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Adherence to statin therapy and the incidence of ischemic stroke in patients with diabetes.

https://arctichealth.org/en/permalink/ahliterature277321
Source
Pharmacoepidemiol Drug Saf. 2016 Feb;25(2):161-9
Publication Type
Article
Date
Feb-2016
Author
Maarit Jaana Korhonen
Päivi Ruokoniemi
Jenni Ilomäki
Atte Meretoja
Arja Helin-Salmivaara
Risto Huupponen
Source
Pharmacoepidemiol Drug Saf. 2016 Feb;25(2):161-9
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Aged
Brain Ischemia - diagnosis - epidemiology - prevention & control
Case-Control Studies
Cohort Studies
Diabetes Mellitus - drug therapy - epidemiology
Female
Finland - epidemiology
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage
Incidence
Male
Medication Adherence
Middle Aged
Population Surveillance - methods
Risk factors
Stroke - diagnosis - epidemiology - prevention & control
Abstract
We aimed to quantify for the first time the relationship between statin adherence and ischemic stroke (IS) in patients with diabetes.
Using Finnish health registers, we assembled a cohort of 52?868 statin initiators with diabetes in 1995-2006. We conducted a nested case-control analysis matching cases with IS with up to four controls for age, sex, date of statin initiation and follow-up duration. Adjusted rate ratios for IS were estimated with conditional logistic regression. Additional potential confounders were considered with inverse probability weighting and the role of unmeasured confounding using external adjustment. Statin adherence was measured as the proportion of days covered (PDC).
Among 1703 cases and 6799 controls, good adherence to statins (PDC?=?80%) was associated with a 23% decreased incidence of IS (95%CI 14-32%) compared with poor adherence (PDC?
PubMed ID
26687512 View in PubMed
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Association of prestroke statin use and lipid levels with outcome of intracerebral hemorrhage.

https://arctichealth.org/en/permalink/ahliterature113146
Source
Stroke. 2013 Aug;44(8):2330-2
Publication Type
Article
Date
Aug-2013
Author
Satu Mustanoja
Daniel Strbian
Jukka Putaala
Atte Meretoja
Sami Curtze
Elena Haapaniemi
Tiina Sairanen
Ronja Hietikko
Joonas Sirén
Markku Kaste
Turgut Tatlisumak
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. satu.mustanoja@hus.fi
Source
Stroke. 2013 Aug;44(8):2330-2
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cerebral Hemorrhage - blood - epidemiology - mortality
Cholesterol, LDL - adverse effects - blood
Female
Finland - epidemiology
Glasgow Coma Scale
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects - therapeutic use
Male
Middle Aged
Outcome Assessment (Health Care)
Registries
Severity of Illness Index
Abstract
It is unclear whether blood lipid profiles and statin use before intracerebral hemorrhage (ICH) are associated with its outcome.
The Helsinki ICH Study, a single-center observational registry of consecutive ICH patients, was used to study the associations between premorbid statin use, baseline lipid levels, and clinical outcome.
The registry includes 964 ICH patients. Statin users (n=187; 19%) were significantly older, had more frequent comorbidities and medication, lower lipid levels, and higher admission Glasgow Coma Scale compared with nonusers. Modified Rankin Scale at discharge or mortality did not differ between statin users and nonusers. Compared with survivors, significantly lower total cholesterol and low-density lipoprotein cholesterol levels were observed in patients who died in hospital (median, 4.1 mmol/L [interquartile range, 3.6-4.4] versus 4.5 [3.8-5.1]; P
PubMed ID
23760210 View in PubMed
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The CAVE score for predicting late seizures after intracerebral hemorrhage.

https://arctichealth.org/en/permalink/ahliterature103116
Source
Stroke. 2014 Jul;45(7):1971-6
Publication Type
Article
Date
Jul-2014
Author
Elena Haapaniemi
Daniel Strbian
Costanza Rossi
Jukka Putaala
Tuulia Sipi
Satu Mustanoja
Tiina Sairanen
Sami Curtze
Jarno Satopää
Reina Roivainen
Markku Kaste
Charlotte Cordonnier
Turgut Tatlisumak
Atte Meretoja
Author Affiliation
Department of Neurology (E.H., D.S., J.P., T. Sipi, S.M., T. Sairanen, S.C., R.R., M.K., T.T., A.M.) and Department of Neurosurgery (J.S.), Helsinki University Central Hospital, Helsinki, Finland; Neurology Department, EA 1046, Université Lille Nord de France, CHU Lille, Lille, France (C.R., C.C.); and Departments of Medicine and the Florey, University of Melbourne, Melbourne, Australia (A.M.).
Source
Stroke. 2014 Jul;45(7):1971-6
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Aged
Cerebral Hemorrhage - complications - epidemiology - mortality
Female
Finland - epidemiology
Humans
Male
Middle Aged
Patient Outcome Assessment
Predictive value of tests
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk
Seizures - epidemiology - etiology - mortality
Severity of Illness Index
Time Factors
Abstract
Seizures are a common complication of intracerebral hemorrhage (ICH). We developed a novel tool to quantify this risk in individual patients.
Retrospective analysis of the observational Helsinki ICH Study (n=993; median follow-up, 2.7 years) and the Lille Prognosis of InTra-Cerebral Hemorrhage (n=325; 2.2 years) cohorts of consecutive ICH patients admitted between 2004 and 2010. Helsinki ICH Study patients' province-wide electronic records were evaluated for early seizures occurring within 7 days of ICH and among 7-day survivors (n=764) for late seizures (LSs) occurring >7 days from ICH. A Cox regression model estimating risk of LSs was used to derive a prognostic score, validated in the Prognosis of InTra-Cerebral Hemorrhage cohort.
Of the Helsinki ICH Study patients, 109 (11.0%) had early seizures within 7 days of ICH. Among the 7-day survivors, 70 (9.2%) patients developed LSs. The cumulative risk of LSs was 7.1%, 10.0%, 10.2%, 11.0%, and 11.8% at 1 to 5 years after ICH, respectively. We created the CAVE score (0-4 points) to estimate the risk of LSs, with 1 point for each of cortical involvement, age10 mL, and early seizures within 7 days of ICH. The risk of LSs was 0.6%, 3.6%, 9.8%, 34.8%, and 46.2% for CAVE scores 0 to 4, respectively. The c-statistic was 0.81 (0.76-0.86) and 0.69 (0.59-0.78) in the validation cohort.
One in 10 patients will develop seizures after ICH. The risk of this adverse outcome can be estimated by a simple score based on baseline variables.
PubMed ID
24876089 View in PubMed
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Direct costs of patients with stroke can be continuously monitored on a national level: performance, effectiveness, and Costs of Treatment episodes in Stroke (PERFECT Stroke) Database in Finland.

https://arctichealth.org/en/permalink/ahliterature134915
Source
Stroke. 2011 Jul;42(7):2007-12
Publication Type
Article
Date
Jul-2011
Author
Atte Meretoja
Markku Kaste
Risto O Roine
Merja Juntunen
Miika Linna
Matti Hillbom
Reijo Marttila
Terttu Erilä
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
Source
Stroke. 2011 Jul;42(7):2007-12
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cerebral Hemorrhage - economics
Databases, Factual
Economics, Medical
Female
Finland
Health Care Costs
Humans
Inpatients
Male
Middle Aged
Outpatients
Registries
Stroke - economics - therapy
Subarachnoid Hemorrhage - economics
Abstract
Treatment of stroke consumes a significant portion of all healthcare expenditure. We developed a system for monitoring costs from individual patient data on a national level in Finland.
Multiple national administrative registers were linked to gain episode-of-care data on all hospital-treated patients with incident stroke over the years 1999 to 2007 (n = 94,316). Inpatient and specialist outpatient costs were evaluated with a cost database, long-term care costs with fixed prices, and medication costs with true retail prices.
For the patients of Year 2007, the mean 1-year costs after an ischemic stroke were $29 580, after an intracerebral hemorrhage $36,220, and after a subarachnoid hemorrhage $42,570, valued in Year 2008 U.S. dollars. Only part of these costs are attributable to stroke, because the annual costs prior to stroke were significant, $8900 before ischemic stroke, $7600 before intracerebral hemorrhage, and $4200 before subarachnoid hemorrhage. Older patients with ischemic stroke, and, among patients with ischemic stroke and subarachnoid hemorrhage, women, incurred higher costs. The mean estimated lifetime costs were $130,000 after ischemic stroke or intracerebral hemorrhage and $80,000 after subarachnoid hemorrhage. Annually $1.6 billion is spent in the care of Finnish patients with stroke, which equals to 7% of the national healthcare expenditure, or 0.6% of the gross domestic product. Costs of patients with stroke are increasing with prolonged survival and the aging population.
Treatment of patients with stroke is a large national investment. Setting up a nationwide system for continuous monitoring of stroke costs is feasible. Cost data should optimally be evaluated in conjunction with effectiveness and performance indicators.
PubMed ID
21527757 View in PubMed
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Effectiveness of primary and comprehensive stroke centers: PERFECT stroke: a nationwide observational study from Finland.

https://arctichealth.org/en/permalink/ahliterature144184
Source
Stroke. 2010 Jun;41(6):1102-7
Publication Type
Article
Date
Jun-2010
Author
Atte Meretoja
Risto O Roine
Markku Kaste
Miika Linna
Susanna Roine
Merja Juntunen
Terttu Erilä
Matti Hillbom
Reijo Marttila
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
Source
Stroke. 2010 Jun;41(6):1102-7
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Disease-Free Survival
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Registries
Retrospective Studies
Stroke - mortality - therapy
Abstract
Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than hospitals without stroke centers.
We did an observational register-linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke.
Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year.
This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers.
PubMed ID
20395609 View in PubMed
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Endovascular therapy for ischemic stroke: Save a minute-save a week.

https://arctichealth.org/en/permalink/ahliterature283159
Source
Neurology. 2017 May 30;88(22):2123-2127
Publication Type
Article
Date
May-30-2017
Author
Atte Meretoja
Mahsa Keshtkaran
Turgut Tatlisumak
Geoffrey A Donnan
Leonid Churilov
Source
Neurology. 2017 May 30;88(22):2123-2127
Date
May-30-2017
Language
English
Publication Type
Article
Keywords
Administration, Intravenous
Aged
Brain Ischemia - drug therapy - therapy
Disability Evaluation
Endovascular Procedures
Female
Fibrinolytic Agents - administration & dosage
Finland
Humans
Male
Middle Aged
Prospective Studies
Quality-Adjusted Life Years
Severity of Illness Index
Sex Factors
Stroke - drug therapy - therapy
Thrombolytic Therapy
Time-to-Treatment
Tissue Plasminogen Activator - administration & dosage
Treatment Outcome
Abstract
To quantify the patient lifetime benefits gained from reduced delays in endovascular therapy for acute ischemic stroke.
We used observational prospective data of consecutive stroke patients treated with IV thrombolysis in Helsinki (1998-2014; n = 2,474) to describe distributions of age, sex, stroke severity, onset-to-treatment times, and 3-month modified Rankin Scale (mRS) in routine clinical practice. We used treatment effects by time of endovascular therapy in large vessel occlusion over and above thrombolysis as reported by the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study to model the shift in 3-month mRS distributions with reducing treatment delays. From the 3-month outcomes we derived patient-expected lifetimes and cumulative long-term disability with incremental treatment delay reductions.
Each minute saved in onset-to-treatment time granted on average 4.2 days of extra healthy life, with a 95% prediction interval 2.3-5.4. Women gained slightly more than men due to their longer life expectancies. Patients younger than 55 years with severe strokes of NIH Stroke Scale score above 10 gained more than a week per each minute saved. In the whole cohort, every 20 minutes decrease in treatment delays led to a gain of average equivalent of 3 months of disability-free life.
Small reductions in endovascular delays lead to marked health benefits over patients' lifetimes. Services need to be optimized to reduce delays to endovascular therapy.
PubMed ID
28455382 View in PubMed
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Extent of secondary intraventricular hemorrhage is an independent predictor of outcomes in intracerebral hemorrhage: data from the Helsinki ICH Study.

https://arctichealth.org/en/permalink/ahliterature269618
Source
Int J Stroke. 2015 Jun;10(4):576-81
Publication Type
Article
Date
Jun-2015
Author
Satu Mustanoja
Jarno Satopää
Atte Meretoja
Jukka Putaala
Daniel Strbian
Sami Curtze
Elena Haapaniemi
Tiina Sairanen
Mika Niemelä
Markku Kaste
Turgut Tatlisumak
Source
Int J Stroke. 2015 Jun;10(4):576-81
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Aged
Cerebral Hemorrhage - mortality - pathology
Female
Finland
Follow-Up Studies
Glasgow Coma Scale
Humans
Male
Middle Aged
Multivariate Analysis
Prognosis
Registries
Risk factors
Severity of Illness Index
Abstract
Intraventricular hemorrhage is a severe subtype of intracerebral hemorrhage associated with high mortality and poor outcome.
We analyzed various intraventricular hemorrhage scores at baseline to find common parameters associated with increased mortality.
Consecutive intracerebral hemorrhage patients treated in Helsinki University Central Hospital during 2005-2010 were included in the Helsinki Intracerebral Hemorrhage Study registry and analyzed for three-month mortality.
After excluding lost-to-follow-up patients, 967 intracerebral hemorrhage patients were included, out of whom 398 (41%) had intraventricular hemorrhage. Intraventricular hemorrhage patients, compared with nonintraventricular hemorrhage patients, had lower baseline Glasgow Coma Scale [median 12 (IQR 6-15) vs. 15 (13-15); P?
PubMed ID
25580771 View in PubMed
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Natural History of Perihematomal Edema and Impact on Outcome After Intracerebral Hemorrhage.

https://arctichealth.org/en/permalink/ahliterature282918
Source
Stroke. 2017 Apr;48(4):873-879
Publication Type
Article
Date
Apr-2017
Author
Teddy Y Wu
Gagan Sharma
Daniel Strbian
Jukka Putaala
Patricia M Desmond
Turgut Tatlisumak
Stephen M Davis
Atte Meretoja
Source
Stroke. 2017 Apr;48(4):873-879
Date
Apr-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain Edema - diagnostic imaging - epidemiology - mortality
Cerebral Hemorrhage - diagnostic imaging - epidemiology - mortality
Female
Finland - epidemiology
Hematoma - diagnostic imaging - epidemiology - mortality
Humans
Middle Aged
Outcome Assessment (Health Care)
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Abstract
Edema may worsen outcome after intracerebral hemorrhage (ICH). We assessed its natural history, factors influencing growth, and association with outcome.
We estimated edema volumes in ICH patients from the Helsinki ICH study using semiautomated planimetry. We assessed the correlation between edema extension distance (EED) and time from ICH onset, creating an edema growth trajectory model up to 3 weeks. We interpolated expected EED at 72 hours and identified clinical and imaging characteristics associated with faster edema growth. Association of EED and mortality was assessed using logistic regression adjusting for predictors of ICH outcome.
From 1013 consecutive patients, 861 were included. There was a strong inverse correlation between EED growth rate (cm/d) and time from onset (days): EED growth=0.162*days exp(-0.927), R(2)=0.82. Baseline factors associated with larger than expected EED were older age (71 versus 68; P=0.002), higher National Institutes of Health Stroke Scale score (14 versus 8; P
PubMed ID
28275199 View in PubMed
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Outcome by stroke etiology in patients receiving thrombolytic treatment: descriptive subtype analysis.

https://arctichealth.org/en/permalink/ahliterature139063
Source
Stroke. 2011 Jan;42(1):102-6
Publication Type
Article
Date
Jan-2011
Author
Satu Mustanoja
Atte Meretoja
Jukka Putaala
Varpu Viitanen
Sami Curtze
Sari Atula
Ville Artto
Olli Häppölä
Markku Kaste
Author Affiliation
Department of Neurology, Helsinki University, Central Hospital, Helsinki, Finland. satu.mustanoja@hus.fi
Source
Stroke. 2011 Jan;42(1):102-6
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atherosclerosis - complications - mortality - therapy
Diabetes Complications - mortality - therapy
Embolism - complications - mortality - therapy
Female
Finland - epidemiology
Humans
Hypercholesterolemia - complications - mortality - therapy
Hypertension - complications - mortality - therapy
Intracranial Hemorrhages - etiology - mortality - therapy
Ischemic Attack, Transient - complications - mortality - therapy
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Stroke - etiology - mortality - therapy
Thrombolytic Therapy
Abstract
treating ischemic stroke with thrombolytic therapy is effective and safe, but limited data exist on its efficacy and safety in different etiologic subtypes.
patients with acute ischemic stroke treated with intravenous thrombolysis between 1995 and 2008 at our hospital were classified according to the Trial of ORG 10172 in Acute Stroke Treatment criteria based on diagnostic evaluation. Clinical outcome of the stroke subtypes by 3-month modified Rankin Scale was compared by multivariate logistic regression. A good outcome was defined as modified Rankin Scale = 2. Symptomatic intracranial hemorrhage was defined according to both National Institute of Neurological Disorders and Stroke and European Cooperative Acute Stroke Study criteria.
of the 957 eligible patients, 41% (389) had cardioembolisms, 23% (217) large-artery atherosclerosis, and 11% (101) small-vessel disease (SVD). A good outcome was more common in SVD than in the other subtypes. Patients with SVD were more often male (64% versus 54%), had a lower baseline National Institutes of Health Stroke Scale score, lower mortality rate, and experienced no symptomatic intracranial hemorrhage. Patients with SVD had a prior stroke more often (20% versus 11%), whereas hypertension, diabetes, hypercholesterolemia, and transient ischemic attacks were equally distributed in all subtypes. Patients with SVD had a better outcome even after adjusting for baseline National Institutes of Health Stroke Scale and glucose level, age, and hyperdense artery sign (OR, 1.81; 1.01 to 3.23). In the adjusted multivariate model, other etiologic groups showed no significant correlation to good outcome.
patients with SVD were spared from bleeding complications and had the best outcome even after adjustment for confounding factors.
PubMed ID
21106955 View in PubMed
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Post-thrombolytic hyperglycemia and 3-month outcome in acute ischemic stroke.

https://arctichealth.org/en/permalink/ahliterature139289
Source
Cerebrovasc Dis. 2011;31(1):83-92
Publication Type
Article
Date
2011
Author
Jukka Putaala
Tiina Sairanen
Atte Meretoja
Perttu J Lindsberg
Marjaana Tiainen
Ron Liebkind
Daniel Strbian
Sari Atula
Ville Artto
Kirsi Rantanen
Pyry Silvonen
Katja Piironen
Sami Curtze
Olli Häppölä
Satu Mustanoja
Janne Pitkäniemi
Oili Salonen
Heli Silvennoinen
Lauri Soinne
Markku Kuisma
Turgut Tatlisumak
Markku Kaste
Author Affiliation
Molecular Neurology Research Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 4, Helsinki, Finland. jukka.putaala@hus.fi
Source
Cerebrovasc Dis. 2011;31(1):83-92
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Blood Glucose - drug effects - metabolism
Brain Ischemia - blood - drug therapy - mortality
Chi-Square Distribution
Female
Fibrinolytic Agents - adverse effects - therapeutic use
Finland
Humans
Hyperglycemia - blood - drug therapy - mortality
Hypoglycemic agents - therapeutic use
Intracranial Hemorrhages - chemically induced
Logistic Models
Male
Middle Aged
Odds Ratio
Retrospective Studies
Risk assessment
Risk factors
Stroke - blood - drug therapy - mortality
Thrombolytic Therapy - adverse effects - mortality
Time Factors
Treatment Outcome
Abstract
Treating hyperglycemia in acute ischemic stroke may be beneficial, but knowledge on its prognostic value and optimal target glucose levels is scarce. We investigated the dynamics of glucose levels and the association of hyperglycemia with outcomes on admission and within 48 h after thrombolysis.
We included 851 consecutive patients with acute ischemic stroke treated with intravenous thrombolysis in the Helsinki University Central Hospital during 1998-2008. Outcome measures were unfavorable 3- month outcome (3-6 on the modified Rankin Scale), death, and symptomatic intracerebral hemorrhage (sICH) according to NINDS criteria. Hyperglycemia was defined as a blood glucose level of =8.0 mmol/l. Four groups were identified based on (a) admission and (b) peak glucose levels 48 h after thrombolysis: (1) persistent normoglycemia (baseline plus 48-hour normoglycemia), (2) baseline hyperglycemia (48-hour normoglycemia), (3) 48-hour hyperglycemia (baseline normoglycemia), and (4) persistent hyperglycemia (baseline plus 48-hour hyperglycemia).
480 (56.4%) of our patients (median age 70 years; onset-to-needle time 199 min; National Institutes of Health Stroke Scale score 9), had persistent normoglycemia, 59 (6.9%) had baseline hyperglycemia, 175 (20.6%) had 48-hour hyperglycemia, while persistent hyperglycemia appeared in 137 (16.1%) patients. Persistent and 48-hour hyperglycemia independently predicted unfavorable outcome [odds ratio (OR) = 2.33, 95% confidence interval (CI) = 1.41-3.86, and OR = 2.17, 95% CI = 1.30-3.38, respectively], death (OR = 6.63, 95% CI = 3.25-13.54, and OR = 3.13, 95% CI = 1.56-6.27, respectively), and sICH (OR = 3.02, 95% CI = 1.68-5.43, and OR = 1.89, 95% CI = 1.04-3.43, respectively), whereas baseline hyperglycemia did not.
Hyperglycemia (=8.0 mmol/l) during 48 h after intravenous thrombolysis of ischemic stroke is strongly associated with unfavorable outcome, sICH, and death.
PubMed ID
21079397 View in PubMed
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14 records – page 1 of 2.