Mortalidad hospitalaria en los infartos isquémicos de la arteria cerebral media: estudio de 1.355 pacientes / In-hospital mortality in middle cerebral artery infarcts: Clinical study of 1355 patients

Pacientes y método: Se estudian 1.355 pacientes consecutivos con infartos de la arteria cerebral media incluidos en el registro de ictus del «Hospital del Sagrat Cor de Barcelona». Se comparan variables demográficas, factores de riesgo, variables clínicas y evolutivas entre los pacientes que fallecen y los que sobreviven. El valor predictor independiente de cada variable relacionada con la mortalidad hospitalaria se analizó mediante un análisis de regresión logística utilizando 2 modelos predictores. El primer modelo estaba basado en datos demograficos, factores de riesgo y datos clínicos, con un total de 14 variables. El segundo modelo estaba basado en datos demográficos, factores de riesgo, datos clínicos y evolutivos, con un total de 20 variables. Resultados: Durante el ingreso hospitalario fallecieron 235 pacientes (17,3%). Las crisis comiciales precoces (OR=4,49; IC del 95%: 1,77–11,40), la edad mayor de 85 años (OR=2,61; IC del 95%: 1,88–2,60), la fibrilación auricular (OR=2,57; IC del 95%: 1,89–3,49), el deficit motor (OR=2,55; IC del 95%: 1,40–4,66), la insuficiencia cardiaca (OR=2,33; IC del 95%: 1,43–3,80) y el déficit sensitivo (OR=2,29; IC del 95%: 1,68–3,12) consituyeron factores predictores independientes de mortalidad hospitalaria en el primer modelo. Junto a dichas variables, las complicaciones cardiacas (OR=5,50: IC del 95%: 3,21–9,40), vasculares (OR=3,74; IC del 95%: 1,58–8,85), el infarto cerebral previo (OR=1,89: IC del 95%: 1,27–2,80), las infecciones (OR=1,82; IC del 95%; 1,27–2,61), y los infartos lacunares (OR=0,02; IC del 95%: 0,01–0,17), constituyeron variables pronósticas independientes relacionadas con la mortalidad hospitalaria en el segundo modelo (AU)

Background and objectives: To determine clinical predictors of in-hospital mortality in patients with middle cerebral artery infarcts (MCAI).Patients and methods: Data from 1.355 patients with MCAI were obtained from consecutive strokes included in the “Sagrat Cor Hospital of Barcelona Stroke Registry”. Demographic, clinical, neuroimaging and outcome variables in the subgroup of patients who died were compared with those in the surviving subgroup. The independent predictive value of each variable on the development of death was assessed with a logistic regression analysis. Two predictive models were constructed. A first model was based on demographic, risk factors and clinical variables (total 14 variables). A second model was based on demographic, risk factors, clinical and outcome variables (total 20). Results: In-hospital death was observed in 235 patients (17.3%). Early seizures (OR=4,49; CI 95%: 1,77–11,40), 85 years old or more (OR=2,61; CI 95%: 1,88–2,60), atrial fibrillation (OR=2,57; CI 95%: 1,89–3,49), limb weakness (OR=2,55; CI 95%: 1,40–4,66), cardiac heart disease (OR=2,33; CI 95%: 1,43–3,80) and sensory symptoms (OR=2,29; CI 95%: 1,68–3,12) appeared to be independent prognostic factors of in-hospital mortality in the first predictive model. In addition to these variables, cardiac complications (OR=5,50: CI 95%: 3,21–9,40), peripheral vascular complications (OR=3,74; CI 95%: 1,58–8,85), previous cerebral infarct (OR=1,89: CI 95%: 1,27–2,80), infections (OR=1,82; CI 95%; 1,27–2,61), and lacunar infarcts (OR=0,02; CI 95%: 0,01–0,17), appeared to be independent prognostic factors of in-hospital mortality in the second model. Conclusions: Clinical features easily obtained at the patient's bedside help clinicians to predict in-hospital mortality in patients with MCAI. Early seizures and age 85 years old or more, were the main clinical predictors of in-hospital mortality (AU)