Sonu Bhaskar1, Peter Stanwell2, Andrew Bivard3, Neil Spratt3, Rhonda Walker4, Gemma H Kitsos3, Mark W Parsons3, Malcolm Evans3, Louise Jordan3, Michael Nilsson5, John Attia6, Christopher Levi3. 1. Department of Neurology, John Hunter Hospital, University of Newcastle; Centre for Translational Neuroscience and Mental Health, and Hunter Medical Research Institute (HMRI), University of Newcastle, Australia. 2. Centre for Translational Neuroscience and Mental Health, and Hunter Medical Research Institute (HMRI), University of Newcastle, Australia. 3. Department of Neurology, John Hunter Hospital, University of Newcastle, Australia. 4. Cardiac and Stroke Outcomes Unit, Hunter New England Local Health District, Newcastle, Australia. 5. Centre for Translational Neuroscience and Mental Health, and Hunter Medical Research Institute (HMRI), University of Newcastle, Australia; Department of Clinical Neuroscience, Sahlgrenska University Hospital, University of Gothenburg, Sweden. 6. Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, University of Newcastle, Australia.
Abstract
BACKGROUND AND PURPOSE: Epidemiological studies on the extent of the interaction and/or influence of stroke severity on clinical outcomes are important. The aim of the present study was to investigate the putative (and degree of) impact of initial stroke severity in predicting the overall functional outcome, in-hospital placement, and mortality in acute ischemic stroke (AIS) in comparison with age, admission to the stroke unit and thrombolytic treatment. MATERIALS AND METHODS: The John Hunter Hospital acute stroke register was used to collect a retrospective cohort of AIS patients being assessed for reperfusion therapy and admitted between January 2006 and December 2013. Univariate and multivariate logistic regression and receiver operating characteristics analyses were used to assess associations with functional outcome, in-hospital placement, and mortality at 90 days. RESULTS: 608 AIS patients with complete datasets were included in the study. On univariate analysis, initial stroke severity showed the strongest independent association to the risk of death within 90 days (Odds ratio (OR) =1.15; P < 0.001; 95% confidence interval (CI) = [1.11, 1.18]); age was a less significant independent influence (OR = 1.02; P = 0.049; 95% CI = [1.00, 1.03]). Multivariate logistic regression analysis demonstrated that initial stroke severity independently predicted the 90 day mortality (OR = 1.16; 95% CI = [1.12, 1.2]; P < 0.0001) and unfavorable outcome (OR = 1.16; 95% CI = [1.13, 1.2]; P < 0.0001). Higher National Institute of Health Stroke Scale at admission was significantly associated with longer in-hospital placement (P < 0.0001). CONCLUSIONS: In this acute stroke cohort, initial stroke severity had a major impact on the likelihood of death following an AIS and appears to be the dominant influence on the overall stroke outcome and in-hospital placement.
BACKGROUND AND PURPOSE: Epidemiological studies on the extent of the interaction and/or influence of stroke severity on clinical outcomes are important. The aim of the present study was to investigate the putative (and degree of) impact of initial stroke severity in predicting the overall functional outcome, in-hospital placement, and mortality in acute ischemic stroke (AIS) in comparison with age, admission to the stroke unit and thrombolytic treatment. MATERIALS AND METHODS: The John Hunter Hospital acute stroke register was used to collect a retrospective cohort of AIS patients being assessed for reperfusion therapy and admitted between January 2006 and December 2013. Univariate and multivariate logistic regression and receiver operating characteristics analyses were used to assess associations with functional outcome, in-hospital placement, and mortality at 90 days. RESULTS: 608 AIS patients with complete datasets were included in the study. On univariate analysis, initial stroke severity showed the strongest independent association to the risk of death within 90 days (Odds ratio (OR) =1.15; P < 0.001; 95% confidence interval (CI) = [1.11, 1.18]); age was a less significant independent influence (OR = 1.02; P = 0.049; 95% CI = [1.00, 1.03]). Multivariate logistic regression analysis demonstrated that initial stroke severity independently predicted the 90 day mortality (OR = 1.16; 95% CI = [1.12, 1.2]; P < 0.0001) and unfavorable outcome (OR = 1.16; 95% CI = [1.13, 1.2]; P < 0.0001). Higher National Institute of Health Stroke Scale at admission was significantly associated with longer in-hospital placement (P < 0.0001). CONCLUSIONS: In this acute stroke cohort, initial stroke severity had a major impact on the likelihood of death following an AIS and appears to be the dominant influence on the overall stroke outcome and in-hospital placement.
Authors: Udit Saraf; Shyam Prabhakaran; K Arun; Ahmed Babiker; Adithyan Rajendran; Chandrasekharan Kesavadas; P N Sylaja Journal: Ann Indian Acad Neurol Date: 2020-06-05 Impact factor: 1.383