Improvements and deficits progression among ischemic stroke patients with pre-stroke depression and thrombolytic therapy

Background

This study aims to identify predictors of improvement or deficit progression in ischemic stroke patients with pre-stroke depression and to evaluate the impact of identified predictors on pre-ischemic stroke depressed patients that received thrombolytic therapy.

Methods

We performed logistic regression analysis to determine demographic and clinical risk factors that are independently associated with clinical improvement or deficits in ischemic stroke patients with pre-stroke depression that received thrombolytic therapy. Multicollinearity effect in the regression models was controlled using variance inflation factors and the fitness of the models was determined using the Hosmer-Lemeshow test.

Results

A total of 5469 ischemic stroke patients were identified of which 4748 patients were not diagnosed with depression while 721 were diagnosed with pre-stroke depression. After controlling for all variables with multivariate analysis, we found that the female gender (OR = 2.545, 95 % CI, 1.167–5.553, P = 0.019), coronary artery disease (OR = 2.935, 95 % CI, 1.296–6.645, P = 0.01), heart rate (OR = 1.025, 95 % CI, 1.001–1.049, P = 0.044), and improvement in ambulation (OR = 2.161, 95 % CI, 1.076–4.343, P = 0.03) were associated with neurological deficits while antidepressant medication (OR = 0.226, 95 % CI, 0.075‐0.686, P = 0.009), and direct admission (OR = 0.212, 95 % CI, 0.071‐0.636, P = 0.006) were associated with improvements in pre-stroke depressed patients who received recombinant tissue plasminogen activator (rtPA).

Conclusions

Our findings indicate that neurological deficits or improvements in hemispheric ischemic stroke patients with pre-stroke depression are associated with baseline stroke severity and that a stratification based on NIHSS scores.