The Conditions Under Which Piracetam Is Used and the Factors That Can Improve National Institute of Health Stroke Scale Score in Ischemic Stroke Patients and the Importance of Previously Unnoticed Factors From a Hospital-Based Observational Study in Taiwan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Source of Data and Study Cohort
- α = 0.05, Zα/2 = 1.96; β = 0.2, Zβ = 0.842
- p1: NIHSS improved rate of piracetam treatment; p2: NIHSS improved rate of no piracetam treatment; = (p1 + p2)/2
2.2. Definition of Epidemiological and Comorbidity Variables
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. Balance of Piracetam and no Piracetam Subgroups between Baseline Epidemiological and Comorbidity Characteristics
3.2. The Factors Associated with Ischemic Stroke Based on Univariate Analysis
3.3. The Factors Associated with Ischemic Stroke Based on Multivariate Analysis
3.4. Sensitivity Analysis for Possible Interaction Test Among Piracetam and Other Covariates, and the Adjusted Ratio Difference in Favor of NIHSS Improvement for These Variables
3.5. Subgroup Analysis
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristics | Piracetam n = 457 (%) | No Piracetam n = 894 (%) | p Value | Standardized Difference |
---|---|---|---|---|
Age (years) | ||||
mean ± SD | 72.0 ± 12.2 | 70.5 ± 12.5 | 0.031 | 0.130 |
Age (years) | ||||
<75 | 246 (53.8%) | 523 (58.5%) | 0.101 | 0.095 |
≥75 | 211 (46.2%) | 371 (41.5%) | ||
Gender | ||||
male | 295 (64.6%) | 577 (64.5%) | 0.960 | 0.002 |
female | 162 (35.4%) | 317 (35.5%) | ||
BMI | ||||
underweight | 17 (3.8%) | 39 (4.5%) | 0.564 | 0.035 |
normal weight | 243 (52.0%) | 421 (48.1%) | 0.078 | |
overweight | 160 (35.6%f) | 328 (37.5%) | 0.039 | |
obese | 39 (8.7%) | 87 (9.9%) | 0.041 | |
Smoking | ||||
non-smoker | 272 (59.5%) | 559 (62.5%) | 0.179 | 0.061 |
current smoker | 138 (30.2%) | 229 (25.6%) | 0.103 | |
ex-smoker | 47 (10.3%) | 106 (11.9%) | 0.051 | |
Hypertension | ||||
negative | 88 (19.3%) | 190 (21.3%) | 0.390 | 0.050 |
positive | 369 (80.7%) | 704 (78.7%) | ||
Diabetes mellitus | ||||
negative | 252 (55.1%) | 449 (50.2%) | 0.087 | 0.094 |
positive | 205 (44.9%) | 445 (49.8%) | ||
Dyslipidemia | ||||
negative | 127 (27.8%) | 290 (32.4%) | 0.080 | 0.100 |
positive | 330 (72.2%) | 604 (67.6%) | ||
Atrial fibrillation | ||||
negative | 370 (81.0%) | 737 (82.4%) | 0.505 | 0.036 |
positive | 87 (19.0%) | 157 (17.6%) | ||
TOAST | ||||
small-vessel occlusion | 135 (29.5%) | 297 (33.2%) | 0.558 | 0.080 |
large-artery atherosclerosis | 140 (30.6%) | 266 (29.8%) | 0.017 | |
cardioembolism | 70 (15.3%) | 123 (13.8%) | 0.043 | |
others | 112 (24.5%) | 208 (23.3%) | 0.028 |
Variables | Group A–NIHSS Improved (>4) n = 131 (%) | Group B–NIHSS Not Improved (≤4) n = 1220 (%) | Univariate Analysis OR (95% CI) | p Value | Multivariate Analysis OR (95% CI) | p Value |
---|---|---|---|---|---|---|
Age (years) | ||||||
<75 | 56 (42.7%) | 713 (58.4%) | 1.00 | <0.001 | 1.00 | 0.053 |
≥75 | 75 (57.3%) | 507 (41.6%) | 1.88 (1.31–2.71) | 1.52 (1.00–2.33) | ||
Gender | ||||||
male | 46 (35.1%) | 443 (35.5%) | 1.00 | 0.932 | 1.00 | 0.437 |
female | 85 (64.9%) | 787 (64.5%) | 1.02 (0.70–1.48) | 0.82 (0.50–1.35) | ||
BMI | ||||||
underweight | 59 (46.5%) | 596 (49.7%) | 1.00 | 0.002 | 1.00 | 0.026 |
normal weight | 14 (11.0%) | 42 (3.6%) | 3.37 (1.74–6.52) | <0.001 | 3.05 (1.47–6.30) | 0.003 |
overweight | 45 (35.4%) | 443 (37.0%) | 1.03 (0.68–1.54) | 0.901 | 1.11 (0.72–1.70) | 0.644 |
obese | 9 (7.1%) | 117 (9.8%) | 0.78 (0.38–1.61) | 0.498 | 0.93 (0.44–2.00) | 0.858 |
Smoking | ||||||
non-smoker | 70 (53.4%) | 761 (62.4%) | 1.00 | 0.083 | 1.00 | 0.017 |
current smoker | 40 (30.5%) | 327 (26.8%) | 1.33 (0.88–2.00) | 0.172 | 1.81 (1.07–3.06) | 0.026 |
ex-smoker | 21 (16.0%) | 132 (10.8%) | 1.73 (1.03–2.91) | 0.039 | 2.29 (1.22–4.28) | 0.009 |
Piracetam | ||||||
negative | 72 (55.0%) | 822 (67.4%) | 1.00 | 0.005 | 1.00 | 0.005 |
positive | 59 (45.0%) | 398 (32.6%) | 1.69 (1.18–2.44) | 1.73 (1.18–2.55) | ||
Hypertension | ||||||
negative | 29 (22.1%) | 249 (20.4%) | 1.00 | 0.642 | 1.00 | 0.465 |
positive | 102 (77.9%) | 971 (79.6%) | 0.90 (0.58–1.39) | 0.84 (0.52–1.35) | ||
Diabetes mellitus | ||||||
negative | 76 (58.0%) | 625 (51.2%) | 1.00 | 0.141 | 1.00 | 0.468 |
positive | 55 (42.0%) | 595 (48.8%) | 0.76 (0.53–1.10) | 0.86 (0.58–1.29) | ||
Dyslipidemia | ||||||
negative | 43 (32.8%) | 374 (30.7%) | 1.00 | 0.610 | 1.00 | 0634 |
positive | 88 (67.2%) | 846 (69.3%) | 0.91 (0.62–1.33) | 1.11 (0.37–1.69) | ||
Atrial fibrillation | ||||||
negative | 82 (62.6%) | 1025 (84.0%) | 1.00 | <0.001 | 1.00 | <0.001 |
positive | 49 (37.4%) | 195 (16.0%) | 3.14 (2.14–4.62) | 3.92 (2.31–8.24) | ||
TOAST | ||||||
small-vessel occlusion | 21 (16.0%) | 411 (33.7%) | 1.00 | <0.001 | 1.00 | <0.001 |
large-artery atherosclerosis | 51 (38.9%) | 355 (29.1%) | 2.81 (1.66–4.77) | <0.001 | 2.68 (1.57–4.60) | <0.001 |
cardioembolism | 34 (26.0%) | 159 (13.0%) | 4.19 (2.36–7.43) | <0.001 | 0.87 (0.38–1.96) | 0.933 |
others | 25 (19.1%) | 295 (24.2%) | 1.66 (0.91–3.02) | 0.098 | 1.06 (0.56–2.02) | 0.640 |
Variables | NIHSS Improved (n = 131) | NIHSS NotImproved (n = 1220) | Rate (Proportion) | 95% CI Lower-Upper Rate | SE | p Value * | Adjusted Ratio Difference of NIHSS Improvement (95% CI) † |
---|---|---|---|---|---|---|---|
Age (years) | |||||||
<75 | 56 | 713 | 0.073 | 0.054–0.091 | 0.009 | 0.061 | - |
≥75 | 75 | 507 | 0.129 | 0.102–0.156 | 0.014 | 0.025 | |
Gender | |||||||
male | 46 | 433 | 0.096 | 0.070–0.122 | 0.013 | 0.273 | - |
female | 85 | 787 | 0.097 | 0.078–0.117 | 0.010 | 0.007 | |
BMI | |||||||
normal weight | 59 | 596 | 0.090 | 0.068–0.112 | 0.011 | 0.016 | reference |
underweight | 14 | 42 | 0.250 | 0.137–0.363 | 0.058 | 0.425 | 20.3% (4.7%–52.2%) |
overweight | 45 | 443 | 0.092 | 0.067–0.118 | 0.013 | 0.688 | - |
obese | 9 | 117 | 0.071 | 0.026–0.116 | 0.023 | 0.035 | - |
Smoking | |||||||
non-smoker | 70 | 761 | 0.084 | 0.065–0.103 | 0.010 | 0.123 | reference |
current smoker | 40 | 327 | 0.109 | 0.077–0.141 | 0.016 | 0.074 | 7.5% (0.6%–18.9%) |
ex-smoker | 21 | 132 | 0.137 | 0.083–0.192 | 0.028 | 0.033 | 11.9% (2.0%–30.2%) |
Piracetam | |||||||
negative | 72 | 822 | 0.081 | 0.063–0.098 | 0.009 | - | reference |
positive | 59 | 398 | 0.129 | 0.098–0.160 | 0.016 | 6.4% (2.2%–13.6%) | |
Hypertension | |||||||
negative | 29 | 249 | 0.104 | 0.070–0.140 | 0.018 | 0.866 | - |
positive | 102 | 971 | 0.095 | 0.078–0.113 | 0.009 | 0.004 | |
Diabetes mellitus | |||||||
negative | 76 | 625 | 0.108 | 0.085–0.131 | 0.012 | 0.018 | - |
positive | 55 | 595 | 0.085 | 0.063–0.106 | 0.011 | 0.124 | |
Dyslipidemia | |||||||
negative | 43 | 374 | 0.103 | 0.074–0.132 | 0.015 | 0.280 | - |
positive | 88 | 846 | 0.094 | 0.075–0.113 | 0.010 | 0.013 | |
Atrial fibrillation | |||||||
negative | 82 | 1025 | 0.074 | 0.059–0.090 | 0.008 | 0.020 | reference |
positive | 49 | 195 | 0.201 | 0.151–0.251 | 0.026 | 0.131 | 23.4% (2.5%–57.9%) |
TOAST | |||||||
Small-vessel occlusion | 21 | 411 | 0.049 | 0.028–0.069 | 0.010 | 0.106 | reference |
large-artery atherosclerosis | 51 | 355 | 0.126 | 0.093–0.158 | 0.016 | 0.145 | 8.6% (2.9%–18.4%) |
cardioembolism | 34 | 159 | 0.176 | 0.122–0.230 | 0.027 | 0.106 | - |
others | 25 | 295 | 0.078 | 0.049–0.108 | 0.015 | 0.453 | - |
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Chen, S.-Y.; Liu, J.-W.; Wang, Y.-H.; Huang, J.-Y.; Chen, S.-C.; Yang, S.-F.; Wang, P.-H. The Conditions Under Which Piracetam Is Used and the Factors That Can Improve National Institute of Health Stroke Scale Score in Ischemic Stroke Patients and the Importance of Previously Unnoticed Factors From a Hospital-Based Observational Study in Taiwan. J. Clin. Med. 2019, 8, 122. https://doi.org/10.3390/jcm8010122
Chen S-Y, Liu J-W, Wang Y-H, Huang J-Y, Chen S-C, Yang S-F, Wang P-H. The Conditions Under Which Piracetam Is Used and the Factors That Can Improve National Institute of Health Stroke Scale Score in Ischemic Stroke Patients and the Importance of Previously Unnoticed Factors From a Hospital-Based Observational Study in Taiwan. Journal of Clinical Medicine. 2019; 8(1):122. https://doi.org/10.3390/jcm8010122
Chicago/Turabian StyleChen, Shu-Yi, Jai-Wen Liu, Yu-Hsun Wang, Jing-Yang Huang, Shiuan-Chih Chen, Shun-Fa Yang, and Po-Hui Wang. 2019. "The Conditions Under Which Piracetam Is Used and the Factors That Can Improve National Institute of Health Stroke Scale Score in Ischemic Stroke Patients and the Importance of Previously Unnoticed Factors From a Hospital-Based Observational Study in Taiwan" Journal of Clinical Medicine 8, no. 1: 122. https://doi.org/10.3390/jcm8010122