22. European Stroke Conference 53 Stroke prognosis In hospital mortality of stroke patients admitted during off-hours is non-inferior to patients admitted during working hours. M.P. Tuinman1, E.G.A. van Golde2, R.P. Portier3, I.L.H. Knottnerus4, H.M. Droste5, J. van der Palen6, P.J.A.M. Brouwers7 Department of Neurology, Medisch Spectrum Twente., Enschede, THE NETHERLANDS1, Department of Neurology, Medisch Spectrum Twente., Enschede, THE NETHERLANDS2, Depart-ment of Neurology, Medisch Spectrum Twente., Enschede, THE NETHERLANDS3, Department of Neurology, Medisch Spectrum Twente., Enschede, THE NETHERLANDS4, Department of Neurol-ogy, Medisch Spectrum Twente., Enschede, THE NETHERLANDS5, Department of Epidemiology, Medisch Spectrum Twente., Enschede, THE NETHERLANDS6, Department of Neurology, Medisch Spectrum Twente., Enschede, THE NETHERLANDS7 BACKGROUND: Previous studies report worse outcome of stroke patients admitted during off-hours (OH) compared to working hours (WH) which is attributed to reduced staff levels. Upgrading staff levels is expensive and many studies didn’t take stroke severity into account. Therefore we examined whether in hospital mortality of patients admitted during OH was non-inferior to patients admitted during WH, after adjustment for stroke severity. METHODS: This retrospective cohort study analyzed patients included in the Enschedese Stroke Service, an ongoing patient-linked database of all stroke patients admitted to a teaching hospital in Enschede, the Netherlands. Analysis was done on the whole group and separately on patients with ischemic or hemorrhagic stroke. Patients were categorized by time of admission, during WH (week-days 08:30 – 17:00) or OH. In hospital mortality was compared, adjusted for vascular risk factors and stroke severity. Both clinical severity at admission (NIHSS-score and Glasgow Coma Scale) and characteristics of brain imaging (dense vessel sign and mass effect) were examined. We chose a non-inferiority margin of 5%. RESULTS: Overall, 3667 patients were studied, admitted from January 2003 until November 2012 (OH-group: n=1879 51.2%). In hospital mortality during OH was 6.5% compared to 7.0% during WH (p=0.525). The OH-group had a higher NIHSS-score (p=0.018) and more frequent a dense ves-sel sign on brain imaging (p=0.005). The adjusted Hazard Ratio of in hospital mortality during OH was 0.740 (95%-CI: 0.576-0.952) for the whole group, 0.727 (95%-CI: 0.523-1.011) for ischemic stroke and 0.746 (95%-CI: 0.503-1.105) for hemorrhagic stroke. CONCLUSION: Adjusted for stroke severity, in hospital mortality of all stroke patients admitted during OH is non-inferior and even superior to WH. Non-inferiority was also found for ischemic stroke. Based on these results, in our hospital reduced staff levels during OH is not associated with increased stroke mortality. 306 © 2013 S. Karger AG, Basel Scientific Programme 54 Stroke prognosis SERUM GROWTH FACTORS ARE SIGNATURES OF LONG-TERM RECOVERY IN PA-TIENTS WITH ACUTE ISCHEMIC STROKE. T. Sobrino1, M. Blanco2, N. Pérez de la Ossa3, A. Dávalos4, J. Martí-Fàbregas5, R. Delgado-Meder-os6, J. Serena7, M. Castellanos8, A. Lago9, B. Fuentes10, J. Castillo11 on behalf of RETICS RENEVAS (Stroke Research Network, RETICS Program, Instituto de Salud Carlos III). Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, IDIS., Santiago de Compostela, SPAIN1, Department of Neurology, Clinical Neu-rosciences Research Laboratory, Hospital Clínico Universitario, IDIS., Santiago de Compostela, SPAIN2, Department of Neurosciences - Acute Stroke Unit, Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN3, Department of Neurosciences - Acute Stroke Unit, Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN4, Stroke Unit, Neurology Department, Hospital de la San-ta Creu i Sant Pau., Barcelona, SPAIN5, Stroke Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN6, Department of Neurology - Stroke Unit, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta., Girona, SPAIN7, Department of Neurology - Stroke Unit, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta,, Girona, SPAIN8, Department of Neurology, Hospital Universitario La Fe,, Valencia, SPAIN9, Department of Neurology and Stroke Centre, Neuroscience and Cerebrovascular Research Labora-tory, La Paz University Hospital,, Madrid, SPAIN10, Department of Neurology, Clinical Neurosci-ences Research Laboratory, Hospital Clínico Universitario, IDIS., Santiago de Compostela, SPAIN11 Background: Growth factors (GF) such as VEGF, Angiopoietin 1 (Ang-1), G-CSF, BDNF and the chemokine SDF-1α mediate functional recovery and reduction of lesion volume in animal models of stroke through neuronal plasticity and brain repair mechanisms. Our aim was to study the associa-tion between serum levels of GF and SDF-1α and clinical outcome in patients with ischemic stroke. Methods: In this multicenter study, 578 patients with non-lacunar stroke (male, 62.1%; mean age, 68y) were included within 24h of symptom onset. The main outcome variable was good functional outcome (modified Rankin scale (mRS) ≤2) at 12 months. Secondary outcome variables were good functional outcome at 3 months and infarct volume (in mL) at 4th-7th days and at 12±3 months. Serum levels of VEGF, Ang-1, G-CSF, BDNF and SDF-1α were measured by ELISA at admission, 7±3 days, and 3±1 and 12±3 months. The effect of GF and SDF-1α as continuous variables on out-come endpoints was analyzed by multivariate logistic and lineal regression models. Results: Except for BDNF, all GF and SDF-1α levels showed a peak value at day 7 and remained elevated during the first 3 months (all p<0.01). High serum levels at day 7 of VEGF (OR,19.3), Ang-1 (OR,14.7), G-CSF (OR,9.6) and SDF-1α (OR,28.5) were independently associated with good outcome at 12 months (all p<0.01). These associations remained equally significant for VEGF, G-CSF and SDF-1α measured at 3 months. Similar results were found for functional outcome at 3 months. Only baseline SDF-1α levels showed a negative correlation with infarct volume at 4th-7th days (B,-11.1), but se-rum levels of VEGF (B, -16.6 and -14.3), G-CSF (B,-11.8 and -9.9) and SDF-1α (B,-35.4 and -38.4) measured at 7 days and 3 months were independently associated with infarct volume at 12 months (all p<0.01). Conclusion: Higher serum levels of VEGF, Ang-1, G-CSF and SDF-1α at day 7 and 3 months after ischemic stroke are associated with good functional outcome and smaller residual in-farction at 1 year.
Karger_ESC London_2013
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