Neurology · 2020
Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Park Tai Hwan, Lee Jeong-Kon, Park Moo-Seok, Park Sang-Soon, Hong Keun-Sik, Ryu Wi-Sun, Kim Dong-Eog, Park Man Seok, Choi Kang-Ho, Kim Joon-Tae, Kang Jihoon, Kim Beom Joon, Han Moon-Ku, Lee Jun, Cha Jae-Kwan, Kim Dae-Hyun, Kim Jae Guk, Lee Soo Joo, Cho Yong-Jin, Kwon Jee-Hyun, Shin Dong-Ick, Yeo Min-Ju, Sohn Sung Il, Hong Jeong-Ho, Lee Ji Sung, Choi Jay Chol, Kim Wook-Joo, Lee Byung-Chul, Yu Kyung-Ho, Oh Mi-Sun, Park Jong-Moo, Kang Kyusik, Lee Kyung Bok, Lee Juneyoung, Gorelick Philip B, Bae Hee-Joon
Аннотация
OBJECTIVE: To improve epidemiologic knowledge of neurologic deterioration (ND) in patients with acute ischemic stroke (AIS).
METHODS: In this prospective observational study, we captured ND prospectively in 29,446 patients with AIS admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in NIH Stroke Scale (NIHSS) score ≥2 (total), or ≥1 (motor or consciousness), or any new neurologic symptoms. Change in incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) score at 3 months and 1 year, and a composite of stroke, myocardial infarction, and all-cause death at 1 year were assessed.
RESULTS: ND occurred in 4,299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence, was within the first 6 hours, which decreased to 2.09 within 24-48 hours, and 0.66 within 72-96 hours after stroke onset. Old age, female sex, diabetes, early arrival, large artery atherosclerosis as a stroke subtype, high NIHSS scores, glucose level, systolic blood pressure, leukocytosis at admission, recanalization therapy, TIA without a relevant lesion, and steno-occlusion of relevant arteries were associated with ND. The causes were stroke progression (71.8%) followed by recurrence (8.5%). Adjusted relative risks (95% CI) for poor outcome (mRS 3-6) at 3 months and 1 year were 1.75 (1.70-1.80) and 1.70 (1.65-1.75), respectively. The adjusted hazard ratio (95% CI) for the composite event was 1.59 (1.45-1.74).
CONCLUSIONS: ND should be taken into consideration as a factor that may influence the outcome in acute ischemic stroke.
METHODS: In this prospective observational study, we captured ND prospectively in 29,446 patients with AIS admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in NIH Stroke Scale (NIHSS) score ≥2 (total), or ≥1 (motor or consciousness), or any new neurologic symptoms. Change in incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) score at 3 months and 1 year, and a composite of stroke, myocardial infarction, and all-cause death at 1 year were assessed.
RESULTS: ND occurred in 4,299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence, was within the first 6 hours, which decreased to 2.09 within 24-48 hours, and 0.66 within 72-96 hours after stroke onset. Old age, female sex, diabetes, early arrival, large artery atherosclerosis as a stroke subtype, high NIHSS scores, glucose level, systolic blood pressure, leukocytosis at admission, recanalization therapy, TIA without a relevant lesion, and steno-occlusion of relevant arteries were associated with ND. The causes were stroke progression (71.8%) followed by recurrence (8.5%). Adjusted relative risks (95% CI) for poor outcome (mRS 3-6) at 3 months and 1 year were 1.75 (1.70-1.80) and 1.70 (1.65-1.75), respectively. The adjusted hazard ratio (95% CI) for the composite event was 1.59 (1.45-1.74).
CONCLUSIONS: ND should be taken into consideration as a factor that may influence the outcome in acute ischemic stroke.