Impacto de las complicaciones neurológicas y médicas sobre la mortalidad y situación funcional de pacientes con ictus agudo / The impact of neurological and medical complications on the mortality and functional situation of acute stroke patients

Introducción. Los pacientes con ictus presentan un elevado riesgo de presentar complicaciones. Su aparición puede condicionar el pronóstico del ictus. Estudiamos la frecuencia y el impacto de la aparición de diversas complicaciones en el pronóstico precoz y a medio plazo en estos pacientes. Pacientes y métodos. Estudio observacional de los pacientes ingresados en una unidad de ictus. Se registraron las complicaciones durante su estancia, distinguiéndose entre complicaciones neurológicas y médicas. Se estudió la influencia de estas según subtipo de ictus en la mortalidad intrahospitalaria y a los 90 días, y en la situación funcional a los 90 días, analizándose los factores clínicos predictores para la aparición de complicaciones. Resultados. Muestra de 847 pacientes. Un 29,5% de los pacientes presento complicaciones, que fueron más frecuentes en el ictus hemorrágico (50,5% frente a 26,6%; p < 0,0001). Las complicaciones más habituales fueron las neurológicas (21%). Para ambos subtipos, la presencia de complicaciones se asoció a mayor mortalidad intrahospitalaria (2,1% frente a 12,6%; p < 0,0001) y a 90 días (5,7% frente a 29,6%; p < 0,0001), y menor probabilidad de independencia a 90 días (72,9% frente a 30,4%; p < 0,0001). La gravedad del ictus al ingreso se mostró como el predictor más potente en la aparición de cualquier tipo de complicación. Conclusiones. La aparición de complicaciones durante la fase aguda del ictus influye de forma diversa en la mortalidad y en el pronóstico funcional. La identificación de factores predictores podría disminuir el impacto sobre la evolución del paciente con un ictus agudo (AU)

Introduction. Stroke patients have a high risk of presenting complications, the appearance of which can condition the prognosis of the stroke. We studied the frequency and impact of the onset of several different complications on the early and mid-term prognosis of these patients. Patients and methods. We conducted an observation-based study of the patients admitted to a stroke unit. The complications that occurred while hospitalised were recorded, a distinction being drawn between neurological and medical complications. The study examined their influence, according to the subtype of stroke, on intra-hospital mortality and that at 90 days, as well as on the functional situation at 90 days, by analysing the clinical factors that are predictive for the appearance of complications. Results. The sample consisted of 847 patients. Altogether, 29.5% of the patients presented complications, which were more frequent in haemorrhagic stroke (50.5% versus 26.6%; p < 0.0001). The most usual complications were of a neurological nature (21%). For both subtypes, the presence of complications was associated with a higher rate of mortality both in hospital (2.1% versus 12.6%; p < 0.0001) and at 90 days (5.7% versus 29.6%; p < 0.0001), and a lower probability of independence at 90 days (72.9% versus 30.4%; p < 0.0001). The severity of the stroke on admission revealed itself as the most powerful predictor of the onset of any type of complication. Conclusions. The appearance of complications during the acute phase of the stroke has an adverse influence on mortality and on the functional prognosis. The identification of predictive factors could reduce the impact upon the progress of acute stroke patients (AU)

Atención extrahospitalaria del ictus. Réplica 2 / Extra-hospital stroke care. Reply 2

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[Development and response to intravenous treatment with tissue plasminogen activator with regard to referral hospitals. The experience of a stroke referral unit]. / Evolución y respuesta al tratamiento intravenoso conactivador del plasminógeno tisular en relación con el hospitalde derivación. Experiencia de una unidad de ictus de referencia.

INTRODUCTION: The intravenous administration of tissue plasminogen inhibitor is a safe and effective treatment for patients with an acute ischaemic stroke. The prognosis depends on a number of factors, the time that elapses between the onset of the stroke and its administration being one of those with the greatest impact. PATIENTS AND METHODS: This is a prospective observational study of the patients who received intravenous fibrinolysis in our stroke unit between June 2007 and December 2010. The patients were divided into two groups, a distinction being made between those who went directly to AE at our hospital and those who were referred from other hospitals in Extremadura. The baseline characteristics, response to treatment and development in each group were compared. RESULTS: The patients who came from outside our health district were mainly males, with a TACI-type stroke and they presented higher scores on the National Institutes of Health Stroke Scale (NIHSS). The time elapsed prior to administration of the fibrinolysis was shorter in the patients from our health district. The NIHSS score on discharge was higher in patients who came from another health district, but there were no differences in the Rankin scale at three months or in the mortality rate. CONCLUSIONS: Patients submitted to fibrinolysis who come from another hospital score higher on the NIHSS on discharge. This is probably due to a bias in the selection of the patients, since those referred are mainly males, who have a poorer clinical situation on admission and receive treatment in a significantly longer time interval following the onset of symptoms.