Abstract 2816: Relation Between Neurologic Deficit Severity and Final Functional Outcome Shifts and Strengthens During First Hours after Onset

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jeffrey L Saver ◽  
Hernan Altman
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Performance Measure ◽  
Neurologic Deficit ◽  
Nihss Score ◽  
Disability Outcome ◽  
Post Onset ◽  
Over Time

Background: Early neurologic deficit severity is the most important determinant of final functional outcome in acute ischemic stroke. Accordingly, in hospital quality performance measures and in clinical trials, deficit severity as assessed by an early NIH Stroke Scale (NIHSS) score is increasingly used to adjust outcomes for baseline prognosis/case mix. However, deficit severity frequently changes during the first hours and days post-onset. Methods: Analysis was performed of control group patients enrolled in the two NINDS TPA trials. Neurologic deficit severity was measured serially using the NIH Stroke Scale (NIHSS) at 1-3 hours post onset, 3-5 hours, 24 hours, 7-10 days, and 90 days. Final global disability outcome was assessed at 90 days using the modified Rankin Scale (mRS). Results: Among the 312 patients, median neurologic deficit severity on the NIHSS improved throughout the 90d observation period, from 15 (9.5-20) at 1-3h through 12 (6-19) at 24h to 7 (2-19) at 90d. Between 1-3h to 24h, more patients spontaneously improved than worsened, 39.1% vs 17.6% (p<0.001). NIHSS scores associated with individual final mRS global disability ranks shifted to lower values over time, e.g. patients with a final day 90 mRS of 2 had the following median NIHSS scores: 12 at 1-3h, 9 at 24h, and 3 at 90d ( Figure ). The correlation coefficient between NIHSS and the final mRS increased over time, from 0.51 at 1-3h through 0.72 at 24h to 0.87 at 90d. Conclusion: During the first 24 hours after onset, spontaneous improvement occurs in 2 of 5 acute ischemic stroke patients. The NIHSS scores associated with individual global disability ranks shift lower over time. Neurologic deficit severity increasingly predicts final disability outcome, accounting for one quarter of the variance at 1-3h, one half at 24h, and three quarters at 90d. It is desirable to consider timing of NIHSS assessment, in addition to the NIHSS score, when performing severity adjustment for performance measure reporting and clinical trials.

Neuroprotection for Acute Ischemic Stroke

2017 ◽  
Author(s):  
Diana Mayor ◽  
Michael Tymianski
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Time Windows ◽  
Treatment Options ◽  
Recombinant Tissue Plasminogen Activator ◽  
Close Monitoring ◽  
Vessel Occlusion

Acute ischemic stroke (AIS) is the leading cause of acquired neurological disability worldwide. AIS most commonly occurs when a cerebral artery is occluded, leading to irreversible brain injury and neurologic disability. Acute supportive physiological interventions and close monitoring on a stroke unit are beneficial to optimize overall recovery and functional outcome. Phamacological treatment options are limited though as the only FDA-approved therapy for AIS is the thrombolytic agent intravenous recombinant tissue plasminogen activator (Alteplase, rtPA), which improves functional outcome in therapeutic time windows ranging up to 3–4.5 hours. Several clinical trials assessing the efficacy of endovascular therapy have shown a benefit in carefully selected patients with a documented large vessel occlusion (LVO), and subsequently are becoming part of the standard practice in this AIS subset. Clinical trials using various imaging paradigms to enhance patient selection for thrombolytic therapy, endovascular therapy and neuroprotection therapies are all progressing.

Abstract 2268: Trends In Reasons For Non-eligibility For tPA

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Mary G George
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Advanced Age ◽  
Stroke Patients ◽  
Rapid Improvement ◽  
Nihss Score ◽  
Mild Stroke ◽  
Over Time ◽  
Iv Tpa

Background: Use of IV tPA has increased over time, as has the adherence to the NQF endorsed performance measure for receipt of IV tPA within 3 hours. Little is known about trends in the reasons for patient ineligibility for IV tPA. This study examines trends in reasons for not providing IV tPA over time and by race and gender among acute ischemic stroke patients in the Paul Coverdell National Acute Stroke Registry (PCNASR), a quality improvement program for acute stroke implemented by state health departments. Methods: There were 13,164 PCNASR patients enrolled from 2008- 2010 with a clinical diagnosis of acute ischemic stroke with documentation of LKW and who arrived within 2 hours of LKW. Cochran-Armitage tests were used to test for trend on accepted reasons for not providing IV tPA within 3 hours of time last known well (LKW). Chi-square tests were used to test for differences among reasons between men and women and between non-Hispanic whites and minorities. Multiple reasons for not giving tPA could be selected. Results: Among 13,164 acute ischemic patients admitted between 2008 and 2010 with documentation of LKW and who arrived within 2 hours of LKW, 3781 (28.7%) received IV tPA, 7284 (55.3%) had documented reasons for not receiving IV tPA, and 2099 (16.0%) did not receive IV tPA. Contraindications to IV tPA, advanced age, rapid improvement and inability to determine eligibility increased over time. Mild stroke decreased over time. Conditions with warning, advanced age, limited life expectancy and family refusal were more common in women; mild stroke and rapid improvement were more common in men. Contraindications were more common in minorities; advanced age, mild stroke and rapid improvement, and family refusal were more common in non-Hispanic whites. When advanced age was selected, 46.6% of patients were over age 90 and 3.4% were under age 80. When stroke too mild was selected, 44.8% of patients had missing NIHSS scores, 42.1% of scores were 0-4, 8.8% were 5-9, and 4.3% were ≥ 10. The three most common reasons for not providing tPA were rapid improvement (40.9%), mild stroke (33.0%), and contraindications (29.2%) in 2010. Conclusions: More than half of ischemic stroke patients arriving within 2 hours of LKW were ineligible to receive IV tPA. There was little use of advanced age for patients under age 80. Documentation of stroke too mild was not substantiated by an NIHSS score in nearly half of patients. Better documentation of NIHSS score should be provided.

Serum Vitamin D Status as a Predictor of Prognosis in Patients with Acute Ischemic Stroke

2015 ◽  
Vol 40 (1-2) ◽  
pp. 73-80 ◽  
Author(s):  
Kwang-Yeol Park ◽  
Pil-Wook Chung ◽  
Yong Bum Kim ◽  
Heui-Soo Moon ◽  
Bum-Chun Suh ◽  
...  
Keyword(s):  
Vitamin D ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Multivariable Analysis ◽  
Stroke Severity ◽  
Baseline Serum ◽  
Nihss Score ◽  
Good Functional Outcome

Background: Low 25-hydroxyvitamin D (25(OH)D) concentrations have been shown to predict risk of cardiovascular disease and all-cause mortality. Although the prevalence of 25(OH)D deficiency is high in patients with acute stroke, the prognostic value of 25(OH)D in stroke has not been clearly established. The purpose of this study was to determine whether the baseline serum 25(OH)D level was associated with the functional outcome in patients with acute ischemic stroke. Methods: From June 2011 to January 2014, consecutive patients with acute ischemic stroke within 7 days of symptom onset were enrolled in this study from a prospectively maintained stroke registry. Serum 25(OH)D level was measured at admission. Clinical and laboratory data including stroke severity using the National Institute of Health Stroke Scale (NIHSS) score were collected during admission, and the functional outcome at 3 months was assessed by modified Rankin scale (mRS). The association between the baseline 25(OH)D level and a good functional outcome (mRS 0-2) at 3 months was analyzed by multiple logistic regression models. Results: A total of 818 patients were enrolled in this study. Mean age was 66.2 (±12.9) years, and 40.5% were female. The mean 25(OH)D level was 47.2 ± 31.7 nmol/l, and the majority of patients met vitamin D deficient status (<50 nmol/l; 68.8%), while an optimal vitamin D level (≥75 nmol/l) was present in only 13.6% of the patients, and 436 (53.3%) patients showed good functional outcome at 3 months. Serum 25(OH)D levels in patients with good outcomes were significantly higher than those with poor outcome (50.2 ± 32.7 vs. 43.9 ± 30.0 nmol/l, p = 0.007). The 3-month functional outcome was significantly associated with month-specific 25(OH)D quartiles in multivariable logistic regression analysis. After adjustment for age and sex, the highest 25(OH)D quartile group had higher tendency for good functional outcome at 3 months (odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.13-2.51). After fully adjusting for other potential confounders, such as stroke severity and vascular risk factors, the association was further strengthened with an OR (95% CI) of 1.90 (1.14-3.16). Other factors associated with good functional outcome in multivariable analysis were younger age, lower initial NIHSS score and absence of diabetes. Conclusions: This study suggests that serum 25(OH)D level is an independent predictor of functional outcome in patients with acute ischemic stroke. Further studies are required to determine whether vitamin D supplementation could improve functional outcome in patients with ischemic stroke.

scholarly journals Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eung-Joon Lee ◽  
Jeonghoon Bae ◽  
Hae-Bong Jeong ◽  
Eun Ji Lee ◽  
Han-Yeong Jeong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Elevated Serum ◽  
Unfavorable Outcome ◽  
Control Group ◽  
Nihss Score ◽  
And Control ◽  
D Dimer

Abstract Background The effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We also explored the factors that independently affect functional outcomes of patients with CRS after MT. Methods We retrospectively reviewed 341 patients who underwent MT after acute ischemic stroke onset between May 2014 and May 2020. We classified the patients into CRS (n = 34) and control (n = 307) groups and compared their clinical details. Among CRS patients, we analyzed the groups with and without good outcomes (3-months modified Rankin scale [mRS] score 0, 1, 2). Multivariate analysis was performed to investigate the independent predictors of unfavorable outcomes in patients with CRS after MT. Results A total of 341 acute ischemic stroke patients received MT, of whom 34 (9.9%) had CRS. Although the baseline National institute of health stroke scale (NIHSS) score and the rate of successful recanalization was not significantly different between CRS patients and control group, CRS patients showed more any cerebral hemorrhage after MT (41.2% vs. controls 23.8%, p = 0.037) and unfavorable functional outcome at 3 months (CRS patients median 3-month mRS score 4, interquartile range [IQR] 2 to 5.25 vs. controls median 3-month mRS score 3, IQR 1 to 4, [p = 0.026]). In the patients with CRS, elevated serum D-dimer level and higher baseline NIHSS score were independently associated with unfavorable functional outcome at 3 months (adjusted odds ratio [aOR]: 1.524, 95% confidence interval [CI]: 1.043–2.226; aOR: 1.264, 95% CI: 1.010–1.582, respectively). Conclusions MT is an appropriate therapeutic treatment for revascularization in CRS patients. However, elevated serum D-dimer levels and higher baseline NIHSS scores were independent predictors of unfavorable outcome. Further research is warranted to evaluate the significance of these predictors.

scholarly journals Serum Interleukin-37 Increases in Patients after Ischemic Stroke and Is Associated with Stroke Recurrence

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ying Zhang ◽  
Chengbi Xu ◽  
Haitao Wang ◽  
Shanji Nan
Keyword(s):  
Ischemic Stroke ◽  
Serum Level ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Recurrent Stroke ◽  
Clinical Severity ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Nihss Score ◽  
Poor Outcome

Background. This study seeks to assess interleukin-37 (IL-37) serum level in acute ischemic stroke and the value of predicting 3-month stroke recurrence and functional outcome in acute ischemic stroke. Methods. From January 1, 2018, to June 30, 2019, all consecutive first-ever acute ischemic stroke patients from our hospital, China, were included. Serum samples, clinical information, and stroke severity (defined by the National Institute of Health stroke scale (NIHSS) score) were collected at baseline. Serum IL-37 level was measured by the enzyme-linked immunosorbent assay (ELISA) method. Functional impairment (defined by the modified Rankin scale (mRS)) and recurrent stroke were assessed 3 months after admission. The relation of IL-37 with either clinical severity at baseline, unfavorable functional outcome, or stroke recurrence at follow-up was evaluated by logistic regression analysis, and the results were presented as odds ratios (OR) with 95% confidence intervals (CI). Results. Three hundred and ten stroke patients were included. The median IL-37 serum level in those patients was 344.1 pg/ml (interquartile range (IQR), 284.4-405.3 vs. control cases: 122.3 pg/ml (IQR, 104.4-1444.0); P < 0.001 ). At 3 months, a total of 36 (11.6%) patients had a stroke recurrence. IL-37 serum levels in those patients were higher than in those patients without stroke recurrence (417.0 pg/ml (IQR, 359.3-436.1) vs. 333.3 pg/ml (279.0-391.0)). In a logistic model adjusted for other factors, IL-37 in the highest quartile (>405.3 pg/ml) was still associated with recurrent stroke ( OR = 3.32 ; 95 % CI = 2.03 – 6.13 ; P < 0.001 ). IL-37 could promote the NIHSS score (area under the curve (AUC) of the IL-37/NIHSS, 0.75; 95% CI, 0.67–0.83; P < 0.001 ), corresponding to a difference of 0.085 (0.005). Serum IL-37 increases in patients with poor outcome, and an IL-37 in the highest quartile is related to poor outcome ( OR = 4.85 ; 95 % CI = 3.11 − 8.22 ; P < 0.001 ). Conclusion. Serum IL-37 increased in patients after ischemic stroke and was associated with stroke recurrence events and poor stroke outcomes. Large randomized controlled trials should be carried out to confirm whether IL-37 lowering treatment improves stroke prognosis.

scholarly journals Effect of sex differences on prognosis of intravenous thrombolysis: data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

2020 ◽  
pp. svn-2020-000351 ◽  
Author(s):  
Hongyu Zhou ◽  
Weiqi Chen ◽  
Yuesong Pan ◽  
Yue Suo ◽  
Xia Meng ◽  
...  
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Ischaemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Chinese Patients ◽  
Nihss Score ◽  
Significant Difference

Background and purposePrevious studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy. This study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic stroke.MethodsThe patients enrolled in this study were from the Chinese Acute Ischemic Stroke Thrombolysis Monitoring and Registration study. The primary outcome was poor functional outcome, defined as a 3-month modified Rankin score of 3–6. The safe outcome was symptomatic intracranial haemorrhage (SICH) and mortality within 7 days and 90 days. Multiple Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and prognosis. Furthermore, the interaction of preonset Rankin scores, baseline National Institute of Health Stroke Scale (NIHSS) scores and Trial of Org 10172 in Acute Stroke Treatment (TOAST) types was statistically analysed.ResultsA total of 1440 patients were recruited, including 541 women and 899 men. The baseline information indicated that women were older at the time of onset (66.2±11.2 years vs 61.0±11.3 years, p<0.001), and more likely to have a history of atrial fibrillation (25.3% vs 11.2%, p<0.001), and had a higher NIHSS score on admission (12.3±6.8 vs 11.6±6.7, p=0.04). According to the prognosis analysis of unsatisfactory functional recovery, there was no significant difference between women and men (45.9% vs 37.1%; adjusted OR 1.01, 95% CI 0.75 to 1.37). As for the safe outcome, the proportion of SICH and mortality in women is relatively high but did not reach statistical significance. There was no significant interaction with sex, age, preonset Rankin score, NIHSS score, TOAST classification and the prognosis of intravenous thrombolysis.ConclusionsFor Chinese patients with ischaemic stroke, although women are older and more severe at the time of onset, the prognosis after intravenous thrombolysis is not significantly different from men.

scholarly journals EFFICACY OF LOW-DOSE THROMBOLYSIS WITH INTRAVENOUS ALTEPLASE WITHIN 6 H OF ACUTE ISCHEMIC STROKE ONSET: EVIDENCE FROM SINGLE REFERRAL CENTER IN INDONESIA

2019 ◽  
pp. 64-68
Author(s):  
Al Rasyid ◽  
Salim Harris ◽  
Mohammad Kurniawan ◽  
Taufik Mesiano ◽  
Rakhmad Hidayat ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cross Sectional Study ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Nihss Score ◽  
Intravenous Alteplase

Objective: This study evaluated the efficacy of thrombolysis with 0.6 mg/kg intravenous alteplase for acute ischemic stroke patients within 6 h of stroke onset. Methods: This cross-sectional study collected data of patients with ischemic stroke received intravenous thrombolytic therapy with 0.6 mg/kg alteplase within 6 h of onset in Cipto Mangunkusumo General Hospital (Rumah Sakit Cipto Mangunkusumo [RSCM]) between November 2014 and August 2017. Efficacy of the thrombolytic therapy was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). NIHSS evaluated on 24 h and 7 d post thrombolytic therapy portrayed clinical outcomes of patients while mRS evaluated on day 30 post-thrombolysis portrayed the functional outcome of patients. Results: The median NIHSS score decreased on 24 h and 7 d post-thrombolysis. 33.3% patients experienced a reduction of NIHSS score ≥4 on 24 h post thrombolytic therapy. On day 7 following thrombolysis, 57.4% patients had a good clinical outcome. On day 30 follow-up, 55.6% patients had a good functional outcome. Conclusion: Thrombolysis using 0.6 mg/kg intravenous alteplase within 6 h of onset is effective for acute ischemic stroke patients.

Abstract TP204: Neutrophil-to-lymphocyte Ratio Predicts Short-term Functional Outcome in Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Meyung Kug Kim ◽  
Yoon Suk Ha ◽  
Bong Goo Yoo
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Nihss Score ◽  
Poor Outcome ◽  
The Poor

Introduction: As indicators of the systemic inflammatory response, the neutrophil-to-lymphocyte ratio (NLR) have been proposed to predict the clinical outcome in cardiovascular disease, diabetes, and various malignancies. We assessed the significance of NLR as a predictor of the outcome in patients with acute ischemic stroke. Methods: We retrospectively analyzed the clinical characteristics, laboratory parameters, and NLR in 356 consecutive patients (62.2% men, mean age 65.8±13.0 years) within 3 days after the onset of acute ischemic stroke between July 2012 and March 2015. The NLR was calculated from the differential counts by dividing the neutrophil number by the lymphocyte number at the time of admission. All subjects were divided into four groups according to quartiles of the NLR. Outcomes were measured as 3-month modified Rankin scale (mRS) score. A good functional outcome was defined as a mRS of 0-2 points, whereas a poor outcome was defined as a mRS of >2 points. Multivariate logistic regression analysis was used to assess association among the clinical, inflammatory and serological parameters including NLR and mRS scores. Results: The frequency of atrial fibrillation, heart failure, hypertension, and diabetes, the NIHSS score at admission, and the level of hs-CRP, D-dimer and the NLR were each significantly higher in the poor outcome group (p < 0.05). The cut-off values of NLR and NIHSS score at admission for prediction of the poor outcome were 2.135 (sensitivity 0.864 and specificity 0.533) and 3.5 (sensitivity 0.862 and specificity 0.787), respectively. In age-adjusted analysis, the NLR were significantly correlated with 3-month mRS score (partial r = 0.329, p < 0.001) and NIHSS score at discharge (partial r = 0.301, p < 0.001). Multivariate logistic regression analysis demonstrated that age of ≥65 (OR, 10.2; 95% CI, 3.31-31.21, p < 0.001), presence of diabetes mellitus (OR, 3.3; 95% CI, 1.36-8.12, p = 0.008), NIHSS score of ≥4 (OR, 26.4 95% CI, 9.81-71.15, p < 0.001), NLR of ≥2.135 (OR, 9.2; 95% CI, 3.18-26.4, p < 0.001) were independently associated with poor functional outcome. Conclusion: The NLR is a useful marker for short-term functional outcome in acute ischemic stroke. The NLR may have a role in risk stratification for predicting poor outcome.

Abstract WP22: A Scoring System Based on Age and DWI Volume Predicts Poor Functional Outcome Following Endovascular Treatment for Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
John Liggins ◽  
Nishant K Mishra ◽  
Hayley M Wheeler ◽  
Matus Straka ◽  
Stephanie Kemp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scoring System ◽  
Poor Functional Outcome ◽  
Nihss Score ◽  
Clinical Variables ◽  
Poor Outcome ◽  
New Scoring

Background: The Houston IAT (HIAT) score predicts poor outcome following endovascular stroke therapy based on clinical variables (age, serum glucose, and NIHSS score). We aimed to validate the HIAT score in an independent cohort of patients treated with endovascular therapy (DEFUSE 2) and determine if prediction of poor outcome could be improved by including neuroimaging variables in the prediction score. Methods: Patients enrolled in the DEFUSE 2 study had a clinical diagnosis of acute ischemic stroke and underwent MRI prior to endovascular treatment. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6 at day 90. The relationship between baseline clinical and neuroimaging variables and poor functional outcome was assessed using univariate and multivariate logistic regression. Statistically significant variables in the multivariate model were used to create a new scoring system. We evaluated the new scoring system and the HIAT score using ROC analysis. Results: One hundred and ten patients were included in the analysis; forty-two patients had a poor functional outcome. Validation of the HIAT score demonstrated similar ROC properties in the DEFUSE 2 cohort (AUC=0.69) compared to the Houston derivation cohort (AUC=0.73). In DEFUSE 2, age (p=0.001), baseline DWI volume (p=0.09), baseline NIHSS score (p=0.03) and hypertension (p=0.003) were associated with poor functional outcome in univariate analysis. In multivariate analysis, age (p<0.001) and baseline DWI volume (p=0.03) were independent predictors of poor functional outcome. Based on this we developed a new scoring system with a maximum of 3 points awarded for age (0 points, < 55; 1 point, 56-69; 2 points, 70-79; 3 points, ≥ 80) and a maximum of 1 point awarded for baseline DWI volume (0 points, volume ≤ 15 cc; 1 point, volume >15 cc). The percentage of patients with poor functional outcomes increased with the number of points awarded (0% poor outcomes in patients with 0 points, 25% with 1 point, 30% with 2 points, 75% with 3 points, and 89% with 4 points). The AUC for the new scoring system was 0.82. Conclusion: The new scoring system that incorporates baseline DWI volume and age predicts poor outcome more accurately than a scoring system based on clinical variables alone.

Abstract P396: Presence of Hypertension and the Effect on Clinical Outcome Scores of IV rt-PA Receiving Patients at a Community Primary Stroke Center (PSC) in Urban Los Angeles

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Jennifer Garland ◽  
Anna Antonio ◽  
Antonio Liu
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Repeated Measures ◽  
Hemorrhagic Transformation ◽  
Nihss Score ◽  
Repeated Measures Design ◽  
Significant Difference ◽  
Outcome Scores ◽  
Over Time

Background: Intravenous recombinant tissue plasminogen activator (IV rt-PA) is the only FDA approved thrombolytic treatment for acute ischemic stroke offering at least a 30% chance of improvement over placebo. Purpose: The purpose of the study was to examine the effect of hypertension (HTN) and other various covariates of patients receiving IV rt-PA thrombolysis treatment for ischemic stroke on clinical outcome scores over time: mRS (modified Ranking Scale) & NIHSS (National Institute of Health Stroke Scale). Methods: A retrospective analysis utilized repeated measures design (SAS Windows version 9.3) on patients receiving IV rt-PA thrombolysis treatment for ischemic stroke from Jan 1, 2012 to Dec 31, 2012. The total cohort used for analysis, N=60. Two cases were not included due to death. Baseline measures were taken at admission and one follow-up time point at discharge. All covariates were included first in univariate models. Those which were found to be significant were then included in multivariate analysis. All statistical significance tests were 2-sided, α=.05 was considered statistically significant. Results: In univariate analyses, there is a significant time effect (p=0.0001), evidenced by the decrease in NIHSS over time and a significant difference in average NIHSS scores between those with and without HTN (p=0.0016). A test of interaction of HTN status by time was not significant ( p >0.05). NIHSS scores appear to decrease faster for those without HTN, however, this difference in rate is not significant. Not having HTN was associated with a decrease in mean NIHSS score over time, while having a hemorrhagic transformation (HT) is associated with an increase in mean NIHSS score. Age, gender, ethnicity, and IV rt-PA door to needle time were not found to be significant predictors of mean NIHSS scores over time. Conclusions: Patients with hemorrhagic transformation were associated with poorer clinical outcomes, as expected. These patients receiving IV rt-PA for acute ischemic stroke generally improved, as expected. It was interesting to note that individuals with HTN appear to be admitted and discharged with higher NIHSS scores versus those without HTN, despite HTN being promptly treated when present. This demonstrates the importance of HTN prevention and blood pressure control treatment.

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