Early predictors of 30-day mortality in supratentorial ischemic stroke patients--first episode

Prognostic factors following stroke remain to be established. The aim of this study was to determine early prognostic factors related with a 30-day mortality in first episode ischemic stroke patients.

The study group comprised 329 consecutive patients, aged between 33 and 99 years (mean age +/- SD 69 +/- 12.6) admitted within 24 hours following their first supratentorial ischemic stroke, confirmed either by computer tomography (CT) and/or autopsy. The following data were assessed within 24 hours of hospitalization: gender, age, history of diabetes mellitus, history of ischemic heart disease, obesity, the neurological deficit at entry and after one day, level of consciousness at entry and after one day, electrocardiographic dysrhythmia at entry, blood pressure at entry and body temperature on the first day following stroke. We also assessed particular serum biochemical and hematological markers including: hematocrit, fibrinogen concentration, platelet count, white blood cell (WBC) count, gamma globulin level, glucose level, cholesterol level, the erythrocyte sedimentation rate (ESR), and creatinine kinase (CK) level. The end-point for assessment was early death (within 30 days). Statistical analysis consisted of univariate analysis and multiple regression.

Univariate analysis demonstrated that an older age, increased neurological deficit at entry and on the next day, decreased consciousness at entry and on the next day, electrocardiographic dysrhythmia, increased body temperature and glucose level, decreased cholesterol level and increased CK level were significantly associated with death after 30 days (p < or = 0.05). During multivariate analysis, only a severe neurological deficit (Scandinavian Stroke Scale < or = 15 points) both at entry and on the next day (OR = 8.3; 95% CI: 2.83-24.35), decreased consciousness within the first 24 hours of hospitalization (OR = 19.2; 95% CI: 2.84-127.77) and electrocardiographic dysrhythmia (OR = 5.2; 95% CI: 2.37-13.77) were associated with death after 30 days.

A severe neurological deficit lasting 24 hours, decreased consciousness within 24 hours of hospitalization and electrocardiographic dysrhythmia are the most important indicators of 30-day mortality in patients with first-time ischemic stroke.