FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2054222043> ?p ?o ?g. }

• W2054222043 endingPage "813" @default.
• W2054222043 startingPage "812" @default.
• W2054222043 abstract "To the Editor: The incidence of spontaneous intracerebral hemorrhage (ICH) increases exponentially with age,1 so individuals aged 80 and older are expected to represent a growing proportion of all people admitted to stroke units (SU) for ICH.1, 2 Age of 80 and older is considered to be a major predictor of ICH mortality independent of characteristics related to ICH severity,3 but supporting evidence is limited to two small noncontemporary cohort studies3, 4 and a large contemporary cohort study that did not control for any confounders.2 Findings from noncontemporary cohorts may not be applicable to individuals with ICH currently benefiting from organized inpatient (SU) care, which has improved ICH survival.1 Another limitation of these studies is the lack of control for prestroke multimorbidity, which is a known predictor of mortality in stroke.5 This prospective study investigated whether, in individuals with ICH admitted to a SU, age of 80 and older predicts in-SU mortality independent of multimorbidity. The study included 213 participants aged 80 and older (mean age 84.9 ± 4.0, 57.9% male) and 259 participants younger than 80 (mean age 68.7 ± 9.9, 39.9% male) with spontaneous first-episode ICH consecutively admitted to the SU of the Maggiore Hospital (Bologna, Italy) between October 2007 and December 2013. The Maggiore Hospital ethics committee approved the study. All participants (or their representatives) provided informed consent. Information was collected from medical records. Multimorbidity was defined as a Charlson Comorbidity Index of 2 or greater.6 Other confounders were sex, hypertension, diabetes mellitus, atrial fibrillation, dementia, prestroke functional impairment (modified Rankin Scale6), neurological impairment on admission (National Institutes of Health Stroke Scale6), anticoagulation-related etiology, pulse pressure, neuroradiological findings (location and intraventricular extension), and recourse to neurosurgical procedures. The association between aged 80 and older and in-SU mortality was estimated using hazard ratios (HRs) and their 95% confidence intervals (CIs) from Cox proportional hazards regression models adjusted for prestroke and ICH-related confounders. Preliminary analyses showed a significant interaction between age and multimorbidity (P = .04). Based on inspection of survival curves and on previous literature,7 the interaction was modeled as a time-dependent variable to obtain separate mortality risk estimates for stays or 7 or fewer days and longer than 7 days. Analyses were performed using SPSS version 21 (IBM Corp., Armonk, NY). P < .05 was considered statistically significant. Mortality at 7 days or fewer (69.3% of all deaths) was unrelated to age or multimorbidity (Table 1). By contrast, mortality at longer than 7 days was six times as high for younger than 80 with multimorbidity and aged 80 and older with and without multimorbidity than for younger than 80 without multimorbidity. In individuals with stroke, deaths within the first week are mostly the direct consequence of hemorrhagic injury, whereas deaths in the following weeks are mostly related to medical complications.7 Therefore, age 80 and older and multimorbidity may fail to affect in-SU mortality during the first week because, at this time, prognosis mainly depends on ICH severity, but after the first week, age 80 and older and multimorbidity may become relevant for managing medical complications. Nevertheless, in the model, the effect of multimorbidity was limited to individuals younger than 80. It may be that, in individuals aged 80 and older, the direct consequences of hemorrhagic injury override those of medical complications for a longer time than in younger individuals. Age-related alterations in cellular architecture and the metabolism of the human brain that may aggravate hematoma expansion and perihematomal edema are consistent with this hypothesis.8 Moreover, animal models show that brain hemorrhage in older age is associated with excess inflammation from overactive microglia and lower neuronal plasticity from hypoactive astrocytes.9 It is unlikely that the results of the current study reflect less-aggressive medical care in older adults. The occurrence of an age-related bias for withdrawal of invasive life support could not be verified, because Italian laws do now allow use of formal do-not-resuscitate orders, but had this bias been relevant in this cohort, participants aged 80 and older would have been expected to have higher mortality than younger participants already during the first week, because withdrawal of invasive life support has a strong effect on mortality during the early phase of ICH.10 Moreover, because of the legal uncertainties surrounding end-of-life decisions in Italy, withdrawal of noninvasive life support (hydration and nutrition) is not performed at the Maggiore SU. Finally, because the Maggiore SU team includes geriatricians, it is unlikely that participants aged 80 and older were denied treatment for medical complications solely because of their age. The main limitation of this study is the lack of data for ICH volume, cause of death, and postdischarge mortality. In addition, there are multimorbidity scores other than the CCI that might be better at predicting outcomes in individuals with ICH. Finally, these findings may not be generalizable to SUs whose teams do not include geriatricians. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Paola Forti and Marco Zoli have received Basic Oriented Research grants from the University of Bologna. Author Contributions: Forti: study concept and design, data analysis and interpretation, preparation of manuscript. Maioli, Procaccianti: study concept and design, data acquisition, data interpretation, preparation of manuscript. Arnone: study concept and design, data acquisition, data interpretation, preparation of manuscript. Nativio, Zagnoni, Riva, Pedone, Pirazzoli, Coveri, Zoli, Di Pasquale: study concept and design, data acquisition, preparation of manuscript. Sponsor's Role: None." @default.
• W2054222043 created "2016-06-24" @default.
• W2054222043 creator A5001281881 @default.
• W2054222043 creator A5003323114 @default.
• W2054222043 creator A5009091792 @default.
• W2054222043 creator A5009420830 @default.
• W2054222043 creator A5010487468 @default.
• W2054222043 creator A5027529869 @default.
• W2054222043 creator A5035219505 @default.
• W2054222043 creator A5037320488 @default.
• W2054222043 creator A5041785978 @default.
• W2054222043 creator A5067221476 @default.
• W2054222043 creator A5081035761 @default.
• W2054222043 creator A5086502594 @default.
• W2054222043 date "2015-04-01" @default.
• W2054222043 modified "2023-09-26" @default.
• W2054222043 title "Mortality After Admission to Stroke Unit for Intracerebral Hemorrhage: Effect of Age 80 and Older and Multimorbidity" @default.
• W2054222043 cites W1947113872 @default.
• W2054222043 cites W1992785267 @default.
• W2054222043 cites W2025378180 @default.
• W2054222043 cites W2036973004 @default.
• W2054222043 cites W2062788069 @default.
• W2054222043 cites W2085403832 @default.
• W2054222043 cites W2087177155 @default.
• W2054222043 cites W2118695506 @default.
• W2054222043 cites W2158866006 @default.
• W2054222043 cites W2163570199 @default.
• W2054222043 doi "https://doi.org/10.1111/jgs.13368" @default.
• W2054222043 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/25900493" @default.
• W2054222043 hasPublicationYear "2015" @default.
• W2054222043 type Work @default.
• W2054222043 sameAs 2054222043 @default.
• W2054222043 citedByCount "2" @default.
• W2054222043 countsByYear W20542220432016 @default.
• W2054222043 countsByYear W20542220432018 @default.
• W2054222043 crossrefType "journal-article" @default.
• W2054222043 hasAuthorship W2054222043A5001281881 @default.
• W2054222043 hasAuthorship W2054222043A5003323114 @default.
• W2054222043 hasAuthorship W2054222043A5009091792 @default.
• W2054222043 hasAuthorship W2054222043A5009420830 @default.
• W2054222043 hasAuthorship W2054222043A5010487468 @default.
• W2054222043 hasAuthorship W2054222043A5027529869 @default.
• W2054222043 hasAuthorship W2054222043A5035219505 @default.
• W2054222043 hasAuthorship W2054222043A5037320488 @default.
• W2054222043 hasAuthorship W2054222043A5041785978 @default.
• W2054222043 hasAuthorship W2054222043A5067221476 @default.
• W2054222043 hasAuthorship W2054222043A5081035761 @default.
• W2054222043 hasAuthorship W2054222043A5086502594 @default.
• W2054222043 hasBestOaLocation W20542220431 @default.
• W2054222043 hasConcept C120665830 @default.
• W2054222043 hasConcept C121332964 @default.
• W2054222043 hasConcept C126322002 @default.
• W2054222043 hasConcept C127413603 @default.
• W2054222043 hasConcept C144024400 @default.
• W2054222043 hasConcept C149923435 @default.
• W2054222043 hasConcept C187212893 @default.
• W2054222043 hasConcept C188816634 @default.
• W2054222043 hasConcept C194828623 @default.
• W2054222043 hasConcept C195910791 @default.
• W2054222043 hasConcept C201903717 @default.
• W2054222043 hasConcept C2777094939 @default.
• W2054222043 hasConcept C2777736543 @default.
• W2054222043 hasConcept C2779159551 @default.
• W2054222043 hasConcept C2780645631 @default.
• W2054222043 hasConcept C3019063607 @default.
• W2054222043 hasConcept C61511704 @default.
• W2054222043 hasConcept C71924100 @default.
• W2054222043 hasConcept C72563966 @default.
• W2054222043 hasConcept C77350462 @default.
• W2054222043 hasConcept C78519656 @default.
• W2054222043 hasConceptScore W2054222043C120665830 @default.
• W2054222043 hasConceptScore W2054222043C121332964 @default.
• W2054222043 hasConceptScore W2054222043C126322002 @default.
• W2054222043 hasConceptScore W2054222043C127413603 @default.
• W2054222043 hasConceptScore W2054222043C144024400 @default.
• W2054222043 hasConceptScore W2054222043C149923435 @default.
• W2054222043 hasConceptScore W2054222043C187212893 @default.
• W2054222043 hasConceptScore W2054222043C188816634 @default.
• W2054222043 hasConceptScore W2054222043C194828623 @default.
• W2054222043 hasConceptScore W2054222043C195910791 @default.
• W2054222043 hasConceptScore W2054222043C201903717 @default.
• W2054222043 hasConceptScore W2054222043C2777094939 @default.
• W2054222043 hasConceptScore W2054222043C2777736543 @default.
• W2054222043 hasConceptScore W2054222043C2779159551 @default.
• W2054222043 hasConceptScore W2054222043C2780645631 @default.
• W2054222043 hasConceptScore W2054222043C3019063607 @default.
• W2054222043 hasConceptScore W2054222043C61511704 @default.
• W2054222043 hasConceptScore W2054222043C71924100 @default.
• W2054222043 hasConceptScore W2054222043C72563966 @default.
• W2054222043 hasConceptScore W2054222043C77350462 @default.
• W2054222043 hasConceptScore W2054222043C78519656 @default.
• W2054222043 hasFunder F4320323553 @default.
• W2054222043 hasIssue "4" @default.
• W2054222043 hasLocation W20542220431 @default.
• W2054222043 hasLocation W20542220432 @default.
• W2054222043 hasOpenAccess W2054222043 @default.
• W2054222043 hasPrimaryLocation W20542220431 @default.
• W2054222043 hasRelatedWork W1988367414 @default.

• next