Correlation between the early neurological deterioration and the poor short-term outcome after intravenous thrombolysis in patients with acute ischemic stroke
10.3760/cma.j.cn101721-20240127-00024
- VernacularTitle:早期神经功能恶化与急性缺血性卒中患者静脉溶栓后短期转归不良的相关性分析
- Author:
Wei WANG
1
;
Yanwen FANG
;
Ping GONG
Author Information
1. 民航总医院神经内科，北京 100123
- Keywords:
Acute ischemic stroke;
Intravenous thrombolysis;
Early neurological deterioration;
Outcome;
Prognosis
- From:
Clinical Medicine of China
2024;40(3):179-185
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the correlation between the early neurological deterioration and the poor short-term outcome after intravenous thrombolysis with recombinant tissue Plasmin activator (rt PA) in patients with acute ischemic stroke.Methods:A retrospective analysis of 268 patients with acute ischemic stroke who received recombinant tissue Plasmin activator(rt-PA) intravenous thrombolytic therapy in the Department of Neurology of Civil Aviation General Hospital from January 2019 to October 2022 was performed. The modified Rankin scale(mRS) was used to evaluate short-term outcome at 14 days after thrombolysis, with a score of 0 to 2 defined as good outcome and a score of 3 to 5 or death defined as poor outcome. Clinical, laboratory and imaging data of the two groups were collected. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression analysis was used to determine the independent risk factors for poor short-term outcomes.Results:Univariate analysis showed that age, baseline NIHSS score, fasting blood sugar, glycated hemoglobin, the proportion of coronary heart disease, proportion of atrial fibrillation, proportion of paraventricular high signal (3 score), proportion of hemorrhage transformation, proportion of END, proportion of double circulation infarction, proportion of new cortical infarction, proportion of new internal capsule infarction, proportion of large atherosclerosis of TOAST classification, and proportion of cardiogenic embolism of TOAST classification in the good outcome group were higher than those in the poor outcome group(68.00 (59.00, 80.00) years old vs 64.00 (54.50, 72.00) years old, 9 (6, 13) points vs 5 (3, 7) points, 6.85 (5.25, 9.20) mmol/L vs 5.64 (4.90, 6.75) mmol/L, 6.40 (5.70, 7.75)% vs 6.00 (5.60, 6.80)%, 31.3% (31/99) vs 17.7% (30/169), 28.3% (28/99) vs 9.5% (16/169), 26.3% (26/99) vs 13.0% (22/169), 19.2% (19/99) vs 5.9%(10/169), 53.5% (53/99) vs 21.9% (37/169), 10.1% (10/99) vs 2.4% (4/169), 44.4% (44/99) vs 22.5% (38/169), 41.4% (41/99) vs 27.8% (47/169), 33.3% (33/99) vs 17.8% (30/169), 25.3% (25/99) vs 6.5% (11/169)), the proportion of small artery occlusion and others of TOAST classification ,platelets were lower than the poor outcome group (29.3%(29/99) vs 53.8%(91/169),12.1%(12/99) vs 21.8%(37/169),199(163,240)×10 9/L vs 221(179,259)×10 9/L). The differences were statistically significant(the statistical values were U=2.80, U=7.94, U=3.24, U=2.29, χ 2=6.53, χ 2=16.11, χ 2=7.45, χ 2=11.40, χ 2=28.02, χ 2=7.54, χ 2=14.18, χ 2=5.24, χ 2=34.44, and U=2.16, respectively; P values were 0.005, <0.001, 0.001, 0.022, 0.011, <0.001, 0.006, 0.001, <0.001, 0.006, <0.001, 0.002, <0.001, and 0.031, respectively). Multivariate Logistic analysis showed that only baseline NIHSS score ( OR=1.212, 95% CI :1.123-1.309, P<0.001) and END ( OR=3.397, 95% CI:1.763-6.546, P<0.001) were independently related to the poor short-term outcome after intravenous thrombolysis in acute ischemic stroke patients. Conclusions:END and High baseline NIHSS score were independent risk factors for poor short-term outcome after intravenous thrombolysis in acute ischemic stroke patients.
