Influencing factors for early clinical deterioration in patients with mild posterior circulation infarction

Qiang HUANG; Ang LI; Yanfei HAN; Yongbo ZHANG

ABSTRACT

Objective:

To study the incidence and influencing factors for clinical deterioration at an early stage in patients with mild posterior circulation infarction (PCI).

Methods:

Totally 291 patients with mild PCI from January 1, 2016 to January 1, 2020 were retrospectively included. Clinical deterioration within 24 h (CD 24h) and clinical deterioration between 2 d and 14 d (CD 14d) were the endpoint events. IBM SPSS Statistics 19.0 software was used for statistical analysis. Pearson chi-square test or Mann-Whitney U test were used to compare the group differences of corresponding variables. Multivariate logistic regression model was used to analyze the influencing factors of the primary endpoint events.

Results:

The incidences of CD 24h and CD 14d were 21.6% (63/291) and 30.6% (89/291) respectively, with the reperfusion therapy rate of 13.4% (39/291). The results of multivariate logistic regression analysis with CD 24h as the endpoint event showed that the baseline NIHSS was a positive independent factor increasing the risk of CD 24h ( OR=1.184, 95% CI=1.078-1.300, P<0.01). Cerebellar infarction (compared with brainstem infarction) ( OR=0.250, 95% CI=0.082-0.757, P=0.014)and non-macroatherosclerosis (compared with major atherosclerosis) ( OR=0.026, 95% CI=0.002-0.325, P=0.005) had negative predictive effects on CD 24h. The results of multivariate logistic regression analysis with CD 14d as the endpoint event showed that pulmonary infection complications after stroke ( OR=28.085, 95% CI=6.863-114.927, P<0.01) and baseline NIHSS ( OR=1.114, 95% CI=1.001-1.240, P=0.048) were independent factors of CD 14d. Reperfusion therapy ( OR=0.089, 95% CI=0.013-0.613, P=0.014) could reduce the risk of CD 14d.Top of basilar syndrome(compared with single brainstem infarction) ( OR=7.526, 95% CI=1.565-36.188, P=0.012) increased the risk of CD 14d, while the non-macroatherosclerotic (compared with the macroatherosclerotic subtype) ( OR=0.076, 95% CI=0.009-0.683, P=0.021) negatively predicted the risk of CD 14d. Baseline NIHSS ( OR=0.834, 95% CI=0.758-0.918, P<0.01), CD 14d ( OR=0.048, 95% CI=0.018-0.130, P<0.01) and pulmonary infection complications ( OR=0.045, 95% CI=0.012-0.167, P<0.01) were negatively predicted the good clinical prognosis (modified Rankin score 14 days after onset ≤2).

Conclusion:

Early clinical deterioration has a negative predictive effect on clinical prognosis improvement of patients with mild PCI. Large artery atherosclerotic stenosis subtype and basilar apex syndrome are the risk factors of CD 24h and CD 14d of patients with mild PCI, and pulmonary infection is the risk factor of CD 14d. Reperfusion therapy in acute phase is helpful to reduce the risk of early clinical deterioration and improve clinical prognosis in patients with mild PCI.