Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Chen, Chien-Fu, Lin, Ruey-Tay, Lin, Hsiu-Fen, Chao, A-Ching
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
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
_version_ 1783251026377179136
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
work_keys_str_mv AT chenchienfu amultiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction
AT linrueytay amultiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction
AT linhsiufen amultiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction
AT chaoaching amultiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction
AT chenchienfu multiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction
AT linrueytay multiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction
AT linhsiufen multiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction
AT chaoaching multiparametermodelpredictinginhospitalmortalityinmalignantcerebralinfarction