Risk Factors Affecting Prognosis Of 3 Months After Acute Ischemic Stroke And The Evaluation Of Effect For Risk Factors Management

ObjectiveTo analyze the factors involved in the functional prognosis,recurrence and mortality of ischemic stroke patients three months after onset.To evaluate the effect of risk factors management for the functional prognosis and recurrence of ischemic stroke patients three months after onset.MethodsWe made a prospective study of 504 patients aged 35 to 84 years old with acute ischemic stroke who had been admitted consecutively to our hospital. Data was collected on a standardized questionnaire: age, sex, risk factors, blood assay index of admission, severity of defect (using NIH Stroke Scale score) etc. Make a follow-up visit for these patients 3 months after onset to observe their condition and record the results as follows:recurrence,mortality,survivors(without recurrence).Those recurrence or died from other disease were removed. For survivors, two groups were considered according to mRS:favorable prognosis:mRS (0,1,2)and unfavorable prognosis:mRS(3,4,5).Results1,The 3-months case-fatality was 7.26% and recurrence rate was 4.36%; Among survivors,31.12% got unfavorable prognosis and 57.26% favorable prognosis.2,Female and Elderly patients (60-84 years) showed a significant effect on 3-month disability and handicap.3,Female, on average, were older, more often had a history of AF(Atrial fibrillation) than were men; Elderly patients were more often had a history of AF and prior stroke and young patients were more often had a history of hyperlipidemia (P<0.05).4,Among brain lesion location, the basal ganglia-thalamus lesion were more common(22.70%).5,The major TOAST types of patients were large artery atherosclerotic(LAA) stroke(77.59%), and among types the proportion of SUE were more in women than men while SAO were more in young than elderly. The major OCSP types were PACI(56.02%) and among PACI women were in the majority(P<0.05).6,Female and elderly had a higher NIHSS Score on admission(P<0.05).7,Those with multiple infarction or brain lesions located in Hemisphere,Frontal lobe,Parietal lobe,insula or Temporal lobe had a worse prognosis(P<0.05); Those with bilateral lesions or brain lesions located in Hemisphere or top of the basilar had a higher mortality, and brain lesions located in basal ganglia had a lower mortality (P<0.05).8,According to the TOAST classification, at 3-months after onset,large artery atherosclerotic stroke patients had a greater neurological deficit; cardioembolic stroke patients had a worst prognosis in terms of mortality; Lacunar stroke had the least neurological deficit and the best prognosis(P<0.05).9,According to the OCSP classification, at 3-months after onset, PACI patients had a greater neurological deficit, followed by POCI; while LACI had the least neurological deficit and the best prognosis(P<0.05).10,Arterial stenosis either Frontal or Posterior was significantly associated with poor prognosis(P<0.05); both Frontal and Posterior arterial stenosis was significantly associated with recurrence(P<0.05).11,Patients with a history of hypertension or stroke were more likely to have a worse prognosis(P<0.05); Patients with a history of AF were more likely to die after CI (P<0.05).12,High LDH,Europhiles and Urea was significantly related with worse prognosis(P<0.05); low Total protein with higher recurrence(P<0.05); high Urea and direct bilirubin with higher mortality(P<0.05).13,There was a trend that the higher the Systolic blood pressure at admission, the worse the functional outcome, so as the temperature,heart rate and respiratory frequency(P<0.05).14,Vision and neglect term of NIHSS Score after 3 months appeared to be lower than at admission, but the difference was not significant(P>0.05).15,The awareness of hypertensive,hyperglycemia and hyperlipidemia were 78.99%,87.50% and 41.95%,respectively.16,Patients quitting smoking after stroke had a worse prognosis(P<0.05),but these patients had a higher NIHSS Score at admission (P<0.05); Patients controlling Blood pressure had a lower recurrence rate (P<0.05).Conclusion1,The 3-months case-fatality was 7.26% and recurrence rate was 4.36%; Among survivors,31.12% got unfavorable prognosis and 57.26% favorable prognosis.2,The following variables were significantly associated with unfavorable prognosis during the first ninety days after CI:female; elderly(60-84 years); a history of hypertension,prior stroke; elevated LDH/Europhiles/Urea; multiple infarction,brain lesions located in Hemisphere,Frontal lobe,Parietal lobe,insula or Temporal lobe; Frontal or/and Posterior arterial stenosis; elevated Systolic blood pressure/temperature/heart rate/respiratory frequency at admission.3,The following variables were significantly associated with higher recurrence during the first ninety days after CI:low Total protein; Frontal and Posterior arterial stenosis.4,The following variables were significantly associated with higher mortality during the first ninety days after CI:a history of AF; elevated Urea/direct bilirubin; bilateral lesions,brain lesions located in Hemisphere or top of the basilar; elevated Systolic blood pressure/temperature at admission. Brain lesions located in basal ganglia had a lower mortality.5,TOAST and OCSP,can be used to predict effectively the prognosis of patients with cerebral infarction.6,all the individual term of NIHSS Score got better in 3 months than onset except for vision and neglect term.7,there were lower awareness of hypertension,diabetes and hyperlipidemia. It is very important to strengthen the health education.8,controlling blood pressure can reduce the risk of recurrence at 3 months after stroke.