Influencing factors of short-term and long-term outcomes in patients with acute ischemic stroke / 国际脑血管病杂志

ABSTRACT

Objective To investigate the influencing factors of short-term and long-term outcomes in patients with acute ischemic stroke. Methods From March 2015 to March 2016, patients with acute ischemic stroke treated at the Department of Neurology, the Second Hospital of Tianjin Medical University were enrolled prospectively. The demographic and baseline clinical data of the patients were recorded. The modified Rankin scale(mRS)was used to assess the short-term outcomes at 14 d and one year after onset. Good outcome was defined as mRS 0-2, and poor outcome was defined as > 2. Death or new cardiocerebrovascular events were recorded.Multivariable logistic regression analysis was used to determine the influencing factors of short-term and long-term outcomes in patients with acute ischemic stroke.Results A total of 514 patients with acute ischemic stroke were enrolled, including 338 (65.8％) with short-term good outcome and 176 (34.2％) with poor outcome. There were significant differences in age, atrial fibrillation, history of past stroke or transient ischemic attack (TIA), etiological typing of stroke, baseline NIHSS score, severity of stroke, pulmonary infection, dysphagia, and urinary incontinence between the short-term good outcome group and the poor outcome group (P<0.05). Multivariable logistic regression analysis showed that history of past stroke or TIA(odds ratio[OR]2.188, 95％ confidence interval[CI] 1.192-4.014;P=0.011),baseline NIHSS score(OR 1.504,95％ CI 1.362-1.661;P=0.001),and urinary incontinence (OR 4.114, 95％ CI 1.934-8.751; P=0.001) were the independent influencing factors of short-term outcome. A total of 467 patients completed 1-year follow-up, including 315 (67.5％)with long-term good outcome and 152(32.5％)with poor outcome.There were significant differences in age,history of ischemic heart disease, stroke or TIA, etiological typing of stroke, baseline NIHSS score, severity of stroke, pulmonary infection, dysphagia, urinary incontinence, secondary prevention of antiplatelet drugs and statins between the long-term good outcome group and the poor outcome group(all P<0.05).Multivariable logistic regression analysis showed that age(OR 1.029,95％ CI 1.004-1.055; P=0.022), past history of stroke or TIA(OR 1.983, 95％ CI 1.082-3.633; P=0.027), baseline NIHSS score (OR 1.271, 95％ CI 1.153-1.400; P=0.001), urinary incontinence (OR 4.996, 95％ CI 2.308-10.813; P= 0.001), and secondary prevention using antiplatelet drugs (OR 0.227, 95％ CI 0.125-0.414; P=0.001) were the independent influencing factors of long-term outcome. The baseline NIHSS score (OR 1.184, 95％ CI 1.070-1.310;P<0.001) and secondary prevention using antiplatelet agents (OR 0.064, 95％ CI 0.014-0.284; P< 0.001) were the independent influencing factors of death or occurring vascular events. Conclusion Age, past history of stroke or TIA, baseline NIHSS score, urinary incontinence, antiplatelet drugs for secondary prevention were independently associated with the outcomes in patients with acute ischemic stroke. Early and targeted intervention of modifiable factors and the emphasis on the use of antiplatelet agents in secondary prevention might reduce stroke recurrence and improve outcomes.