Discharge Neurological Deficit as a Predictor of Early Stroke Recurrence: A Nationwide Registry-Based...

Area of Science:

• Neurology
• Cardiovascular Research
• Public Health

Background:

• Early stroke recurrence poses a significant risk to ischemic stroke survivors.
• Admission stroke severity is commonly used for prognosis, but discharge neurological deficits are less explored.
• Predicting recurrent ischemic stroke is crucial for effective post-stroke management.

Purpose of the Study:

• To evaluate the predictive value of discharge National Institutes of Health Stroke Scale (NIHSS) scores for 1-year ischemic stroke recurrence.
• To compare the predictive power of discharge NIHSS scores against initial stroke severity.
• To inform post-stroke risk stratification and follow-up planning.

Main Methods:

• Analysis of 39,947 first-ever ischemic stroke patients from the Korean Registry of Regional Cardiocerebrovascular Center for Stroke (KRS) (2014-2022).
• Utilized propensity score matching to adjust for baseline covariates.
• Assessed stroke recurrence within 1 year, defined by new, imaging-confirmed neurological deficits.

Main Results:

• Discharge NIHSS score significantly predicted 1-year ischemic stroke recurrence (HR per point, 1.03; P=0.028).
• Patients with a discharge NIHSS score ≥5 exhibited 20-30% higher recurrence rates.
• Higher discharge modified Rankin Scale (mRS) scores and hypertension were also associated with increased recurrence risk.

Conclusions:

• Discharge NIHSS score is a significant independent predictor of early ischemic stroke recurrence.
• Neurological status at discharge is a more potent indicator of recurrence risk than initial stroke severity.
• Incorporating discharge neurological assessment into risk stratification can optimize post-stroke care and follow-up strategies.