Clinical course, causes of worsening, and outcomes of severe ischemic stroke: A prospective multicenter cohort study.
10.1097/CM9.0000000000003556
- Author:
Simiao WU
1
;
Yanan WANG
1
;
Ruozhen YUAN
2
;
Meng LIU
1
;
Xing HUA
1
;
Linrui HUANG
1
;
Fuqiang GUO
3
;
Dongdong YANG
4
;
Zuoxiao LI
5
;
Bihua WU
6
;
Chun WANG
7
;
Jingfeng DUAN
8
;
Tianjin LING
9
;
Hao ZHANG
10
;
Shihong ZHANG
1
;
Bo WU
1
;
Cairong ZHU
11
;
Craig S ANDERSON
12
;
Ming LIU
1
Author Information
1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
2. Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
3. Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China.
4. Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China.
5. Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
6. Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 634700, China.
7. Department of Neurology, People's Hospital of Deyang City, Deyang, Sichuan 618000, China.
8. Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan 621000, China.
9. Department of Neurology, The First People's Hospital of Ziyang, Ziyang, Sichuan 641300, China.
10. Department of Neurology, Jiangyou People's Hospital, Jiangyou, Sichuan 621000, China.
11. Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
12. The George Institute for Global Health, Sydney, NSW 2050, Australia.
- Publication Type:Multicenter Study
- Keywords:
Brain edema;
Clinical course;
Clinical worsening;
Outcomes;
Reperfusion;
Severe stroke
- MeSH:
Humans;
Male;
Female;
Prospective Studies;
Ischemic Stroke/mortality*;
Aged;
Middle Aged;
Aged, 80 and over;
Stroke;
Brain Ischemia
- From:
Chinese Medical Journal
2025;138(13):1578-1586
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Severe stroke has high rates of mortality and morbidity. This study aimed to investigate the clinical course, causes of worsening, and outcomes of severe ischemic stroke.
METHODS:This prospective, multicenter cohort study enrolled adult patients admitted ≤30 days after ischemic stroke from nine hospitals in China between September 2017 and December 2019. Severe stroke was defined as a score of ≥15 on the National Institutes of Health Stroke Scale (NIHSS). Clinical worsening was defined as an increase of 4 in the NIHSS score from baseline. Unfavorable functional outcome was defined as a modified Rankin scale score ≥3 at 3 months and 1 year after stroke onset, respectively. We performed Logistic regression to explore baseline features and reperfusion therapies associated with clinical worsening and functional outcomes.
RESULTS:Among 4201 patients enrolled, 854 patients (20.33%) had severe stroke on admission. Of 3347 patients without severe stroke on admission, 142 (4.24%) patients developed severe stroke in hospital. Of 854 patients with severe stroke on admission, 33.95% (290/854) experienced clinical worsening (median time from stroke onset: 43 h, Q1-Q3: 20-88 h), with brain edema (54.83% [159/290]) as the leading cause; 24.59% (210/854) of these patients died by 30 days, and 81.47% (677/831) and 78.44% (633/807) had unfavorable functional outcomes at 3 months and 1 year respectively. Reperfusion reduced the risk of worsening (adjusted odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.12-0.49, P <0.01), 30-day death (adjusted OR: 0.22, 95% CI: 0.11-0.41, P <0.01), and unfavorable functional outcomes at 3 months (adjusted OR: 0.24, 95% CI: 0.08-0.68, P <0.01) and 1 year (adjusted OR: 0.17, 95% CI: 0.06-0.50, P <0.01).
CONCLUSIONS:Approximately one-fifth of patients with ischemic stroke had severe neurological deficits on admission. Clinical worsening mainly occurred in the first 3 to 4 days after stroke onset, with brain edema as the leading cause of worsening. Reperfusion reduced the risk of clinical worsening and improved functional outcomes.
REGISTRATION:ClinicalTrials.gov , NCT03222024.
