Predictors of dependence after MCA ischemic stroke submitted to thrombolysis
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Published on: January 18, 2018
Renata Dal-Prá Ducci1, Marcos Christiano Lange1, Francisco Manoel Branco Germiniani1
1a Department of Neurology , Hospital de Clínicas, Universidade Federal do Paraná , Curitiba , Brazil.
Insights
Stroke severity (NIHSS), large artery atherosclerosis, pneumonia, and seizures predict long-term dependence after ischemic stroke treated with IVT. Identifying these factors aids in improving patient outcomes and stroke care efficacy.
Area of Science:
- Neurology
- Clinical Medicine
- Public Health
Background:
- Stroke is a leading cause of long-term disability globally.
- Middle Cerebral Artery (MCA) territory ischemic strokes are common.
- Intravenous thrombolysis (IVT) is a critical treatment for acute ischemic stroke.
Purpose of the Study:
- To identify predictors of early (3-month) and late (after 3-month) dependence.
- To analyze variables associated with functional outcomes in patients with first-ever MCA ischemic stroke treated with IVT.
Main Methods:
- A 5-year single-center cohort study of 144 patients with first-ever MCA ischemic stroke treated with IVT.
- Logistic regression analysis was used to determine predictors of early and late dependence.
Main Results:
- NIHSS score at admission, large artery atherosclerosis (LAA) stroke, and in-hospital pneumonia predicted early dependence.
- NIHSS score at admission, in-hospital pneumonia, and post-discharge seizures predicted late dependence.
- 47.2% of patients were dependent at 3 months, and 39.4% were dependent after 3 months.
Conclusions:
- NIHSS, LAA stroke, in-hospital pneumonia, and seizures after discharge are significant predictors of dependence.
- These findings highlight key factors influencing recovery and long-term outcomes in MCA stroke patients receiving IVT.
- This study is the first to exclusively focus on predictors of post-stroke dependence in first-ever MCA IS patients treated with IVT.
Objectives:
Stroke is one of the most common causes of disability-adjusted life years worldwide. The aim of this study is to identify variables associated with dependence at 3 months and also after the first 3 months after the first-ever ischemic stroke (IS) in middle cerebral artery (MCA) territory submitted to intravenous thrombolysis (IVT).
Methods:
A single-center cohort study of patients with first-ever MCA IS treated with IVT at the Hospital de Clínicas, Universidade Federal do Paraná, was followed over 5 years. Logistic regression was performed to determine predictors of early and late dependence.
Results:
A total of 144 patients were included; 48.6% women, and 47.2% were dependent at 3 months after stroke. NIHSS at admission (OR = 1.3, 95%CI = 1.16-1.45, p < 0.001), large artery atherosclerosis (LAA) stroke (OR = 4.11, 95%CI = 1.31-12.85, p = 0.014) and pneumonia during hospitalization (OR = 9.17, 95%CI = 1.42-59.07, p = 0.019) were predictors for early dependence. For the late dependence analyses, 99 patients were included; 49.5% women and 39.4% were dependent after 3 months of stroke. NIHSS at admission (OR = 1.33, 95%CI = 1.15-1.54, p < 0.001), pneumonia during hospitalization (OR = 11.08, 95%CI = 1.45-84.73, p = 0.019) and seizure after discharge (OR = 5.82, 95%CI = 1.06-32.01, p = 0.040) were predictors for late dependence.
Discussion:
.Dependence is an important indicator of the efficacy of stroke care. Besides it was not possible to evaluate rehabilitation, this is the first study on predictors of post-stroke dependence that focus exclusively on patients with first-ever MCA IS submitted to IVT. NIHSS, LAA stroke, in-hospital pneumonia and seizures after discharge were associated with dependence after first-ever MCA IS submitted to IVT.
