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A multiparameter model predicting in-hospital mortality in malignant cerebral infarction
The early identification of patients with large hemisphere infarctions (LHIs) at risk of fatal brain edema may result in better outcomes. A quantitative model using parameters obtained at admission may be a predictor of in-hospital mortality from LHI. This prospective study enrolled all patients wit...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515753/ https://www.ncbi.nlm.nih.gov/pubmed/28700481 http://dx.doi.org/10.1097/MD.0000000000007443 |
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author | Chen, Chien-Fu Lin, Ruey-Tay Lin, Hsiu-Fen Chao, A-Ching |
author_facet | Chen, Chien-Fu Lin, Ruey-Tay Lin, Hsiu-Fen Chao, A-Ching |
author_sort | Chen, Chien-Fu |
collection | PubMed |
description | The early identification of patients with large hemisphere infarctions (LHIs) at risk of fatal brain edema may result in better outcomes. A quantitative model using parameters obtained at admission may be a predictor of in-hospital mortality from LHI. This prospective study enrolled all patients with LHI involving >50% of the middle cerebral artery (MCA) admitted to our neurological intensive care unit within 48 hours of symptom onset. Early clinical and radiographic parameters and the baseline CHADS(2) score (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke [double weight]) were analyzed regarding their ability to predict patient outcomes. Seventy-seven patients with LHIs were identified, 33 (42.9%) with complete MCA infarction (CMCA), and 44 (57.1%) with incomplete MCA infarction (IMCA). The predictors of CMCA score included: >1/3 early hypodensity in computed tomography findings, hyperdense MCA sign, brain edema, initial National Institutes of Health Stroke Scale (NIHSS) score ≥17, and stroke in progression during the 1st 5 days of admission. The cutoff CMCA score was 2, with a sensitivity of 81.8% and specificity of 70.5%. Mortality score 1, used for predicting in-hospital mortality from LHI, included CMCA and CHADS(2) scores ≥4 (sensitivity 100.0%, specificity 57.4%), and mortality score 2 included CMCA and CHADS(2) scores ≥4, and NIHSS score ≥26, during the 1st 5 days (sensitivity 100.0%, specificity 91.7%). Patients qualifying for a mortality score of 2 were at high-risk of in-hospital mortality from LHI. These findings may aid in identifying patients who may benefit from invasive therapeutic strategies, and in better describing the characteristics of those at risk of mortality. |
format | Online Article Text |
id | pubmed-5515753 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-55157532017-07-28 A multiparameter model predicting in-hospital mortality in malignant cerebral infarction Chen, Chien-Fu Lin, Ruey-Tay Lin, Hsiu-Fen Chao, A-Ching Medicine (Baltimore) 5300 The early identification of patients with large hemisphere infarctions (LHIs) at risk of fatal brain edema may result in better outcomes. A quantitative model using parameters obtained at admission may be a predictor of in-hospital mortality from LHI. This prospective study enrolled all patients with LHI involving >50% of the middle cerebral artery (MCA) admitted to our neurological intensive care unit within 48 hours of symptom onset. Early clinical and radiographic parameters and the baseline CHADS(2) score (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke [double weight]) were analyzed regarding their ability to predict patient outcomes. Seventy-seven patients with LHIs were identified, 33 (42.9%) with complete MCA infarction (CMCA), and 44 (57.1%) with incomplete MCA infarction (IMCA). The predictors of CMCA score included: >1/3 early hypodensity in computed tomography findings, hyperdense MCA sign, brain edema, initial National Institutes of Health Stroke Scale (NIHSS) score ≥17, and stroke in progression during the 1st 5 days of admission. The cutoff CMCA score was 2, with a sensitivity of 81.8% and specificity of 70.5%. Mortality score 1, used for predicting in-hospital mortality from LHI, included CMCA and CHADS(2) scores ≥4 (sensitivity 100.0%, specificity 57.4%), and mortality score 2 included CMCA and CHADS(2) scores ≥4, and NIHSS score ≥26, during the 1st 5 days (sensitivity 100.0%, specificity 91.7%). Patients qualifying for a mortality score of 2 were at high-risk of in-hospital mortality from LHI. These findings may aid in identifying patients who may benefit from invasive therapeutic strategies, and in better describing the characteristics of those at risk of mortality. Wolters Kluwer Health 2017-07-14 /pmc/articles/PMC5515753/ /pubmed/28700481 http://dx.doi.org/10.1097/MD.0000000000007443 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 |
spellingShingle | 5300 Chen, Chien-Fu Lin, Ruey-Tay Lin, Hsiu-Fen Chao, A-Ching A multiparameter model predicting in-hospital mortality in malignant cerebral infarction |
title | A multiparameter model predicting in-hospital mortality in malignant cerebral infarction |
title_full | A multiparameter model predicting in-hospital mortality in malignant cerebral infarction |
title_fullStr | A multiparameter model predicting in-hospital mortality in malignant cerebral infarction |
title_full_unstemmed | A multiparameter model predicting in-hospital mortality in malignant cerebral infarction |
title_short | A multiparameter model predicting in-hospital mortality in malignant cerebral infarction |
title_sort | multiparameter model predicting in-hospital mortality in malignant cerebral infarction |
topic | 5300 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515753/ https://www.ncbi.nlm.nih.gov/pubmed/28700481 http://dx.doi.org/10.1097/MD.0000000000007443 |
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