, Pilar Vázquez-Alen, Patricia Muñoz, Arístides de Alarcón, Encarnación Gutiérrez Carretero, Ana Álvarez-Uría, Mª Carmen Fariñas, Raquel Rodríguez-García, Miguel Ángel Goenaga, Guillermo Cuervo, Antonio Plata-Ciezar, Carmen Hidalgo-Tenorio, Gonzalo Aldamiz-Echevarría, Manuel Martínez-Sellés","doi":"10.1177/17474930241255560","DOIUrl":"10.1177/17474930241255560","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE.</p><p><strong>Methods: </strong>Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021.</p><p><strong>Results: </strong>Out of 5667 IE cases, 1125 had acute stroke (19.8%): 818 ischemic strokes (811 cardioembolic strokes (193 with hemorrhagic transformation), 4 transient ischemic attacks, 3 lacunar infarctions), 127 intracranial hemorrhages, and 27 other neurological complications (cerebral abscesses, encephalitis, and meningitis). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs 63.7%, p = 0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p = 0.01), surgical indication (69.9% vs 65.9%, p = 0.001), in-hospital mortality (40.9% vs 22.0%, p < 0.001), and 1-year mortality (46.2% vs 27.9%, p < 0.001). The following variables were independently associated with stroke: mitral location (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.34-1.8, p < 0.001), vascular phenomenon (OR = 2.9, 95% CI = 2.4-3.6, p = 0.0001), acute renal failure (OR = 1.2, 95% CI = 1.0-1.4, p = 0.021), septic shock (OR = 1.3, 95% CI = 1.1-1.6, p = 0.007), sepsis (OR = 1.3, 95% CI = 1.1-1.6, p = 0.005), surgery indicated but not performed (OR = 1.4, 95% CI = 1.2-1.7, p < 0.001), community-acquired IE (OR = 1.2, 95% CI = 1-1.4, p = 0.017), and peripheral embolization (OR = 1.6, 95% CI = 1.4-1.9, p < 0.001). Stroke was an independent predictor of in-hospital (OR = 2.1, 95% CI = 1.78-2.51, p < 0.001) and 1-year mortality (hazard ratio = 1.9, 95% CI = 1.6-2.5).</p><p><strong>Conclusion: </strong>One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"989-998"},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population. 多种族亚裔人群中脑卒中患者复发和预后的相关人口学因素。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-06 DOI: 10.1177/17474930241257759
Keng Siang Lee, Isabel Siow, Tessa Riandini, Kaavya Narasimhalu, Kelvin Bryan Tan, Deidre Anne De Silva

Objective: There is a paucity of studies investigating the outcomes among Asian stroke patients. Identifying subgroups of stroke patients at risk of poorer outcomes could identify patients who would benefit from targeted interventions. Therefore, the aim of this study was to identify which ischemic stroke patients at high risk of recurrent events and mortality.

Methods: This cohort study adhered to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. We obtained data from the Singapore Stroke Registry (SSR) from 2005 to 2016 and cross referenced to the Death Registry and the Myocardial Infarction Registry. Outcome measures included recurrent stroke, acute myocardial infarction (AMI), and all-cause and stroke-related deaths. Multivariable Cox proportional hazards regression models were performed to determine risk factors for recurrent stroke, AMI, and all-cause and stroke-related deaths.

Results: A total of 64,915 patients (6705 young, and 58,210 older) were included in our analysis. Older stroke patients were found to have an increased risk of recurrent stroke (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.12-1.30), AMI (HR = 1.73, 95% CI = 1.54-1.95), all-cause death (HR = 2.49, 95% CI = 2.34-2.64), and stroke-related death (HR = 176, 95% CI = 1.61-1.92). Among young stroke patients, males were at increased risk for recurrent stroke (HR = 1.18, 95% CI = 1.01-1.39) and AMI (HR = 1.41, 95% CI = 1.08-1.83), but at reduced risk for all-cause (HR = 0.78, 95% CI = 0.69-0.89) and stroke-related deaths (HR = 0.79, 95% CI = 0.67-0.94). Ethnicity appeared to influence outcomes, with Malay patients at increased risk of recurrent stroke (HR = 1.37, 95% CI = 1.14-1.65), AMI (HR = 2.45, 95% CI = 1.87-3.22), and all-cause (HR = 1.43, 95% CI = 1.24-1.66) and stroke-related deaths (HR = 1.34, 95% CI = 1.09-1.64). Indian patients were also at increased risk of AMI (HR = 1.96, 95% CI = 1.41-2.72). Similar findings were seen among the older stroke patients.

Conclusion: This study found that older stroke patients are at risk of poorer outcomes. Within the young stroke population specifically, males were predisposed to recurrent stroke and AMI but were protected against all-cause and stroke-related deaths. Males were also at reduced risk of all-cause and stroke-related deaths in the older stroke population. In addition, Malay and Indian patients experience poorer outcomes after first stroke. Further optimization of risk factors targeting these high-priority populations are needed to achieve high-quality care.

目的:有关亚裔中风患者预后的研究很少。识别有较差预后风险的中风患者亚群可确定哪些患者可从有针对性的干预措施中获益。因此,本研究旨在确定哪些缺血性脑卒中患者有复发和死亡的高风险:这项队列研究遵循了《加强流行病学观察性研究的报告》(STrengthening the Reporting of OBservational studies in Epidemiology,STROBE)指南。我们从新加坡卒中登记处(SSR)获得了 2005 年至 2016 年的数据,并与死亡登记处、心肌梗死登记处进行了交叉比对。结果指标包括复发性卒中、急性心肌梗死(AMI)、全因死亡和卒中相关死亡。采用多变量考克斯比例危险回归模型确定复发性中风、急性心肌梗死、全因和中风相关死亡的风险因素:共有 64,915 名患者(6,705 名年轻患者和 58,210 名老年患者)纳入了我们的分析。发现老年中风患者复发中风(HR = 1.21,95%CI:1.12-1.30)、急性心肌梗死(HR = 1.73,95%CI:1.54-1.95)、全因死亡(HR = 2.49,95%CI:2.34-2.64)和中风相关死亡(HR = 176,95%CI:1.61-1.92)的风险增加。在年轻脑卒中患者中,男性复发脑卒中(HR = 1.18,95%CI:1.01-1.39)和急性心肌梗死(HR = 1.41,95%CI:1.08-1.83)的风险增加,但全因(HR = 0.78,95%CI:0.69-0.89)和脑卒中相关死亡(HR = 0.79,95%CI:0.67-0.94)的风险降低。种族似乎对预后有影响,马来患者复发中风(HR = 1.37,95%CI:1.14-1.65)、AMI(HR = 2.45,95%CI:1.87-3.22)、全因(HR = 1.43,95%CI:1.24-1.66)和中风相关死亡(HR = 1.34,95%CI:1.09-1.64)的风险增加。印度患者发生急性心肌梗死的风险也有所增加(HR = 1.96,95%CI:1.41-2.72)。在老年中风患者中也有类似发现:本研究发现,老年脑卒中患者的预后风险较低。特别是在年轻中风人群中,男性易患中风复发和急性心肌梗死,但可避免全因死亡和中风相关死亡。在老年中风人群中,男性全因死亡和中风相关死亡的风险也有所降低。此外,马来和印度患者在首次中风后的预后较差。需要针对这些高危人群进一步优化风险因素,以实现高质量的医疗服务。
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引用次数: 0
Enhanced versus standard hydration in acute ischemic stroke: REVIVE-A randomized clinical trial. 急性缺血性脑卒中患者加强水合与标准水合的对比:REVIVE - 随机临床试验。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1177/17474930241259940
Leng Chieh Lin, Tsong-Hai Lee, Yen Chu Huang, Yuan Hsiung Tsai, Jen Tsung Yang, Lan Yan Yang, Yu-Bin Pan, Meng Lee, Kuan-Fu Chen, Yu-Cheng Hung, Hsien-Hung Cheng, I-Neng Lee, Ming Hsueh Lee, Tefa Chiu, Yeu-Jhy Chang, Zhong Ning Leonard Goh, Chen-June Seak

Rationale: Early neurological deterioration (END) within 72 h of stroke onset is associated with poor prognosis. Optimizing hydration might reduce the risk of END.

Aims: This study aimed to determine in acute ischemic stroke patients if enhanced hydration versus standard hydration reduced the incidence of major (primary) and minor (secondary) END, as well as whether it increased the incidence of early neurological improvement (secondary), at 72 h after admission.

Sample size estimate: A total of 244 participants per arm.

Methods and design: A prospective, double-blinded, multicenter, parallel-group, randomized controlled trial conducted at four hospitals from April 2014 to July 2020, with data analyzed in August 2020. The sample size estimated was 488 participants (244 per arm). Ischemic stroke patients with measurable neurological deficits of onset within 12 h of emergency department presentation and blood urea nitrogen/creatinine (BUN/Cr) ratio ⩾ 15 at point of admission were enrolled and randomized to 0.9% sodium chloride infusions of varying rates-enhanced hydration (20 mL/kg body weight, one-third given via bolus and remainder over 8 h) versus standard hydration (60 mL/h for 8 h), followed by maintenance infusion of 40-80 mL/h for the subsequent 64 h. The primary outcome measure was the incidence of major END at 72 h after admission, defined as an increase in National Institutes of Health Stroke Scale of ⩾ 4 points from baseline.

Results: Overall, 487 participants were randomized (median age 67 years; 287 females). At 72 h, 7 (2.9%) in the enhanced hydration arm and 5 (2.0%) in the standard hydration developed major END (p = 0.54). The incidence of minor END and early neurological improvement did not differ between treatment arms.

Conclusion and relevance: Enhanced hydration did not reduce END or improve short-term outcomes in acute ischemic stroke.

Trial registration: ClinicalTrials.gov (NCT02099383, https://clinicaltrials.gov/study/NCT02099383).

理由:卒中发生后 72 小时内的早期神经功能恶化 (END) 与预后不良有关。目的:确定急性缺血性脑卒中患者入院 72 小时后,加强水化与标准水化相比是否能降低主要(主要)和次要(次要)END 的发生率,以及是否能增加早期神经功能改善(次要)的发生率:前瞻性、双盲、多中心、平行组、随机对照试验,2014 年 4 月至 2020 年 7 月在 4 家医院进行,2020 年 8 月分析数据。样本量估计为 488 人(每组 244 人)。缺血性脑卒中患者在急诊科就诊 12 小时内出现可测量的神经功能缺损,且入院时血尿素氮/肌酐 (BUN/Cr) 比值≥15,这些患者被纳入试验并随机接受不同速率的 0.9% 氯化钠输注--加强型水合(20 毫升/千克体重,三分之一为栓剂输注,其余在 8 小时内输注)与标准型水合(60 毫升/小时,持续 8 小时),随后 64 小时内维持 40-80 毫升/小时的输注。主要结果指标是入院 72 小时后早期严重神经功能恶化的发生率,即美国国立卫生研究院卒中量表比基线增加≥4 分:487名参与者接受了随机治疗(中位年龄67岁;287名女性)。72小时后加强补液组中有 7 人(2.9%)出现严重早期神经功能恶化,标准补液组中有 5 人(2.0%)出现严重早期神经功能恶化(P=0.54)。轻微早期神经功能恶化和早期神经功能改善的发生率在不同治疗组之间没有差异:试验注册:试验注册:ClinicalTrials.gov (NCT02099383, https://clinicaltrials.gov/study/NCT02099383)。
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引用次数: 0
A scoping review of patient and public involvement in empirical stroke research. 卒中实证研究中患者和公众参与 (PPI) 的范围审查。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1177/17474930241262638
Paula da Cruz Peniche, Christina Danielli Coelho de Morais Faria, Patricia Hall, Caitriona Fingleton, Louise McPhillips, Rebecca Gaetz, Aaron Roche, Laura McCann, Padraig O'Beaglaoich, Diarmuid Murphy, Julianne Hickey, Olive Lennon

Background: Impactful, evidence-based solutions in surveillance, prevention, acute care, and rehabilitation for stroke survivors are required to address the high global burden of stroke. Patient and public involvement (PPI), where patients, their families, and the public are actively involved as research partners, enhances the relevance, credibility, and impact of stroke-related research.

Aims: This scoping review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Scoping Review guidelines, aims to identify and summarize how PPI is currently implemented and reported in empirical stroke research using a participatory approach.

Summary of review: A comprehensive search strategy was developed and implemented across Medline, CINAHL, EMBASE, PsynchINFO, and Cochrane electronic databases, supplemented by gray literature searches. Empirical stroke research articles in the English language, published from 2014 up to 2023, and documenting PPI activity were included. Of the 18,143 original articles identified, 2824 full-text manuscripts matching from this time window were screened. Only 2% (n = 72) of these directly reported embedded PPI activity in empirical research. The majority were qualitative in design (60%) and conducted in high-income countries (96%). Only one included study originated from a developing country, where the burden of stroke is highest. Most studies (94%) provided some information about the activities carried out with their PPI partners, mainly centered on the study design (57%) and management (64%), with only 4% of studies integrating PPI across all research cycle phases from funding application to dissemination. When studies were examined for compliance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP) short-form checklist, only 11% of included studies were 100% compliant. Twenty-one studies (29%) reported barriers and facilitators to including PPI in stroke research. Organization, authentic partnership, and experienced PPI representatives were common facilitators and identified barriers reflected concerns around adequate funding, time required, and diversity in perspectives. A positive reporting bias for PPI impact was observed, summarized as keeping the patient perspective central to the research process, improved care of study participants, validation of study findings, and improved communication/lay-summaries of complex research concepts.

Conclusions: PPI is underutilized and inconsistently reported in current empirical stroke research. PPI must become more widely adopted, notably in low- and middle-income countries. Consensus-driven standards for inclusion of PPI by funding organizations and publishers are required to support its widespread adoption.

背景:要解决中风给全球带来的沉重负担,需要在监测、预防、急性期治疗和康复方面为中 风幸存者提供有影响力的循证解决方案。患者和公众参与(Patient and Public Involvement,PPI),即患者、患者家属和公众作为研究伙伴积极参与,可提高中风相关研究的相关性、可信度和影响力。目的:本范围界定综述遵循 PRISMA 范围界定综述指南,旨在确定和总结目前在实证中风研究中如何使用参与式方法实施和报告 PPI:制定并实施了全面的检索策略,涵盖 Medline、CINAHL、EMBASE、PsynchINFO 和 Cochrane 电子数据库,并辅以灰色文献检索。纳入了从 2014 年到 2023 年发表的、记录 PPI 活动的英文脑卒中实证研究论文。在确定的 18,143 篇原始论文中,筛选了 2,824 篇与该时间窗口匹配的全文手稿。其中只有 2%(n=72)直接报告了实证研究中的嵌入式 PPI 活动。大多数研究采用定性设计(60%),在高收入国家进行(96%)。只有一项纳入的研究来自中风负担最重的发展中国家。大多数研究(94%)提供了一些有关与其 PPI 合作伙伴开展活动的信息,主要集中在研究设计(57%)和管理(64%)方面,只有 4% 的研究将 PPI 纳入了从资金申请到传播的所有研究周期阶段。在检查研究是否符合《患者和公众参与报告指南》(GRIPP2)简表清单时,只有 11% 的纳入研究 100%符合要求。21项研究(29%)报告了将患者和公众参与纳入卒中研究的障碍和促进因素。组织、真实的合作关系和经验丰富的 PPI 代表是常见的促进因素,已确定的障碍反映了对充足资金、所需时间和观点多样性的担忧。研究发现,PPI 的影响存在积极的报告偏差,概括为将患者视角置于研究过程的中心位置、改善对研究参与者的护理、验证研究结果以及改善复杂研究概念的沟通/非专业总结:结论:在目前的卒中实证研究中,PPI 未得到充分利用,报告也不一致。必须更广泛地采用 PPI,尤其是在中低收入国家。为支持 PPI 的广泛采用,资助机构和出版商需要制定以共识为导向的 PPI 纳入标准。
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International Journal of Stroke
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