Evidence map›Paper›PMID 37126535›Full record

ArticlePloS one2023

Effect of alteplase, benzodiazepines and beta-blocker on post-stroke pneumonia: Exploration of VISTA-Acute.

Thanh G Phan, Richard Beare, Philip M Bath, Svitlana Ievlieva, Stella Ho, John Ly, Amanda G Thrift, Velandai K Srikanth, Henry Ma, VISTA-Acute Collaborators

Open access · goldAbstract read
In one paragraph

Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.6field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 2 countries.

Thanh G PhanDepartment of Neurology, Monash Medical Centre, Clayton, Australia.ORCID 0000-0003-3400-6323
Richard BeareDepartment of Medicine, Peninsula Health and Central Clinical School, Monash University and National Centre for Healthy Ageing, Melbourne, Australia.
Philip M BathDivision of Clinical Neuroscience, Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom.ORCID 0000-0003-2734-5132
Svitlana IevlievaDepartment of Neurology, Monash Medical Centre, Clayton, Australia.
Stella HoDepartment of Pharmacy, Monash Health, Clayton, Australia.
John LyDepartment of Neurology, Monash Medical Centre, Clayton, Australia.
Amanda G ThriftStroke and Aging Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
Velandai K SrikanthDepartment of Medicine, Peninsula Health and Central Clinical School, Monash University and National Centre for Healthy Ageing, Melbourne, Australia.
Henry MaDepartment of Neurology, Monash Medical Centre, Clayton, Australia.
VISTA-Acute Collaborators
Monash Medical Centre · AUMonash Health · AUPeninsula Health · AUUniversity of Nottingham · GB

Funding

StrokeNet I-ACQUIRE 12-month Follow-up StudyU01NS106655 · NINDS · VIRGINIA POLYTECHNIC INST AND ST UNIV · PI LO, WARREN DAVID, RAMEY, SHARON LANDESMAN · 2019 to 2024
$15.2M
National Pediatric Rehabilitation Resource Center: Techniques DevelopmentP2CHD101912 · NICHD · VIRGINIA POLYTECHNIC INST AND ST UNIV · PI HEATHCOCK, JILL C. · 2020 to 2024
$5.0M
African Neurobiobank for Precision Stroke Medicine - (ELSI) ProjectU01HG010273 · NHGRI · COLLEGE OF MEDICINE, UNIVERSITY OF IBADAN · PI AKINYEMI, RUFUS OLUSOLA, ARULOGUN, OYEDUNNI SOLA · 2018 to 2022
$512k
Promoting Physical Activity and Healthy Eating Among Adults in a Faith-Based Setting In Lagos, Nigeria.K43TW010704 · FIC · COLLEGE OF MEDICINE, UNIVERSITY OF LAGOS · PI ODUKOYA, OLUWAKEMI · 2017 to 2021
$501k
FIC NIH HHS K43 TW010704Medical Research Council MR/S011676/1NHGRI NIH HHS U01 HG010273NICHD NIH HHS P2C HD101912NINDS NIH HHS U01 NS106655Wellcome TrustWellcome Trust 221854/Z/20/Z
6 · The paper itself

Abstract

backgroundPost-stroke pneumonia is a frequent complication of stroke and is associated with high mortality. Investigators have described its associations with beta-blocker. However, there has been no evaluation of the role of recombinant tissue plasminogen activator (RTPA). We postulate that RTPA may modify the effect of stroke on pneumonia by reducing stroke disability. We explore this using data from neuroprotection trials in Virtual International Stroke Trials Archive (VISTA)-Acute.

methodWe evaluated the impact of RTPA and other medications in random forest model. Random forest is a type of supervised ensemble tree-based machine learning method. We used the standard approach for performing random forest and partitioned the data into training (70%) and validation (30%) sets. This action enabled to the model developed on training data to be evaluated in the validation data. We borrowed idea from Coalition Game Theory on fair distribution of marginal profit (Shapley value) to determine proportional contribution of a covariate to the model. Consistent with other analysis using the VISTA-Acute data, the diagnosis of post-stroke pneumonia was based on reports of serious adverse events.

resultsThe overall frequency of pneumonia was 10.9% (614/5652). It was present in 11.5% of the RTPA (270/2358) and 10.4% (344/3295) of the no RTPA groups. There was significant (p<0.05) imbalance in covariates (age, baseline National Institutes of Health Stroke Scale (NIHSS), diabetes, and sex). The AUC for training data was 0.70 (95% CI 0.65-0.76), validation data was 0.67 (95% CI 0.62-0.73). The Shapley value shows that baseline NIHSS (≥10) and age (≥80) made the largest contribution to the model of pneumonia while absence of benzodiazepine may protect against pneumonia. RTPA and beta-blocker had very low effect on frequency of pneumonia.

conclusionIn this cohort pneumonia was strongly associated with stroke severity and age whereas RTPA had a much lower effect. An intriguing finding is a possible association between benzodiazepine and pneumonia but this requires further evaluation.

Indexed as

PneumoniaStrokeAdrenergic beta-AntagonistsBenzodiazepinesFibrinolytic AgentsHumansThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeAdrenergic beta-AntagonistsBenzodiazepinesFibrinolytic AgentsTissue Plasminogen Activator

Identifiers

PMID37126535
PMCPMC10150972
OpenAlexW4367598184

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.