Analysis Of Predictive Factors Of Adverse Prognosis In Patients With Acute Ischemic Stroke Treated By Intravenous Thrombolysis

Objectives:As for the treatment of acute ischemic stroke,the internationally recognized treatment is intravenous thrombolysis,which can reduce mortality and improve clinical prognosis.However,not all patients benefit from the potential risks of thrombolysis(such as intracranial hemorrhage).At present,there are many studies on the effectiveness,safety and prognosis of stroke in patients with acute ischemic stroke receiving intravenous thrombolysis,but there are few studies on the predictive factors of adverse prognosis.This study analyzed the predictive factors of adverse prognosis of intravenous thrombolytic therapy in patients with acute ischemic stroke,strengthened the identification of patients with poor prognosis after thrombolytic therapy,and provided a reference index for precise thrombolytic therapy of neurologists.Methods:This study prospectively selected patients with acute ischemic stroke who received intravenous thrombolytic therapy within 6 hours after the onset of emergency in the Second Affiliated hospital of Dalian Medical University from September 2018 to September 2019.According to the entry and discharge criteria,the general clinical data(including demographic data,past history),laboratory test indicators,imaging tests,and The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the severity of stroke in patients,and follow-up of stroke patients’ neurological function recovery at 3 months after thrombolysis.The clinical prognosis assessment uses Modified Rankin scale(m RS)score at 3 months after thrombolysis,m RS score of 0-2was defined as good functional outcome,and m RS score > 2 was defined as poor outcome prognosis.The patients were divided into good prognosis group and bad prognosis group.SPSS 25.0 software was used to perform statistical analysis on general clinical data,laboratory tests,and imaging.First,single-factor analysis was performed,and then the statistically significant variables in the single-factor analysis were put into a multi-factor Logistics regression model analysis.Calculate odds ratio(OR)and 95%confidence interval(95% CI).Resultes: The study finally included 141 patients with acute ischemic stroke who received intravenous thrombolysis within 6 hours of onset.114 patients in the group with good prognosis,including 73 males and 41 females,had an average age of(65±10.7)years;27 patients in the group with poor prognosis,including 13 males and 14 females,had an average age of(72±10.5)years.Univariate analysis showed that age,NIHSS score before thrombolysis,systolic blood pressure before thrombolysis,emergency blood glucose,red blood cell distribution width(Red blood cell distribution width,RDW),urea nitrogen,hemoglobin,history of hypertension,history of ischemic stroke,transient ischemic attack(TIA)or history of atrial fibrillation were correlated with the adverse outcomes of three months after intravenous thrombolysis(P<0.05).In terms of gender,diastolic blood pressure before thrombolysis,time from onset to thrombolysis,diabetes,coronary heart disease,myocardial infarction,cardiac insufficiency,hyperlipidemia,family history of cerebrovascular disease,smoking history,drinking history,history of antiplatelet use before stroke,history of statins use before stroke,white blood cell count,neutrophil count,platelet count,fibrinogen,creatinine,uric acid,early signs of CT on cerebral infarction,There was no statistical difference between the two groups of data(P>0.05).Multivariate logistic regression analysis: The NIHSS score before thrombolysis [OR1.327,95% CI(1.156-1.524),P<0.001],systolic blood pressure before thrombolysis[OR 1.037,95% CI(1.000-1.076),P = 0.048 ],Previous ischemic stroke / TIA [OR14.407,95% CI(3.007-69.020),P= 0.001],Red blood cell distribution width(RDW)[OR 2.608,95% CI(1.221-5.570),P = 0.013] had statistical significance.Conclusions:The high NIHSS score,high systolic blood pressure,previous history of ischemic stroke/TIA,and RDW in patients with acute ischemic stroke before intravenous thrombolysis were predictors of poor prognosis at 3 months after intravenous thrombolysis.