The Study On Influence Factors And Outcome Of Early Neurological Deterioration In Patients With Ischemic Stroke

ObjectivesThe objectives of this study are to investigate the prevalence of early neurological deterioration,to identify risk factors for early neurological deterioration,and to explore the effect of early neurological deterioration on the recurrence,death and functional disability in patients with acute ischemic stroke.MethodsThis study is divided into two parts,the first is using cross-sectional survey.We enrolled 3,015 patients who were consecutively admitted to the Huai-He Hospital,Kaifeng,China.Finally,1,165 patients met the inclusion criteria and provided informed consent for their participation.Data were collected with respect to patients'socio-demographic(age,sex,place of residence,marital status,work status and body mass index),lifestyles(smoking,drinking),disease related information(time to hospital arrival,NIHSS score at admission,hospitalization day,hypertension,diabetes and coronary heart disease),and blood samples(total bilirubin,direct bilirubin,albumin,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,serum glucose,C reactive protein,homocysteine,fibrinogen and D-dimer).The second is a cohort study using the method of follow-up survey,After a year,the patients'survival condition,recurrence status,and functional disability were assessed to determine the association between early neurological deterioration and patients'outcome by follow-up.Data was inputted by EpiData 3.1 to establish the database and SPSS 17.0 was applied to conducted the statistical analysis.Means and standard deviations(SD)were presented for continuous variables,while frequency and percentage were used for categorical variables.The differences of variables within groups were compared through the t-test,chi-square test and Non-parametric test.Multivariate logistic regression models were used to investigate the risk factors of functional outcome with a forward,stepwise selection strategy.Two-tailed analyses were conducted with the level of significance set at P<0.05.Results1.The average age of 1165 acute ischemic stroke patients was 63.75±12.52 years,male 646 cases(55.5%),female 519 cases(44.5%).The demographic data of patients showed most of the people live in the rural areas occupy 53.5%,married(including spouses and married,divorced/widowed,remarry)accounted for 89.3%,the incumbent retired accounted for 9.0%,accounted for 24.6%,most of the unemployed accounted for 66.4%;the average value of BMI in patients with ischemic stroke is 25.16±3.60 kg/m~2;The proportions of smoking and alcohol drinking were 26.2%and 16.0%respectively;The patients'clinical disease data showed that only 209 people(18.0%)in the 12 h to the hospital,most of the objects(51.4%)belongs to the moderate level of NIHSS scores on admission,there were 607 people in8~15 hospitalization days of patients.Patients with hypertension,diabetes and coronary heart disease accounted for 56.6%,20.3%and 15.8%respectively.2.There were 376 acute ischemic stroke patients suffering from END,The prevalence of END in patients with acute ischemic stroke was 32.3%.3.The results of univariate analysis showed that NIHSS score on admission,diabetes,coronary heart disease,glucose,C reactive protein,homocysteine and D-dimer were the influential factors of END in patients with acute ischemic stroke(P<0.05).4.The results of the multivariate Logistic regression analysis showed that NIHSS score on admission,diabetes,C reactive protein and homocysteine independently predicted END in patients with acute ischemic stroke(P<0.05).5.The patients were followed up for one year after discharge,and 101 were lost,the lost rate was about 8.7%.The results showed that END had no effect on the recurrence of ischemic stroke patients,and was a risk factor for death,functional disability and poor outcome(P<0.05).Conclusions1.The incidence of END in patients with acute ischemic stroke was 32.3%,and the incidence of END was almost the same as that of the study at home and abroad.2.NIHSS score on admission,diabetes,C reactive protein and homocysteine were important factors affecting the occurrence of END in patients with acute ischemic stroke.3.END had no effect on the recurrence of ischemic stroke patients,but was a risk factor for death, functional disability and poor outcome after one year.