Qiao Han, Shoujiang You, Toshiki Maeda, Yanan Wang, Menglu Ouyang, Qiang Li, Lili Song, Yang Zhao, Xinwen Ren, Chen Chen, Candice Delcourt, Zien Zhou, Yongjun Cao, Chun-Feng Liu, Danni Zheng, Hisatomi Arima, Thompson G Robinson, Xiaoying Chen, Richard I Lindley, John Chalmers, Craig S Anderson, Xia Wang
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Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death).</p><p><strong>Results: </strong>Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p ≤ 0.01) and DND (all p ≤ 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p < 0.001).</p><p><strong>Conclusion: </strong>We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. 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引用次数: 0
摘要
背景和目的：我们旨在确定参加国际高血压和溶栓卒中强化控制研究（ENCHANTED）的急性缺血性卒中患者早期（END）和延迟神经功能恶化（DND）的预测因素及其与功能预后的关系：END和DND的定义分别为从基线到24小时和从24小时到72小时美国国立卫生研究院卒中量表（NIHSS）增加≥2分或格拉斯哥昏迷量表减少≥1分或死亡。采用多变量逻辑回归模型确定END和DND的独立预测因素及其与90天预后（改良Rankin量表[mRS]上2-6 vs 0-1和3-6 vs 0-2的二分法评分以及死亡）的关系：在4496名患者中，分别有871名（19.4%）和302名（8.4%）患者经历了END和DND。较高的基线 NIHSS 评分、较高的年龄、明显的动脉粥样硬化导致的大动脉闭塞、心栓塞性卒中亚型、出血性梗死和 24 小时内的实质血肿都是END（所有 P 均≤0.01）和 DND（所有 P 均≤0.024）的独立预测因素。此外，基线收缩压（BP）较高（比值比 [OR] 1.07，95% 置信区间 [CI]1.02-1.12）、24 小时内舒张压变化较大（OR 1.07，95% CI 1.04-1.09）、亚洲患者（OR 1.25，95% CI 1.03-1.52）是END的唯一独立预测因素。然而，亚洲人种与 DND 呈负相关（OR 0.64，95% CI 0.47-0.86）。在所有卒中亚型中，24 小时内出血性梗死和实质性血肿是END 的主要预测因素。END和DND均与90天后功能预后不良有关（均为P<0.001）：我们发现了急性缺血性卒中溶栓治疗后END和DND重叠且独特的人口统计学和临床预测因素。END和DND均可预测90天后的不良预后。
Predictors of Early versus Delayed Neurological Deterioration after Thrombolysis for Ischemic Stroke.
Introduction: We aimed to determine predictors of early (END) and delayed neurological deterioration (DND) and their association with the functional outcome in patients with acute ischemic stroke (AIS) who participated in the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).
Methods: END and DND (without END) were defined as scores of a ≥2-point increase on the National Institutes of Health Stroke Scale (NIHSS) or a ≥1-point decrease on the Glasgow coma scale or death, from baseline to 24 h and 24-72 h, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death).
Results: Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p ≤ 0.01) and DND (all p ≤ 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p < 0.001).
Conclusion: We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. Both END and DND predict unfavorable outcomes at 90 days.
期刊介绍：
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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