Analysis Of Risk Factors For Early Neurological Deterioration In Patients With Acute Cerebral Infarction After Intravenous Thrombolysis

Background and Objective:Early neurological deterioration(END)refers to the worsening of neurological deficits caused by various reasons after intravenous thrombolysis(IVT)in patients with acute cerebral infarction(ACI),which is closely related to the prognosis of ACI patients.In order to better understand the causes of END in ACI patients after IVT and make preventive decisions for ACI patients,this study investigated and analyzed the incidence,causes,and risk factors of END in ACI patients after IVT,and explored its application value.Methods:199 patients with ACI who underwent IVT in the emergency room of the Second Affiliated Hospital of Nanchang University from December 2020 to October 2022 were continuously collected.They were divided into alteplase(rt-PA)group 178 cases and urokinase(UK)group 21 cases according to the different thrombolytic drugs.They were then divided into END subgroup and non-END subgroup according to whether END occurred after IVT.END is defined as an increase in the NIHSS score of ACI patients by 4 or more points or death within 24 hours after IVT compared to before IVT.Collected all clinical data of the enrolled patients,including demographic information: age,gender,weight,smoking history,and drinking history;Clinical characteristics: complications(hypertension,diabetes,history of atrial fibrillation,cerebrovascular disease,cardiovascular disease,hyperlipidemia),previous use of anticoagulant drugs,previous use of antiplatelet drugs,systolic blood pressure(SBP)at admission,diastolic blood pressure(DBP)at admission,SBP 2 hours after thrombolysis,DBP 2 hours after thrombolysis,NIHSS score before thrombolysis NIHSS score 24 hours after thrombolysis,time from onset to thrombolysis,thrombolytic drugs(rt PA,UK),TOAST etiology type(large atherosclerosis type/small artery occlusion type/cardiogenic embolism type);Laboratory indicators at admission: white blood cell count,percentage of neutrophils,platelet count,hematocrit,platelet hematocrit,fibrinogen,prothrombin time(PT),activated partial thromboplastin time(APTT),international standardized ratio(INR),D-dimer,blood creatinine,uric acid;Imaging data at admission: whether there is leukoaraiosis,whether there is severe stenosis or occlusion of large arteries,and infarction area(lacunar infarction/moderate infarction/large infarction).To analyze the incidence and causes of END in patients with ACI after IVT.Single factor analysis and multivariate logistic regression analysis were conducted to determine the independent risk factors and influencing factors for the occurrence of END after intravenous thrombolysis with rt-PA.Then,based on the screened independent risk factors,a joint prediction is made,and the predicted values are analyzed using the ROC curve to evaluate their predictive value.Statistical analysis using SPSS software showed that P<0.05 was statistically significant.Results:Of the 199 ACI patients who received IVT,59(29.6%)developed END.Among the ACI patients undergoing intravenous thrombolysis with rt-PA,52(29.2%)patients developed END;undergoing intravenous thrombolysis in UK,7(33.3%)patients developed END.Cerebral hemorrhage(27 patients,45.8%)is the main cause of END,followed by cerebral infarction progression(13 patients,22.0%).Multivariate logistic regression analysis showed that leukocyte count [OR=1.283,95% CI(1.060-1.553),P=0.011],INR [OR=1.257,95% CI(1.803-8.756),P=0.008],D-dimer[OR=1.297,95% CI(1.034-1.628),P=0.025],and severe stenosis or occlusion of the large artery [OR=6.830,95% CI(2.789-16.729),P=0.000] were independent risk factors for END in ACI patients receiving rt-PA intravenous thrombolysis,Severe stenosis or occlusion of the large arteries [OR=6.830,95% CI(2.789-16.729),P=0.000] was most associated with END.PT [OR=0.000,95% CI(0.000-0.009),P=0.009] is a protective factor.The area under curve(AUC)was 0.813(CI:0.737-0.888,P=0.000)for ROC curve analysis combined with the predicted values of independent risk factors,indicating a good predictive ability.Conclusion:The occurrence of END is relatively common,and choosing rt-PA or UK intravenous thrombolysis treatment has no effect on the incidence of END.The main cause of END after intravenous thrombolysis treatment is cerebral hemorrhage,followed by the progression of cerebral infarction.High white blood cell count,INR,D-dimer,and the presence of severe arterial stenosis or occlusion are independent risk factors for the occurrence of END after intravenous thrombolysis with rt-PA,and the combination of these independent risk factors has good application value in evaluating the occurrence of END.