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Predictors of Early versus Delayed Neurological Deterioration after Thrombolysis for Ischemic Stroke.
Han, Qiao; You, Shoujiang; Maeda, Toshiki; Wang, Yanan; Ouyang, Menglu; Li, Qiang; Song, Lili; Zhao, Yang; Ren, Xinwen; Chen, Chen; Delcourt, Candice; Zhou, Zien; Cao, Yongjun; Liu, Chun-Feng; Zheng, Danni; Arima, Hisatomi; Robinson, Thompson G; Chen, Xiaoying; Lindley, Richard I; Chalmers, John; Anderson, Craig S; Wang, Xia.
Afiliación
  • Han Q; Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of SooChow University, Suzhou, China, 305188560@qq.com.
  • You S; Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China, 305188560@qq.com.
  • Maeda T; Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of SooChow University, Suzhou, China.
  • Wang Y; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Ouyang M; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Li Q; Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan.
  • Song L; Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
  • Zhao Y; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Ren X; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Chen C; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Delcourt C; The George Institute for Global Health China, Beijing, China.
  • Zhou Z; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Cao Y; The George Institute for Global Health China, Beijing, China.
  • Liu CF; The George Institute for Global Health China, Beijing, China.
  • Zheng D; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Arima H; The George Institute for Global Health China, Beijing, China.
  • Robinson TG; Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
  • Chen X; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Lindley RI; Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
  • Chalmers J; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Anderson CS; Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of SooChow University, Suzhou, China.
  • Wang X; Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of SooChow University, Suzhou, China.
Cerebrovasc Dis ; : 1-9, 2024 May 15.
Article en En | MEDLINE | ID: mdl-38749409
ABSTRACT

INTRODUCTION:

We aimed to determine predictors of early (END) and delayed neurological deterioration (DND) and their association with the functional outcome in patients with acute ischemic stroke (AIS) who participated in the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

METHODS:

END and DND (without END) were defined as scores of a ≥2-point increase on the National Institutes of Health Stroke Scale (NIHSS) or a ≥1-point decrease on the Glasgow coma scale or death, from baseline to 24 h and 24-72 h, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death).

RESULTS:

Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p ≤ 0.01) and DND (all p ≤ 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p < 0.001).

CONCLUSION:

We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. Both END and DND predict unfavorable outcomes at 90 days.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2024 Tipo del documento: Article
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2024 Tipo del documento: Article