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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Dynamic Decrease in Eosinophil After Intravenous Thrombolysis Predicts Poor Prognosis of Acute Ischemic Stroke: A

Dehao Yang1, Honghao Huang2,3, Yiyun Weng4

  • 1Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Frontiers in Immunology
|July 26, 2021
PubMed
Summary
This summary is machine-generated.

A significant decrease in blood eosinophils after r-tPA treatment for acute ischemic stroke (AIS) predicts poor outcomes and death. This finding improves predictive models but requires careful interpretation in non-cardioembolic cases.

Keywords:
acute ischemic strokeeosinophilinflammationintravenous thrombolysisprognosis

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Area of Science:

  • Neurology
  • Hematology
  • Biomarkers

Background:

  • Blood eosinophil counts are linked to atherosclerosis and stroke severity.
  • Understanding eosinophil dynamics in acute ischemic stroke (AIS) is crucial for predicting patient outcomes.

Purpose of the Study:

  • To investigate the temporal profile of eosinophils in AIS patients receiving recombinant tissue plasminogen activator (r-tPA).
  • To assess the association between dynamic eosinophil changes and 3-month outcomes across different AIS etiologies.
  • To evaluate the incremental predictive value of dynamic eosinophils and compare their prognostic utility with the neutrophil-to-lymphocyte ratio (NLR).

Main Methods:

  • A cohort of 623 AIS patients receiving intravenous thrombolysis was analyzed.
  • Blood samples were collected at admission, within 24 hours, and on day seven post-treatment.
  • Multivariate logistic regression, restricted cubic splines, and metrics like NRI and IDI were used to assess associations and predictive abilities.

Main Results:

  • A median decrease of 25% in eosinophil counts was observed post-thrombolysis.
  • A >75% eosinophil decrease correlated with significantly higher risks of poor outcome (2.585 times) and death (13.836 times).
  • Adding eosinophil changes to conventional models enhanced prediction for poor outcomes (NRI 53.3%, IDI 2.2%) and death (NRI 101.0%, IDI 6.9%).

Conclusions:

  • Dynamic eosinophil reduction post-r-tPA treatment is a significant predictor of poor 3-month outcomes and mortality in AIS patients.
  • Eosinophil dynamics improve the predictive capacity of existing clinical models for AIS.
  • The prognostic value of eosinophil changes may be less pronounced in non-cardioembolic AIS cases.