A. Cook, David J. Li, Melissa A. Nestor, M. Bastin
Background: Augmented renal clearance (ARC; creatinine clearance [CrCl] >130 mL/min/1.73 m 2 ) is prevalent in patients with neurological injuries and may influence their exposure to important pharmacological therapies. Little is known about the relationship between estimated and measured CrCl in this population. Methods: This single-center, prospective, observational cohort study aimed to describe the association between ARC and estimated CrCl and neurological outcomes in a broad neurocritical care population. Prospective patient screening criteria included adults aged 18–85 years, with critical illness due to neurologic causes (such as ischemic stroke or subarachnoid hemorrhage) and lack of renal dysfunction on admission. Patients who had at least one urine CrCl measurement performed within the first 7 days of hospitalization were included. Two cohorts were evaluated: those with ARC and those without ARC. Results: Fifty-seven patients were included, of whom 49 (86%) exhibited ARC. Subjects with ARC were more likely to be male and had a significantly higher median measured CrCl (201.7 mL/min/1.73 m 2 ) than those without ARC (109.8 mL/min/ 1.73 m 2 ). The Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score displayed the strongest association (vs. CrCl equations) with ARC development (area under the receiver operating characteristic curve, 0.648). Conclusion: The prevalence of ARC in the present study of a broad neurocritical care population appeared to be high (86%). The ARCTIC score had higher sensitivity and specificity for diagnosing ARC than the common serum creatinine-based estimation.
{"title":"Prevalence and prediction of augmented renal clearance in the neurocritical care population","authors":"A. Cook, David J. Li, Melissa A. Nestor, M. Bastin","doi":"10.18700/jnc.220061","DOIUrl":"https://doi.org/10.18700/jnc.220061","url":null,"abstract":"Background: Augmented renal clearance (ARC; creatinine clearance [CrCl] >130 mL/min/1.73 m 2 ) is prevalent in patients with neurological injuries and may influence their exposure to important pharmacological therapies. Little is known about the relationship between estimated and measured CrCl in this population. Methods: This single-center, prospective, observational cohort study aimed to describe the association between ARC and estimated CrCl and neurological outcomes in a broad neurocritical care population. Prospective patient screening criteria included adults aged 18–85 years, with critical illness due to neurologic causes (such as ischemic stroke or subarachnoid hemorrhage) and lack of renal dysfunction on admission. Patients who had at least one urine CrCl measurement performed within the first 7 days of hospitalization were included. Two cohorts were evaluated: those with ARC and those without ARC. Results: Fifty-seven patients were included, of whom 49 (86%) exhibited ARC. Subjects with ARC were more likely to be male and had a significantly higher median measured CrCl (201.7 mL/min/1.73 m 2 ) than those without ARC (109.8 mL/min/ 1.73 m 2 ). The Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score displayed the strongest association (vs. CrCl equations) with ARC development (area under the receiver operating characteristic curve, 0.648). Conclusion: The prevalence of ARC in the present study of a broad neurocritical care population appeared to be high (86%). The ARCTIC score had higher sensitivity and specificity for diagnosing ARC than the common serum creatinine-based estimation.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44322013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Do Yeon Kim, Jihoon Kang, H. Jeong, Chan-Young Park, J. Kim, B. Kim, Moon‐Ku Han, H. Bae, Baik-Kyun Kim
Background: Although atrial fibrillation (AF)-associated acute ischemic stroke (AIS) is on the rise, is devastating, and life-threatening, there is limited data on the clinical course and in-hospital mortality of patients treated in the intensive care unit (ICU). This study aimed to describe the clinical course and factors associated with in-hospital mortality in AF-associated AIS patients admitted to the ICU. Methods: This study was a retrospective analysis of a prospective nationwide multicenter cohort including non-valvular AF-AIS patients receiving ICU care admitted to 14 stroke centers in South Korea from 2017 to 2020. In-hospital outcomes, including in-hospital mortality and neurological deterioration (ND) have been described. Result: Amongst 2,487 AF-associated AIS patients, 259 (10.4%) were treated in the ICU. In-hospital mortality and ND occurred in 8.5% and 17.0% of the patients, respectively. Higher rates of initial National Institute for Health Stroke Scale scores, symptomatic steno-occlusive lesions, and CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65–74, Female) scores were found in those with in-hospital mortality. The CHA2DS2-VASc score after admission increased the risk of in-hospital mortality (odds ratio [OR], 1.48; 95% confidence in-terval [CI], 1.00–2.18) were associated with in-hospital mortality. Antithrombotic use within 48 hours was related to decreased in-hospital mortality (OR, 0.26; 95% CI, 0.10–0.67). Conclusion: ICU care in AF-associated AIS is common, and the establishment of optimal treatment strategies in the ICU may be needed.
{"title":"In-hospital mortality of atrial fibrillation-associated acute ischemic stroke in the intensive care unit","authors":"Do Yeon Kim, Jihoon Kang, H. Jeong, Chan-Young Park, J. Kim, B. Kim, Moon‐Ku Han, H. Bae, Baik-Kyun Kim","doi":"10.18700/jnc.220063","DOIUrl":"https://doi.org/10.18700/jnc.220063","url":null,"abstract":"Background: Although atrial fibrillation (AF)-associated acute ischemic stroke (AIS) is on the rise, is devastating, and life-threatening, there is limited data on the clinical course and in-hospital mortality of patients treated in the intensive care unit (ICU). This study aimed to describe the clinical course and factors associated with in-hospital mortality in AF-associated AIS patients admitted to the ICU. Methods: This study was a retrospective analysis of a prospective nationwide multicenter cohort including non-valvular AF-AIS patients receiving ICU care admitted to 14 stroke centers in South Korea from 2017 to 2020. In-hospital outcomes, including in-hospital mortality and neurological deterioration (ND) have been described. Result: Amongst 2,487 AF-associated AIS patients, 259 (10.4%) were treated in the ICU. In-hospital mortality and ND occurred in 8.5% and 17.0% of the patients, respectively. Higher rates of initial National Institute for Health Stroke Scale scores, symptomatic steno-occlusive lesions, and CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65–74, Female) scores were found in those with in-hospital mortality. The CHA2DS2-VASc score after admission increased the risk of in-hospital mortality (odds ratio [OR], 1.48; 95% confidence in-terval [CI], 1.00–2.18) were associated with in-hospital mortality. Antithrombotic use within 48 hours was related to decreased in-hospital mortality (OR, 0.26; 95% CI, 0.10–0.67). Conclusion: ICU care in AF-associated AIS is common, and the establishment of optimal treatment strategies in the ICU may be needed.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46512757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cerebral hyperperfusion syndrome (CHS) is a failure of autoregulation after a revascularization procedure. It has rarely been reported in patients with no pre-existing cerebral hypoperfusion. Case Report: We present a rare case of a patient who underwent stent graft implantation to treat postirradiated carotid blowout syndrome. The patient developed hypertension, focal neurological deficit, and seizures after the procedure; neuroimages revealed ipsilateral cerebral edema, swelling, and increased cerebral perfusion. CHS was diagnosed based on clinical and radiological findings. The patient recovered gradually after receiving supportive care. Conclusion: Owing to the risk of CHS, monitoring for cerebral perfusion and prevention of hypertension is suggested for patients who undergo stent graft placement for postirradiated carotid blowout syndrome.
{"title":"Cerebral hyperperfusion syndrome after endovascular stent graft reconstruction for postirradiated carotid blowout syndrome: a case report","authors":"Yu-Cheng Huang, Yen-Heng Lin, Chung-wei Lee, Ting-Wei Liao","doi":"10.18700/jnc.220059","DOIUrl":"https://doi.org/10.18700/jnc.220059","url":null,"abstract":"Background: Cerebral hyperperfusion syndrome (CHS) is a failure of autoregulation after a revascularization procedure. It has rarely been reported in patients with no pre-existing cerebral hypoperfusion. Case Report: We present a rare case of a patient who underwent stent graft implantation to treat postirradiated carotid blowout syndrome. The patient developed hypertension, focal neurological deficit, and seizures after the procedure; neuroimages revealed ipsilateral cerebral edema, swelling, and increased cerebral perfusion. CHS was diagnosed based on clinical and radiological findings. The patient recovered gradually after receiving supportive care. Conclusion: Owing to the risk of CHS, monitoring for cerebral perfusion and prevention of hypertension is suggested for patients who undergo stent graft placement for postirradiated carotid blowout syndrome.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47793451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
es-sential treatment modality for emergent large vessel occlusion within 8–24 hours of symptom onset, as multiple randomized Background: Whether thrombectomy benefits differ according to sex remains debatable. We aimed to investigate whether there was a difference in stroke outcomes between men and women treated with thrombectomy. Methods: We studied 173 patients with anterior circulation strokes. Failed recanalization was defined as thrombolysis in cerebral infarction grade 0-2a. Scores >2 on the modified Rankin Scale at 3 months were regarded as poor outcomes. To prove that failed recanalization mediated the association between sex differences and functional outcome, the four steps of the reasoning process adapted from Baron and Kenny’s causal-steps approach were tested. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Results: This study included 76 women and 97 men. Women were older and presented with atrial fibrillation more frequently than men. Female sex was independently associated with failed recanalization (aOR, 2.729; 95% CI, 1.334–5.582), which was an independent predictor of poor outcomes (aOR, 4.630; 95% CI, 1.882–11.389). Women were associated with poor outcomes in the analysis adjusted for confounders, except for failed recanalization (aOR, 2.285; 95% CI, 1.064–4.906). However, the association became insignificant in the additional analysis adjusted for failed recanalization (aOR, 1.670; 95% CI, 0.738–3.784). The indirect effect between female sex and poor outcomes via failed recanalization was statistically significant (aOR, 1.038; 95% CI, 1.010–1.127). Conclusion: Our study showed that failed recanalization mediated the association between women and poor outcomes after thrombectomy. Nonetheless, this might be explained by chance given our limited study population.
{"title":"Failed recanalization mediates the association of women with poor outcomes after thrombectomy: a single-center experience","authors":"Seung-Jae Lee, Tae-Kyeong Lee, J. Moon","doi":"10.18700/jnc.220054","DOIUrl":"https://doi.org/10.18700/jnc.220054","url":null,"abstract":"es-sential treatment modality for emergent large vessel occlusion within 8–24 hours of symptom onset, as multiple randomized Background: Whether thrombectomy benefits differ according to sex remains debatable. We aimed to investigate whether there was a difference in stroke outcomes between men and women treated with thrombectomy. Methods: We studied 173 patients with anterior circulation strokes. Failed recanalization was defined as thrombolysis in cerebral infarction grade 0-2a. Scores >2 on the modified Rankin Scale at 3 months were regarded as poor outcomes. To prove that failed recanalization mediated the association between sex differences and functional outcome, the four steps of the reasoning process adapted from Baron and Kenny’s causal-steps approach were tested. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Results: This study included 76 women and 97 men. Women were older and presented with atrial fibrillation more frequently than men. Female sex was independently associated with failed recanalization (aOR, 2.729; 95% CI, 1.334–5.582), which was an independent predictor of poor outcomes (aOR, 4.630; 95% CI, 1.882–11.389). Women were associated with poor outcomes in the analysis adjusted for confounders, except for failed recanalization (aOR, 2.285; 95% CI, 1.064–4.906). However, the association became insignificant in the additional analysis adjusted for failed recanalization (aOR, 1.670; 95% CI, 0.738–3.784). The indirect effect between female sex and poor outcomes via failed recanalization was statistically significant (aOR, 1.038; 95% CI, 1.010–1.127). Conclusion: Our study showed that failed recanalization mediated the association between women and poor outcomes after thrombectomy. Nonetheless, this might be explained by chance given our limited study population.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42259119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Morvan syndrome is characterized by neuromyotonia, dysautonomia, and various neuropsychiatric symptoms, as well as sleep disturbances, although these are less common than neuromuscular symptoms. Herein, we report a case of Morvan syndrome with peculiar sleep disturbances, documented via polysomnography. Case Report: We present herein the case of a 67-year-old man who developed agitation and severe insomnia after undergoing a thymectomy for the treatment of myasthenia gravis, which was subsequently diagnosed as agrypnia excitata due to Morvan syndrome, based on 24-hour polysomnography. Conclusion: We presented the 24-hour polysomnographic findings of a case of agrypnia excitata in Morvan syndrome. An extended polysomnography, however, might be helpful in analyzing sleep disturbances in Morvan syndrome.
{"title":"Morvan syndrome presenting with agrypnia excitata in post-thymectomy myasthenia gravis: a case report","authors":"Seong-il Oh, Mi‐Ri Kang, K. Ji","doi":"10.18700/jnc.220057","DOIUrl":"https://doi.org/10.18700/jnc.220057","url":null,"abstract":"Background: Morvan syndrome is characterized by neuromyotonia, dysautonomia, and various neuropsychiatric symptoms, as well as sleep disturbances, although these are less common than neuromuscular symptoms. Herein, we report a case of Morvan syndrome with peculiar sleep disturbances, documented via polysomnography. Case Report: We present herein the case of a 67-year-old man who developed agitation and severe insomnia after undergoing a thymectomy for the treatment of myasthenia gravis, which was subsequently diagnosed as agrypnia excitata due to Morvan syndrome, based on 24-hour polysomnography. Conclusion: We presented the 24-hour polysomnographic findings of a case of agrypnia excitata in Morvan syndrome. An extended polysomnography, however, might be helpful in analyzing sleep disturbances in Morvan syndrome.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46373237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since the times of Rokitansky and Cushing, we have been fascinated by the connections between the gut and the brain. Recent advances in next-generation sequencing techniques have shown that this relationship is even more complex and integral to our sense of self than previously imagined. As these techniques refine our understanding of the abundance and diversity of the gut bacterial microbiome, the relationship between the gut and the brain has been redefined. Now, this is understood as a complex symbiotic network with bidirectional communication, the gut-brain axis. The implication of this communication involves an intense focus of research on a variety of chronic psychiatric, neurological, neurodegenerative, and neuro-oncological diseases. Recently, the gut-brain axis has been studied in neurologically ill patients requiring intensive care. Preliminary studies have shown that acute brain injury changes the bacterial phenotype from one that is symbiotic with the host human to one that is pathologic, termed the “pathobiome.” This can contribute to nosocomial pneumonia and sepsis. The first studies in neurologically ill patients in the neurointensive care unit (NeuroICU) demonstrated changes in the gut microbiome between neuroICU patients and healthy matched subjects. Specifically, a decrease in short-chain fatty acid-producing bacteria and increase in harmful gut microbes have been associated with mortality and decreased function at discharge. Although these preliminary findings are exciting and have opened a new field of research in the complex NeuroICU population, there are several limitations and challenges. Further investigation is needed to confirm these correlations and understand their implications on patients in a complex intensive care environment.
{"title":"Gut microbiome and neurocritically ill patients","authors":"A. Dono, Y. Esquenazi, HUIMAHN A. Choi","doi":"10.18700/jnc.220058","DOIUrl":"https://doi.org/10.18700/jnc.220058","url":null,"abstract":"Since the times of Rokitansky and Cushing, we have been fascinated by the connections between the gut and the brain. Recent advances in next-generation sequencing techniques have shown that this relationship is even more complex and integral to our sense of self than previously imagined. As these techniques refine our understanding of the abundance and diversity of the gut bacterial microbiome, the relationship between the gut and the brain has been redefined. Now, this is understood as a complex symbiotic network with bidirectional communication, the gut-brain axis. The implication of this communication involves an intense focus of research on a variety of chronic psychiatric, neurological, neurodegenerative, and neuro-oncological diseases. Recently, the gut-brain axis has been studied in neurologically ill patients requiring intensive care. Preliminary studies have shown that acute brain injury changes the bacterial phenotype from one that is symbiotic with the host human to one that is pathologic, termed the “pathobiome.” This can contribute to nosocomial pneumonia and sepsis. The first studies in neurologically ill patients in the neurointensive care unit (NeuroICU) demonstrated changes in the gut microbiome between neuroICU patients and healthy matched subjects. Specifically, a decrease in short-chain fatty acid-producing bacteria and increase in harmful gut microbes have been associated with mortality and decreased function at discharge. Although these preliminary findings are exciting and have opened a new field of research in the complex NeuroICU population, there are several limitations and challenges. Further investigation is needed to confirm these correlations and understand their implications on patients in a complex intensive care environment.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42370259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Timely recognition and intervention for venous outflow obstruction due to intrathoracic pathology are critical for controlling elevated intracranial pressure.Case Report: A 26-year-old man with pectus excavatum and a posterior fossa tumor requiring biopsy, decompression, and cerebrospinal fluid diversion developed pneumomediastinum following intubation with tension physiology and progressive elevation of intracranial pressure. Emergent tracheostomy was performed to decompress intrathoracic pressure, augment venous return, and ultimately expedite the patient’s definitive cancer therapy. Conclusion: Recognition of the mediastinal pathology leading to venous obstruction may be required for the management of malignant intracranial hypertension. Tracheostomy may be a means to decompress mediastinal pressure and augment venous outflow in rare cases of pneumomediastinum with tension physiology.
{"title":"Urgent decompression of tension pneumomediastinum in a patient to relieve elevated intracranial pressure: a case report","authors":"K. M. Ahmed, Teresa V. Chan-Leveno, B. Lussier","doi":"10.18700/jnc.220051","DOIUrl":"https://doi.org/10.18700/jnc.220051","url":null,"abstract":"Background: Timely recognition and intervention for venous outflow obstruction due to intrathoracic pathology are critical for controlling elevated intracranial pressure.Case Report: A 26-year-old man with pectus excavatum and a posterior fossa tumor requiring biopsy, decompression, and cerebrospinal fluid diversion developed pneumomediastinum following intubation with tension physiology and progressive elevation of intracranial pressure. Emergent tracheostomy was performed to decompress intrathoracic pressure, augment venous return, and ultimately expedite the patient’s definitive cancer therapy. Conclusion: Recognition of the mediastinal pathology leading to venous obstruction may be required for the management of malignant intracranial hypertension. Tracheostomy may be a means to decompress mediastinal pressure and augment venous outflow in rare cases of pneumomediastinum with tension physiology.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43213717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tracey H. Fan, Merry Huang, Carrie Price, Lavien Premraj, Nivedha V. Kannapadi, J. Suarez, Sung-Min Cho
1 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA Albert S. Cook Library, Towson University, Towson, MD, USA Griffith University School of Medicine, Gold Coast, Australia 5 Department of Neurology, Neurosurgery, Surgery and Anesthesiology/Critical Care School of Medicine, Johns Hopkins University, Baltimore, MD, USA 6 Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ORIGINAL ARTICLE
{"title":"Prevalence and outcomes of acute respiratory distress syndrome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis","authors":"Tracey H. Fan, Merry Huang, Carrie Price, Lavien Premraj, Nivedha V. Kannapadi, J. Suarez, Sung-Min Cho","doi":"10.18700/jnc.220043","DOIUrl":"https://doi.org/10.18700/jnc.220043","url":null,"abstract":"1 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA Albert S. Cook Library, Towson University, Towson, MD, USA Griffith University School of Medicine, Gold Coast, Australia 5 Department of Neurology, Neurosurgery, Surgery and Anesthesiology/Critical Care School of Medicine, Johns Hopkins University, Baltimore, MD, USA 6 Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ORIGINAL ARTICLE","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43309645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyun-Seung Ryu, S. Ahn, C. Kim, Kyungmi Oh, J. Han, Dae Wook Lee, S. Kim, H. Kim
Background: Hypomagnesemia is associated with stroke severity and increased in-hospital mortality in patients with acute ischemic stroke. This study aimed to assess whether serum magnesium concentration could predict functional outcomes of patients with acute ischemic stroke. Methods: A total of 1,006 patients with acute ischemic stroke were analyzed. A serum magnesium level <1.6 mEq/L was defined as hypomagnesemia. Poor functional outcome was defined as a 3-month modified Rankin Scale (mRS) score ≥4. Multivariate logistic regression models were used to determine the effect of hypomagnesemia on the prognosis of ischemic stroke. Furthermore, patients were grouped according to severity and type of stroke. Within each group, subgroup analyses and interaction analyses were performed to determine whether the effect of hypomagnesemia on functional outcomes was still valid under different clinical conditions. Results: The adjusted odds ratio (OR) for poor 3-month mRS in patients with hypomagnesemia was 2.15 (95% confidence interval [CI], 1.16–3.98; P =0.015). Hypomagnesemia was significantly associated with poor 3-month functional outcomes in patients with minor stroke (Initial National Institutes of Health Stroke Scale [NIHSS] score <5: adjusted OR, 4.20; 95% CI, 1.67–10.59; P =0.002). A significant interaction ( P =0.047) was also observed between hypomagnesemia and the severity of the initial NIHSS. Although there was no significant interaction ( P =0.053), hypomagnesemia was significantly associated with poor functional outcomes in the cardioembolic stroke group (adjusted OR, 3.41; 95% CI, 1.24–9.41; P =0.018). Conclusion: Hypomagnesemia was a strong prognostic marker of poor functional outcome in certain subgroups, especially in patients with mild stroke severity and cardioembolic stroke.
{"title":"Hypomagnesemia as a prognostic marker of ischemic stroke","authors":"Hyun-Seung Ryu, S. Ahn, C. Kim, Kyungmi Oh, J. Han, Dae Wook Lee, S. Kim, H. Kim","doi":"10.18700/jnc.210035","DOIUrl":"https://doi.org/10.18700/jnc.210035","url":null,"abstract":"Background: Hypomagnesemia is associated with stroke severity and increased in-hospital mortality in patients with acute ischemic stroke. This study aimed to assess whether serum magnesium concentration could predict functional outcomes of patients with acute ischemic stroke. Methods: A total of 1,006 patients with acute ischemic stroke were analyzed. A serum magnesium level <1.6 mEq/L was defined as hypomagnesemia. Poor functional outcome was defined as a 3-month modified Rankin Scale (mRS) score ≥4. Multivariate logistic regression models were used to determine the effect of hypomagnesemia on the prognosis of ischemic stroke. Furthermore, patients were grouped according to severity and type of stroke. Within each group, subgroup analyses and interaction analyses were performed to determine whether the effect of hypomagnesemia on functional outcomes was still valid under different clinical conditions. Results: The adjusted odds ratio (OR) for poor 3-month mRS in patients with hypomagnesemia was 2.15 (95% confidence interval [CI], 1.16–3.98; P =0.015). Hypomagnesemia was significantly associated with poor 3-month functional outcomes in patients with minor stroke (Initial National Institutes of Health Stroke Scale [NIHSS] score <5: adjusted OR, 4.20; 95% CI, 1.67–10.59; P =0.002). A significant interaction ( P =0.047) was also observed between hypomagnesemia and the severity of the initial NIHSS. Although there was no significant interaction ( P =0.053), hypomagnesemia was significantly associated with poor functional outcomes in the cardioembolic stroke group (adjusted OR, 3.41; 95% CI, 1.24–9.41; P =0.018). Conclusion: Hypomagnesemia was a strong prognostic marker of poor functional outcome in certain subgroups, especially in patients with mild stroke severity and cardioembolic stroke.","PeriodicalId":33246,"journal":{"name":"Journal of Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46862296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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