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Complications as important predictors of disability in ischemic stroke

Rizaldy Taslim Pinzon, Rosa De Lima Renita Sanyasi
Submission date: Wednesday, 26 July 2017
Published date: Monday, 13 November 2017


Stroke is the main cause of disability and death in many countries. The high incidence of disability in stroke survivors requires special attention to determine various predictive factors of disability. This study aimed to identify the various predictive factors of disability in ischemic stroke.

This study was a cross sectional study on 4510 ischemic stroke patients. Each patient’s data had been recorded in the electronic stroke registry of Bethesda Hospital. Ischemic stroke diagnosis was confirmed by brain CT scan, which was interpreted by a neurologist and a radiologist. Disability was assessed using the modified Rankin scale. Predictors of disability were assessed. Multiple logistic regression analysis was used to analyse the data.

The subjects were predominantly males, >60 years of age, and suffered stroke for the first time. The incidence of disability was 31.5% (1420/4510). Multiple logistic regression analysis showed that the presence of complications (OR: 6.43; 95% CI: 4.74-8.73; p<0.001), decreased level of consciousness (OR: 4.82; 95% CI: 3.95-5.90; p <0.001), onset ³3 hours (OR: 1.93; 95% CI: 1.52-2.45; p<0.001), recurrent stroke (OR: 1.63; 95% CI: 1.39-1.90; p<0.001), and age >60 years (OR: 1.55; 95% CI: 1.35-1.79; p<0.001) were independent predictive factors of disability.

We demonstrated that a substantial proportion of patients with ischemic stroke become disabled. And the presence of complications was the most predictive factor of disability in ischemic stroke.


Stroke, ischemic; cohort study; predictive factors; disability

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Badan Penelitian dan Pengembangan Kesehatan. Riset kesehatan dasar. Jakarta: Kementerian Kesehatan Republik Indonesia; 2013.

Zhou M, Offer A, Yang G, et al. Body mass index, blood pressure, and mortality from stroke: a nationally representative prospective study of 212 000 Chinese men. Stroke 2008;39:753-9. DOI: 10.1161/STROKEAHA.107.495374.

Toyoda K. Epidemiology and registry studies of stroke in Japan. J Stroke 2013;15:21-6.

Krishnamurthi R, Feigin V, Forouzanfar M, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet Glob Health 2013;1:259-81.

Alguren B. Functioning after stroke, an application of the international classification of functioning disability and health (ICF) [dissertation]. Jonkoping: School of Health Sciences Jonkoping University;2010.

Luengo-Fernandez R, Paul NLM, Gray AM, et al. Population-based study of disability and institutionalization after transient ischemic attack and stroke: 10-year results of the Oxford Vascular Study. Stroke 2013;44:2854-61. doi: 10.1161/STROKEAHA.113.001584.

Schnitzler A, Wolmant F, Tuppin P, et al. Prevalence of self-reported stroke and disability in the French adult population: a transversal study. PloS ONE 2014;9:e115375. doi: 10.1371/journal.pone. 0115375.

Kalaria R. Cerebrovascular disease and mechanisms of cognitive impairment: evidence from clinicopathological studies in humans. Stroke 2012;43:2526-34. DOI: 10.1161/STROKEAHA.112. 655803.

Hong KS, Saver JL, Kang DW, et al. Years of optimum health lost due to complication after acute ischemic stroke: disability-adjusted life-years analysis. Stroke 2010;41:1758-65. doi: 10.1161/STROKEAHA.109.576066.

Lanywati G, Mihardja LK, Delima. Faktor risiko dominan penderita stroke di Indonesia. Buletin Penelitian Kesehatan 2016;44:49-58.

Yang Y, Shi YZ, Zhang N, et al. The disability rate of 5-year post-stroke and its correlation factors: a national survey in China. PLoS ONE 2016;11:e0165341. DOI: 10.1371/journal.pone. 0165341.

Astuti WD, Budijanto D. Tingkat disabilitas fisik berdasarkan penyakit degeneratif yang diderita menurut faktor sosial demografi. Buletin Penelitian Sistem Kesehatan 2009;12:378-92.

Norris M, Allotey P, Barrett G. “It burdens me”: the impact of stroke in central Aceh, Indonesia. Soc Health Illn 2012;34:826-40.

Wahyudi R, Hasmono D, Fitrina R, et al. Injected citicoline improves impairment and disability during acute phase treatment in ischemic stroke patients. Folia Medica Indonesiana 2015;51:245-51.

Chung JW, Park SH, Kim N, et al. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging. J Am Heart Assoc 2014;3:e001119. DOI: 10.1161/JAHA.114.001119.

Braz L. Scales in stroke patients: the modified Rankin scale. Int J Clin Neurosci Mental Health 2016;3 Suppl 1:L22.

Sridharan SE, Unnikrishnan JP, Sukumaran S, et al. Incidence, types, risk factors, and outcome of stroke in a developing country - the Trivandrum stroke registry. Stroke 2009;40:1212-8. doi: 10.1161/STROKEAHA.108.531293

Kooi CW, Peng HC, Aziz ZA, et al. A review of stroke research in Malaysia from 2000-2014. Med J Malaysia 2016;71 Suppl 1:58-69.

Mendis S. Stroke disability and rehabilitation of stroke: World Health Organization perspective. Int J Stroke 2012;8:3-4

Ghandehari K, Mood ZI. Khorasan stroke registry: analysis of 1392 stroke patients. Arch Iranian Med 2007;10:327-34.

Ovbiagele B, Nguyen-Huynh MN. Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics 2011;8:319–29.

Ghani L, Mihardja LK, Delima. Faktor risiko dominan penderita stroke di Indonesia. Buletin Penelitian Kesehatan 2016;44:49-58.

Samai AA, Schild SM. Sex differences in predictors of ischemic stroke: current perspectives. Vasc Health Risk Manage 2015;11: 427–36. doi: 10.2147/VHRM.S65886.

Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics – 2016 Update, a report from the American heart association. Circulation 2015;132:e1-e323; DOI: 10.1161/CIR.0000000000000350.

Lisabeth LD, Brown DL, Hughes R, et al. Acute stroke symptoms, comparing women and men. Stroke 2009;40:2031-6. DOI: 10.1161/STROKEAHA.109.546812.

Shigematsu K, Nakano H, Watanabe Y. Speech disturbance at stroke onset is correlated with stroke early mortality. BMC Neurology 2013;13:87. doi: 10.1186/1471-2377-13-87.

Caso V, Paciaroni M, Agnelli G, et al. Gender differences in patients with acute ischemic stroke. Women’s Health 2010;6:51–7.

Grube MM, Koennecke HC, Walter G, et al. Influence of acute complications on outcome 3 months after ischemic stroke. PLoS ONE 2013;8:e75719. DOI: 10.1371/journal.pone. 0075719.

Durièiè S, Tamara R, Milorad Ž. Risk factors of the first stroke. Med 2015;LXVIII:17-21.

Tong X, Kuklina E, Gillespie C, et al. Medical complications among hospitalizations for ischemic stroke in the United States from 1998 to 2007. Stroke 2010;41:980-6. DOI: 10.1161/STROKEAHA.110.578674.

Nadeau JO, Fang J, Kapral MK, et al. On behalf of the investigators for the registry of the Canadian Stroke Network. Outcome after stroke upon awakening. Can J Neurol Sci 2005;32:232-6.

Li J, Wang D, Tao W, et al. Early consciousness disorder in acute ischemic stroke: incidence, risk factors and outcome. BMC Neurol 2016;16:140. doi: 10.1186/s12883-016-0666-4.

Kuster GW, Dutra LA, Brasil IP, et al. Outcome determinants of stroke in a Brazilian primary stroke center. Stroke Res Treat 2014. DOI: 10.1155/2014/194768.

Hong KS, Saver JL. Years of disability-adjusted life gained as a result of thrombolytic therapy for acute ischemic stroke. Stroke 2010;41:471-7. DOI: 10.1161/STROKEAHA.109.571083

Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014;384:1929–35. doi: 10.1016/S0140-6736(14)60584-5.

Varona JF. Long-term prognosis of ischemic stroke in young adults. Stroke Res Treat 2011. DOI: 10.4061/2011/879817.

do Carmo JF, Morelato RL, Pinto HP, et al. Disability after stroke: a systematic review. Fisioter Mov 2015;28:407-18.

Knoflach M, Matosevic B, Rucker M, et al. Functional recovery after ischemic stroke-a matter of age: data from the Austrian stroke unit registry. Neurology 2012;78:279-85.

Appelros P, Stegmayr B, Terent A. A review on sex differences in stroke treatment and outcome. Acta Neurol Scand 2010;121:359-69.

Maredza M, Bertram MY, Tollman SM. Disease burden of stroke in rural South Africa: an estimate of incidence, mortality and disability adjusted life years. BMC Neurology 2015;15:54. DOI: 10.1186/s12883-015-0311-7.

Petrea RE, Beiser AS, Seshadri S, et al. Gender differences in stroke incidence and poststroke disability in the Framingham Heart study. Stroke 2009;40:1032-7. DOI: 10.1161/STROKEAHA.108. 542894

Sharma M, Gubitz GJ. Management of stroke in diabetes. Can J Diabetes 2013;37:S124-5.

Wu L, Wang A, Wang X, et al. Factors for short-term outcomes in patients with a minor stroke: results from China national stroke registry. BMC Neurol 2015;15:253. DOI: 10.1186/s12883-015-0505-z.


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