Abstract
Objective
Stroke is the leading cause of mortality and long-term disabilities worldwide. In addition to clinical presentation, many scoring systems and various laboratory values have been associated with predicting prognosis. In this study, we aimed to investigate the relationship between the aortic knob width (AKW) and prognosis in people presenting to the emergency department with stroke.
Material and Methods
Three hundred fifty-two patients, who admitted to the emergency department of our hospital with acute ischemic (206 males, 146 females, mean age, 68.3±13.3 years) stroke were included to the study. The number of patients who died in the hospital were recorded. Those who were discharged were followed up and called from the central information system and by phone, and it was recorded whether they were exitus within 3 months. AKW were obtained from the chest radiographies of the patients.
Results
Total of 95 patients became exitus during their hospitalization and within the 3 months to follow. Two groups were created; group 1: 95 patients that became exitus (48 males, 47 females; mean age 75.5±11.8 years); group 2: 257 patients (158 males, 99 females, mean age 65.6±12.7 years). AKW was significantly higher in group 1 as compared to group 2 (44.1±6.9 vs. 39.7±7.6 mm; p<0.001). When the AKW value was correlated with scoring systems, there was a weak but significant correlation. Multivariate logistic regression analysis revealed, AKW was one of the independent predictors of mortality. For AKW predicting in-hospital mortality, cut-off value was 42.05 mm with 72.7% sensitivity and 65.4% specificity.
Conclusion
AKW, which can be easily obtained from chest radiography, can also be correlated with 3 months mortality and prognosis in stroke patients. The patients with a finding of AKW over 42.05 mm may be correlated with a poorer outcome
Keywords: Stroke, aortic knob width, chest radiography, mortality, prognosis
References
O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-123.
Liaw N, Liebeskind D. Emerging therapies in acute ischemic stroke. F1000Res. 2020;9:F1000 Faculty Rev-546.
Wan J, Wang X, Zhen Y, Chen X, Yao P, Liu W, et al. The predictive role of the neutrophil-lymphocyte ratio in the prognosis of adult patients with stroke. Chin Neurosurg J. 2020;6:22.
Harrison JK, McArthur KS, Quinn TJ. Assessment scales in stroke: clinimetric and clinical considerations. Clin Interv Aging. 2013;8:201-211.
Lee EJ, Han JH, Kwon KY, Kim JH, Han KH, Sung SY, et al. The Relationship between Aortic Knob Width and Metabolic Syndrome. Korean J Fam Med. 2018;39(4):253-259.
Yun KH, Jeong MH, Oh SK, Park EM, Kim YK, Rhee SJ, et al. Clinical significance of aortic knob width and calcification in unstable angina. Circ J. 2006;70(10):1280-1283.
Hong YJ, Jeong MH, Choi YH, Ma EH, Ko JS, Lee MG, et al. Relation between aortic knob calcium observed by simple chest x-ray or fluoroscopy and plaque components in patients with diabetes mellitus. Am J Cardiol. 2010;106(1):38-43.
Flint AC, Cullen SP, Faigeles BS, Rao VA. Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score. AJNR Am J Neuroradiol. 2010;31(7):1192-116.
Abdul-Rahim AH, Quinn TJ, Alder S, Clark AB, Musgrave SD, Langhorne P, et al. Derivation and Validation of a Novel Prognostic Scale (Modified-Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. Stroke. 2016;47(1):74-79.
Gattringer T, Posekany A, Niederkorn K, Knoflach M, Poltrum B, Mutzenbach S, et al. Predicting Early Mortality of Acute Ischemic Stroke. Stroke. 2019;50(2):349-356.
Kelly PJ, Crispino G, Sheehan O, Kelly L, Marnane M, Merwick A, et al. Incidence, event rates, and early outcome of stroke in Dublin, Ireland: the North Dublin population stroke study. Stroke. 2012;43(8):2042-2047.
Johnston KC, Connors AF Jr, Wagner DP, Haley EC Jr. Predicting outcome in ischemic stroke: external validation of predictive risk models. Stroke. 2003;34(1):200-202.
Zuhaid M, Salman, Chawla JA, Farooq U, Ahmad A, Khan S, Asfandiyar M. Frequency of modifiable risk factors in stroke patients. J Ayub Med Coll Abbottabad. 2014;26(2):235-238.
Mayer L, Grams A, Freyschlag CF, Gummerer M, Knoflach M. Management and prognosis of acute extracranial internal carotid artery occlusion. Ann Transl Med. 2020;8(19):1268.
Weimar C, König IR, Kraywinkel K, Ziegler A, Diener HC; German Stroke Study Collaboration. Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke. 2004;35(1):158-162.
Chen Q, Xia T, Zhang M, Xia N, Liu J, Yang Y. Radiomics in Stroke Neuroimaging: Techniques, Applications, and Challenges. Aging Dis. 2021;12(1):143-154.
Erkan H, Korkmaz L, Agac MT, Acar Z, Kiris A, Erkan M, et al. Relation between carotid intima-media thickness and aortic knob width in patients with essential hypertension. Blood Press Monit. 2011;16(6):282-284.
Rayner BL, Goodman H, Opie LH. The chest radiograph. A useful investigation in the evaluation of hypertensive patients. Am J Hypertens. 2004;17(6):507-510.
Tanne D, Tenenbaum A, Shemesh J, Schwammenthal Y, Fisman EZ, Schwammenthal E, et al. Calcification of the thoracic aorta by spiral computed tomography among hypertensive patients: associations and risk of ischemic cerebrovascular events. Int J Cardiol. 2007;120(1):32-37.
Kianoush S, Al Rifai M, Cainzos-Achirica M, Al-Mallah MH, Tison GH, Yeboah J, et al. Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2017;267:61-67.
Lee KB, Lim SH, Kim KH, Kim KJ, Kim YR, Chang WN, et al. Six-month functional recovery of stroke patients: a multi-time-point study. Int J Rehabil Res. 2015;38(2):173-180.
Lai YJ, Hanneman SK, Casarez RL, Wang J, McCullough LD. Blood biomarkers for physical recovery in ischemic stroke: a systematic review. Am J Transl Res. 2019;11(8):4603-4613.
De Marchis GM, Katan M, Weck A, Fluri F, Foerch C, Findling O, et al. Copeptin adds prognostic information after ischemic stroke: results from the CoRisk study. Neurology. 2013;80(14):1278-1286.
Wang L, Wang C, Wu S, Li Y, Guo W, Liu M. Red blood cell distribution width is associated with mortality after acute ischemic stroke: a cohort study and systematic review. Ann Transl Med. 2020;8(4):81.
Chen C, Gu L, Chen L, Hu W, Feng X, Qiu F, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Potential Predictors of Prognosis in Acute Ischemic Stroke. Front Neurol. 2021;11:525621.
