Abstract 201: Effect of Statin Treatment Before and After Hospitalization on Mortality Following Acute Ischemic Stroke: Importance of Confounding by Stroke Severity and Palliative Care
Bibliographic record
Abstract
Background: Statins may improve outcomes following acute ischemic stroke (AIS), but studies often fail to account for confounders such as stroke severity and palliative care. We examined the effect of statin treatment both before and after hospital admission in AIS. Methods: Data were prospectively collected from 10646 AIS admissions to 11 hospitals participating in the Registry of the Canadian Stroke Network between 2003-2008. The effect of statins taken before and after admission on stroke mortality was determined using multivariable logistic regression. We repeated analyses using oral hypoglycemic agents as a marker of the avoidance of oral agents in the acute setting. Results: Pre-admission 31% of patients were taking statins. Severe stroke (Canadian Neurological Scale < 5) was slightly lower in patients using statins pre-admission (19.2% vs. 20.9%). Pre-admission statins were associated with significantly lower adjusted mortality at 180-days (OR=0.82, 95% CI 0.69, 0.97), but not at 30-days (OR=0.90, 95% CI 0.73, 1.11). Post-admission 65% of patients received statins. Patients who were on statins pre-admission but off statins post-admission (i.e., ‘On-Off’ or discontinuation) had strikingly higher mortality, however, this effect was markedly attenuated after adjustment (Table). Stroke severity and palliative care were identified as major confounders. Continuing or initiating statin treatment post-admission was associated with significantly lower mortality compared to patients who were never treated with statins, however, oral hypoglycemic agents exhibited similar associations (Table). Conclusions: Pre-admission statin use was associated with lower 6-month mortality. Stroke severity and palliative care confounded the relationships between post-admission treatment and mortality, especially for patients in whom statins were discontinued. Well conducted RCTs are needed to quantify the benefits of statins in the acute setting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".