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Clinical factors adversely affecting early outcome after brain infarction
1Department of Neurology, Hospital Universitário Clementino Fraga Filho (HUCFF), Federal University of Rio de Janeiro (UFRJ).
Insights
Early coma and persistent consciousness disturbances after acute brain infarction (BI) significantly increase early death risk. A history of congestive heart failure (CHF) also impacts survival in BI patients.
Area of Science:
- Neurology
- Clinical Medicine
- Cardiovascular Research
Background:
- Acute brain infarction (BI) poses a significant risk of early mortality.
- Identifying prognostic factors is crucial for managing acute stroke patients.
Purpose of the Study:
- To analyze adverse factors influencing early death (within 30 days) in acute CT-confirmed brain infarction patients.
- To identify key predictors of 30-day mortality in acute stroke.
Main Methods:
- Studied 109 consecutive patients during the acute phase of CT-confirmed brain infarction.
- Utilized univariate analysis and multiple regression to assess demographic, clinical, and laboratory factors.
- End-point was early death (within 30 days).
Main Results:
- Key adverse factors for 30-day mortality included coma, stroke in hospitalized patients, Babinski sign, impaired consciousness, large artery atherothrombosis, embolism, and cardiac failure.
- In conscious patients, history of congestive heart failure (CHF) reduced survival.
- In patients with impaired consciousness, persistent disturbances after 48-72 hours were the main predictor of high fatality.
Conclusions:
- Impairment of consciousness, particularly coma 2-3 days post-onset, significantly increases early fatality in acute BI.
- A history of CHF is a critical factor for early mortality, especially in patients presenting without consciousness disturbances.
- A prognostic algorithm incorporating these variables can predict approximate 30-day fatality rates.
Purpose And Methods:
One-hundred-and-nine consecutive patients admitted during the acute phase of a CT-confirmed brain infarction (BI) were studied. Putative adverse influence of demographic and stroke risk factors, previous medical history, clinical presentation, initial and follow-up neurological examination, initial general evaluation, laboratory findings, chest X-ray and electrocardiographic findings, treatment, and topography and etiology of the ischemic insult was analysed. The end-point for assessment was early death (within 30 days). Statistical analysis was performed with univariate analysis and multiple regression.
Results:
The main adverse factors related to an increased death risk during the first 30 days were, in decreasing order of importance: coma 48-72 hours after admission; stroke occurring in already hospitalized patients; Babinski sign on admission; minor degrees of impairment of consciousness 48-72 hours after admission; stroke related to large artery atherothrombosis and to embolism; a history of early impairment of consciousness; cardiac failure on admission. In 53 lucid patients on admission, only a history of congestive heart failure (CHF) was associated with a reduced survival rate. In 56 patients with impaired consciousness, the presence of a Babinski sign increased death risk, but the main factor predicting a high case-fatality rate was the persistence of consciousness disturbances after 48-72 hours.
Conclusions:
The presence of impairment of consciousness, especially coma, 2-3 days after disease onset, and a history of CHF greatly increase the early case fatality rate in patients with acute BI presenting with or without consciousness disturbances at admission, respectively. The use of a prognostic algorythm considering these few variables seems to predict the approximate 30-day fatality rates.