Analysis of risk factors for early neurological deterioration in patients with acute middle cerebral artery infarction / 中国脑血管病杂志

ABSTRACT

Objective To investigate the risk factors for early neurological deterioration (END) in patients with acute middle cerebral artery infarction.Methods From January 2009 to December 2012,81 patients with acute middle cerebral artery infarction completed cerebral angiography admitted to the Department of Neurology,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.END was defined as that the National Institutes of Health Stroke Scale (NIHSS) score increased ≥2 or the motor score increased ≥ 1 with in 72 h after admission compared with the baseline score on admission.All the patients were divided into either an END group (26 cases) or a non-END group (55 cases) according to whether the occurrence of END.Univariate factor analysis was used to analyze the differences of the clinical data between the two groups.The grade standard of collateral circulation was assessment with the collateral circulation assessment system of the American Society of Interventional and Therapeutic Neuroradiology/Sociey of Interventional Radiology.Multivariable Logistic regression analysis was used to analyze the risk factors for END after acute middle cerebral artery infarction.Results Compared with the patients in the non-END group,the proportions of age 60 years (65.4％ [17/26] vs.36.4％ [20/55];x2 =5.992,P =0.014),high-sensitivity C-reactive protein level ≥4.0 mg/L (76.9％ [20/26] vs.45.5％ [25/55];x2 =7.080,P =0.008) and diabetes (38.5％ [10/26] vs.16.4％ [9/55],x2 =4.802,P =0.028) in the END group were increased significantly,while the collateral circulation grade was decreased significantly (Z =-3.253,P ＜ 0.01).Multivariable Logistic regression analysis showed that the age ≥60 years (OR,3.412,95 ％ CI 1.075-10.824;P =0.037),high-sensitivity C-reactive protein level ≥ 4.0 mg/L (OR,3.812,95％ CI 1.141-12.740;P =0.030),and collateral circulation grade (OR,2.165,95％ CI 1.241-5.514;P =0.009) were the independent risk factor for END in acute middle cerebral artery infarction.Conclusion The decreased collateral circulation level,age ≥ 60 years and high-sensitivity C-reactive protein≥4.0 mg/L were the independent risk factors for occurring END in acute middle cerebral artery infarction.