Early Neurological Change After Ischemic Stroke Is Associated With 90-Day Outcome
Por:
Heitsch, L, Ibanez, L, Carrera, C, Binkley, MM, Strbian, D, Tatlisumak, T, Bustamante, A, Ribo, M, Molina, C, Davalos, A, Lopez-Cancio, E, Munoz-Narbona, L, Soriano-Tarraga, C, Giralt-Steinhauer, E, Obach, V, Slowik, A, Pera, J, Lapicka-Bodzioch, K, Derbisz, J, Sobrino, T, Castillo, J, Campos, F, Rodriguez-Castro, E, Arias-Rivas, S, Segura, T, Serrano-Heras, G, Vives-Bauza, C, Diaz-Navarro, R, Tur, S, Jimenez, C, Marti-Fabregas, J, Delgado-Mederos, R, Arenillas, J, Krupinski, J, Cullell, N, Torres-Aguila, NP, Muino, E, Carcel-Marquez, J, Moniche, F, Cabezas, JA, Ford, AL, Dhar, R, Roquer, J, Khatri, P, Jimenez-Conde, J, Fernandez-Cadenas, I, Montaner, J, Rosand, J, Cruchaga, C, Lee, JM
Publicada:
1 ene 2021
Resumen:
Background and Purpose:
Large-scale observational studies of acute ischemic stroke (AIS) promise to reveal mechanisms underlying cerebral ischemia. However, meaningful quantitative phenotypes attainable in large patient populations are needed. We characterize a dynamic metric of AIS instability, defined by change in National Institutes of Health Stroke Scale score (NIHSS) from baseline to 24 hours baseline to 24 hours (NIHSSbaseline - NIHSS24hours = Delta NIHSS6-24h), to examine its relevance to AIS mechanisms and long-term outcomes.
Methods:
Patients with NIHSS prospectively recorded within 6 hours after onset and then 24 hours later were enrolled in the GENISIS study (Genetics of Early Neurological Instability After Ischemic Stroke). Stepwise linear regression determined variables that independently influenced Delta NIHSS6-24h. In a subcohort of tPA (alteplase)-treated patients with large vessel occlusion, the influence of early sustained recanalization and hemorrhagic transformation on Delta NIHSS6-24h was examined. Finally, the association of Delta NIHSS6-24h with 90-day favorable outcomes (modified Rankin Scale score 0-2) was assessed. Independent analysis was performed using data from the 2 NINDS-tPA stroke trials (National Institute of Neurological Disorders and Stroke rt-PA).
Results:
For 2555 patients with AIS, median baseline NIHSS was 9 (interquartile range, 4-16), and median Delta NIHSS6-24h was 2 (interquartile range, 0-5). In a multivariable model, baseline NIHSS, tPA-treatment, age, glucose, site, and systolic blood pressure independently predicted Delta NIHSS6-24h (R-2=0.15). In the large vessel occlusion subcohort, early sustained recanalization and hemorrhagic transformation increased the explained variance (R-2=0.27), but much of the variance remained unexplained. Delta NIHSS6-24h had a significant and independent association with 90-day favorable outcome. For the subjects in the 2 NINDS-tPA trials, Delta NIHSS3-24h was similarly associated with 90-day outcomes.
Conclusions:
The dynamic phenotype, Delta NIHSS6-24h, captures both explained and unexplained mechanisms involved in AIS and is significantly and independently associated with long-term outcomes. Thus, Delta NIHSS6-24h promises to be an easily obtainable and meaningful quantitative phenotype for large-scale genomic studies of AIS.
Filiaciones:
Heitsch, L:
Washington Univ, Div Emergency Med, Sch Med, St Louis, MO 63110 USA
Washington Univ, Dept Neurol, Sch Med, St Louis, MO 63110 USA
Ibanez, L:
Washington Univ, Dept Psychiat, Sch Med, St Louis, MO 63110 USA
Carrera, C:
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Res Lab, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Unit, Barcelona, Spain
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Neurol, Barcelona, Spain
Binkley, MM:
Washington Univ, Dept Neurol, Sch Med, St Louis, MO 63110 USA
Strbian, D:
Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland
Tatlisumak, T:
Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland
Univ Gothenburg, Dept Clin Neurosci, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden
Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden
Bustamante, A:
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Res Lab, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Unit, Barcelona, Spain
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Neurol, Barcelona, Spain
Ribo, M:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Neurol, Barcelona, Spain
Molina, C:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Neurol, Barcelona, Spain
Davalos, A:
Hosp Badalona Germans Trias & Pujol, Dept Neurol, Badalona, Spain
Lopez-Cancio, E:
Hosp Univ Cent Asturias HUCA, Dept Neurol, Oviedo, Spain
Munoz-Narbona, L:
Inst Hosp Mar Invest Med IMIM, Barcelona, Spain
Soriano-Tarraga, C:
Inst Hosp Mar Invest Med IMIM, Barcelona, Spain
Giralt-Steinhauer, E:
Inst Hosp Mar Invest Med IMIM, Barcelona, Spain
Hosp Mar, Dept Neurol, Barcelona, Spain
Obach, V:
Univ Barcelona, Hosp Clin, Dept Neurosci, Barcelona, Spain
August Pi i Sunyer Biomed Res Inst IDIBAPS, Barcelona, Spain
Slowik, A:
Jagiellonian Univ Med Coll, Dept Neurol, Krakow, Poland
Pera, J:
Jagiellonian Univ Med Coll, Dept Neurol, Krakow, Poland
Lapicka-Bodzioch, K:
Jagiellonian Univ Med Coll, Dept Neurogenet, Krakow, Poland
Derbisz, J:
Jagiellonian Univ Med Coll, Dept Neurol, Krakow, Poland
Sobrino, T:
Univ Santiago de Compostela, Hosp Clin Univ, Hlth Res Inst Santiago de Compostela, Clin Neurosci Res Lab, Santiago De Compostela, Spain
Hosp Univ Albacete, Dept Neurol, Albacete, Spain
Castillo, J:
Univ Santiago de Compostela, Hosp Clin Univ, Hlth Res Inst Santiago de Compostela, Clin Neurosci Res Lab, Santiago De Compostela, Spain
Campos, F:
Univ Santiago de Compostela, Hosp Clin Univ, Hlth Res Inst Santiago de Compostela, Clin Neurosci Res Lab, Santiago De Compostela, Spain
Rodriguez-Castro, E:
Univ Santiago de Compostela, Hosp Clin Univ, Hlth Res Inst Santiago de Compostela, Clin Neurosci Res Lab, Santiago De Compostela, Spain
Arias-Rivas, S:
Univ Santiago de Compostela, Hosp Clin Univ, Hlth Res Inst Santiago de Compostela, Clin Neurosci Res Lab, Santiago De Compostela, Spain
Segura, T:
Univ Santiago de Compostela, Hosp Clin Univ, Hlth Res Inst Santiago de Compostela, Clin Neurosci Res Lab, Santiago De Compostela, Spain
Hosp Univ Albacete, Dept Neurol, Albacete, Spain
Serrano-Heras, G:
Hosp Univ Albacete, Dept Neurol, Albacete, Spain
Vives-Bauza, C:
IdISBa, Dept Neurol, Son Espases Univ Hosp, Palma De Mallorca, Spain
Diaz-Navarro, R:
IdISBa, Dept Neurol, Son Espases Univ Hosp, Palma De Mallorca, Spain
Tur, S:
IdISBa, Dept Neurol, Son Espases Univ Hosp, Palma De Mallorca, Spain
Jimenez, C:
IdISBa, Dept Neurol, Son Espases Univ Hosp, Palma De Mallorca, Spain
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Delgado-Mederos, R:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Arenillas, J:
Hosp Clin Univ Valladolid, Dept Neurol, Valladolid, Spain
Krupinski, J:
Hosp Mutua Terrassa, Dept Neurol, Barcelona, Spain
Manchester Met Univ, Ctr Biosci, Sch Life Sci, Manchester, Lancs, England
Cullell, N:
St Pau Hosp, Fundacio Docencia & Recerca Mutua Terrassa, Stroke Pharmacogen & Genet, Barcelona, Spain
St Pau Hosp, St Pau Inst Res, Stroke Pharmacogen & Genet, Barcelona, Spain
Torres-Aguila, NP:
St Pau Hosp, St Pau Inst Res, Stroke Pharmacogen & Genet, Barcelona, Spain
Muino, E:
St Pau Hosp, Fundacio Docencia & Recerca Mutua Terrassa, Stroke Pharmacogen & Genet, Barcelona, Spain
St Pau Hosp, St Pau Inst Res, Stroke Pharmacogen & Genet, Barcelona, Spain
Carcel-Marquez, J:
St Pau Hosp, Fundacio Docencia & Recerca Mutua Terrassa, Stroke Pharmacogen & Genet, Barcelona, Spain
St Pau Hosp, St Pau Inst Res, Stroke Pharmacogen & Genet, Barcelona, Spain
Moniche, F:
Hosp Univ Virgen del Rocio, Dept Neurol, Seville, Spain
Cabezas, JA:
Hosp Univ Virgen del Rocio, Dept Neurol, Seville, Spain
Ford, AL:
Washington Univ, Dept Neurol, Sch Med, St Louis, MO 63110 USA
Dhar, R:
Washington Univ, Dept Neurol, Sch Med, St Louis, MO 63110 USA
Roquer, J:
Inst Hosp Mar Invest Med IMIM, Barcelona, Spain
Hosp Mar, Dept Neurol, Barcelona, Spain
Khatri, P:
Univ Cincinnati, Dept Neurol, Cincinnati, OH 45221 USA
Jimenez-Conde, J:
Inst Hosp Mar Invest Med IMIM, Barcelona, Spain
Hosp Mar, Dept Neurol, Barcelona, Spain
Fernandez-Cadenas, I:
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Res Lab, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Unit, Barcelona, Spain
Hosp Mutua Terrassa, Dept Neurol, Barcelona, Spain
St Pau Hosp, Fundacio Docencia & Recerca Mutua Terrassa, Stroke Pharmacogen & Genet, Barcelona, Spain
Montaner, J:
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Res Lab, Barcelona, Spain
Univ Autonoma Barcelona, Vall dHebron Inst Res VHIR, Neurovasc Unit, Barcelona, Spain
Univ Seville, Inst Biomed Seville, IBiS Hosp Univ Virgen del Rocio, CSIC, Seville, Spain
Hosp Univ Virgen Macarena, Dept Neurol, Seville, Spain
Rosand, J:
Harvard Med Sch, Div Neurocrit Care & Emergency Neurol, Massachusetts Gen Hosp, Henry & Alison Ctr Brain Hlth,Ctr Genom Med, Boston, MA 02115 USA
Cruchaga, C:
Washington Univ, Dept Psychiat, Sch Med, St Louis, MO 63110 USA
Lee, JM:
Washington Univ, Dept Neurol, Sch Med, St Louis, MO 63110 USA
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