[Progressive apoplexy. Incidence, risk factors and prognosis--the Copenhagen Stroke Study]

Clinical progression after arrival to hospital is frequent in acute stroke patients. Risk factors and mechanisms behind progression have remained largely unknown. This prospective, community-based study of 1006 acute stroke patients was undertaken to uncover factors of importance in the development of stroke-in-progression (SIP), and to assess the impact of SIP on prognosis. The diagnosis of progression was based on the Scandinavian Neurological Stroke Scale (SSS). Patients were divided according to whether progression occurred early (within 36 hours from stroke onset) or late (within the first week from onset). A marked progression developed in 32%. The following risk factors for early progression were identified: Systolic blood pressure on admission decreased the relative risk by 0.66 per 20 mmHg elevation (95% CI 0.55-0.83) and diabetes increased the relative risk by 1.9 (95% CI 1.1-3.3). Stroke severity was the only risk factor found in late progression (OR 1.4 per 20-point increase in stroke severity (95% CI 1.1-1.7)). These relations were independent of age, sex, blood glucose, heart disease and other stroke risk factors. SIP doubled mortality (0.001) and numbers discharged to nursing homes (0.001), and was associated with increased neurological deficits and decreased functional ability (0.0001) in survivors. These findings suggest that a causal relationship exists between the systemic blood pressure and the development of progression in the early phase of stroke and that this relationship is enhanced in patients with diabetes. The impact of SIP on prognosis is severe and lasting.