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Published on: September 17, 2014
Predictors of poor outcome in embolic stroke of undetermined source
Ali M Al Khathaami1, Bayan Al Bdah, Abdulmjeed Alnosair
1Division of Neurology, Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
Insights
Older age, pre-stroke disability, and severe stroke predict poor outcomes in Embolic Stroke of Undetermined Source (ESUS). Identifying these clinical predictors aids in managing ESUS patients and improving discharge outcomes.
Area of Science:
- Neurology
- Stroke Medicine
- Clinical Epidemiology
Background:
- Embolic Stroke of Undetermined Source (ESUS) represents a significant subtype of ischemic stroke.
- Predicting outcomes in ESUS patients is crucial for effective clinical management and resource allocation.
Purpose of the Study:
- To identify clinical predictors associated with death or disability at discharge among patients diagnosed with ESUS.
- To inform prognosis and guide treatment strategies for ESUS patients.
Main Methods:
- Retrospective review of ischemic stroke patients meeting ESUS criteria at a tertiary care center.
- Comparison of patients with poor outcomes (death or modified Rankin Scale [mRS] score > 2) versus favorable outcomes.
- Multivariate logistic regression analysis to determine significant predictors of poor outcome.
Main Results:
- Of 147 ESUS patients, 28.8% experienced poor outcomes.
- Key predictors of poor outcome included a high National Institutes of Health Stroke Scale (NIHSS) score (>5), pre-stroke functional disability (mRS > 1), and older age (>60 years).
- The odds ratios for these predictors were substantial, highlighting their clinical significance.
Conclusions:
- A notable proportion of ESUS patients face death or disability upon discharge.
- Older age, pre-existing functional limitations, and stroke severity are critical factors influencing ESUS patient outcomes.
- These findings underscore the need for targeted interventions and closer monitoring for high-risk ESUS individuals.
Objective:
To identify the clinical predictors of death or disability at discharge.
Methods:
We retrospectively reviewed all ischemic stroke patients admitted to the stroke unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia, from February 2016 - July 2018. We applied the Cryptogenic Stroke/ESUS International Working Group Embolic stroke of undetermined source (ESUS) criteria. We compared patients with poor outcomes (death or modified Rankin Scale [mRS] score more than 2 ) to those with favorable outcomes. Multivariate logistic regression was used to identify predictors of poor outcome. The regression model included age more than 60 years, gender, body mass index more than 25 kg/meter square, smoking history, comorbidities, previous ischemic/transient ischemic attack, pre-stroke mRS score more than 1, National Institutes of Health Stroke Scale (NIHSS) score at admission more than 5, pre-stroke antiplatelet use, and thrombolysis treatment.
Results:
Out of 147 patients who met the ESUS criteria, 28.8% had poor outcomes. Predictors of poor outcome were NIHSS score more than 5 (odds ratio [OR] 11.1, 95% confidence interval [CI] 4.4-28.2), pre-stroke mRS score more than 1 (OR 3.7, 95% CI 1.14-11.59), and age more than 60 years (OR 2.4, 95% CI 1.14-5.22).
Conclusion:
A significant proportion of ESUS patients were dead or disabled at discharge. Poor outcome was more in older patients with pre-stroke functional disability and moderate to severe stroke.
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