Analysis Of Related Factors Of Early Neurological Deterioration In Patients With Acute Ischemic Stroke

Objective:The aim of this study was to investigate the related factors of early neurological deterioration(END)in patients with acute ischemic stroke(AIS),and to investigate the incidence and related factors of END events in different infarct sites.Methods:This study retrospectively included 465 AIS patients who were admitted to the Second Affiliated Hospital of Soochow University from January 2017 to June 2019 and were hospitalized within 24 hours of onset.The NIHSS scores were assessed at admission 24 hours,48 hours,72 hours,and discharge.This study defines END as an increase in NIHSS score of? 2 points within 72 hours after the onset of AIS.Combined with patients'brain MRI-DWI,the infarct site was divided into anterior circulation cortical infarction,subcortical infarction,complete anterior circulation infarction and posterior circulation infarction.According to whether END occurred,it was divided into END group and non-END group,and univariate and multivariate logistic regression analysis was performed on baseline data,laboratory tests and imaging studies of all patients.Results:This study included 465 patients with AIS,and 78 patients experienced early neurological deterioration,accounting for 16.8%.Multivariate Logistic regression analysis showed that concurrent infection(OR,2.428;95%CI[1.040?5.668],P=0.040)and infarct site(OR,2.520;95%CI[1.376?4.617],P=0.003)were independent factors associated with END in AIS patients.Among all AIS patients,66 patients(14.2%)with anterior circulation cortical infarction,156 patients(33.5%)with subcortical infarction,99(21.3%)with complete anterior circulation infarction,and 144(31.0%)with posterior circulation infarction.Complete anterior circulation infarction had the highest incidence of END(41.0%),followed by subcortical infarction(29.5%)and posterior circulation infarction(25.6%),anterior circulation cortical infarction had the lowest incidence of END(3.8%).In patients with complete anterior circulation infarction,concurrent infection was an independent risk factor for END events(OR,4.749;95%CI[1.769-12.746],P=0.002);among patients with subcortical infarction,fasting blood glucose is higher in the END group than in the non-END group(P=0.018);in patients with posterior circulation infarction,a higher baseline NIHSS score was an independent risk factor for END events(OR,1.471;95%CI[1.167-1.853],P=0.001).Conclusion:During the hospitalization of patients with acute ischemic stroke,the risk of END with concurrent infection increases.The incidence of END in different infarct sites is significantly different.The incidence of END events in the anterior circulation cortical infarction is the lowest,and the incidence of END events in the complete anterior circulation infarction is the highest.Co-infection is an independent risk factor for END events in complete anterior circulation infarction.Higher fasting blood glucose levels are associated with an increased risk of END in subcortical infarction.A higher baseline NIHSS score is an independent risk factor for END events in patients with posterior circulation infarction.