Prognostic index for stroke mortality.
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Biomedical subjects
Kate Tilling
Publications and source records attributed to Kate Tilling.
Effect of acute glycaemic index on clinical outcome after acute stroke.
Studies have shown that hyperglycaemia acutely after stroke independently predicts poorer survival and independence. Whether the change in glycaemic index in the acute phase of stroke has any effect on stroke outcome is unclear. Glycated serum proteins (GSP) reflect blood glucose concentration during the preceding 2 weeks. The aim of this study is to measure the association between the change in GSP % in the first 2 weeks after stroke and outcome. 167 patients were included. 117 (70%) patients were alive at 3 months. Admission glucose was higher in dead patients (7.8 mmol/l) compared to survivors (6.6 mmol/l) (p < 0.01). GSP at day 14 was higher in non survivors (21.8%) compared with survivors (19.1%) (p < 0.0001) as was the change in GSP (2.0 %) in non survivors compared with survivors (0.1%) (p < 0.0001). After adjusting for case mix, the change in GSP % was significantly associated with stroke mortality (p = 0.04). The odds ratio for death at 3 months after stroke associated with every 1% increase in change between GSP day 14 and GSP day 0, was 1.28 (95% CI: 1.1-1.62). Increases in glycaemic index as determined by GSP % are associated with excess in stroke mortality after adjusting for case mix. Intervention trials are required to test the hypothesis that improving glycaemic index after acute stroke improves outcome.
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Re: Randomized controlled study of stroke unit versus stroke team care in different stroke subtypes.
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Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study.
BACKGROUND: Evidence on the effectiveness of highly active antiretroviral therapy (HAART) for HIV-infected individuals is limited. Most clinical trials examined surrogate endpoints over short periods of follow-up and there has been no placebo-controlled randomised trial of HAART. Estimation of treatment effects in observational studies is problematic, because of confounding by indication. We aimed to use novel methodology to overcome this problem in the Swiss HIV Cohort Study. METHODS: Patients were included if they had been examined after January 1996, when HAART became available in Switzerland, were not on HAART, and were free of AIDS at baseline. Cox regression models were weighted to create a statistical population in which the probability of being treated at each time point was unrelated to prognostic factors. RESULTS: Low CD4 counts and increasing HIV-1 viral load were associated with increased probability of starting HAART. Overall hazard ratios were 0.14 (95% CI 0.07-0.29) for HAART compared with no treatment, and 0.49 (0.31-0.79) compared with dual therapy. Compared with no treatment, HAART became more beneficial with increasing time since initiation but was less beneficial for patients whose presumed mode of transmission was via intravenous drug use (hazard ratio 0.27, 0.12-0.61) than for other patients (0.08, 0.03-0.19). INTERPRETATION: Our results, which are appropriately controlled for confounding by indication, are consistent with reported declines in rates of AIDS and death in developed countries, and provide a context in which to consider adverse effects of HAART.
Acquired Immunodeficiency Syndrome↗