Combination of five clinical data as prognostic factors of mortality after ischemic stroke
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Abstract
Background
The mortality rate after ischemic stoke is influenced by various factors. Prognosis after ischemic stroke can be predicted using a scoring system to help the doctor to evaluate patient’s condition, neurologic deficits, and possible prognosis as well as make appropriate management decisions. The objective of this study was to identify the factors which determine mortality rates in patients after ischemic stroke and to determine the prognosis of ischemic stroke patients using the predictive mortality score.
Methods
This was a nested case control study using data from the stroke registry and medical records of patients at the Neurology Clinic of Bethesda Hospital Yogyakarta between 2011-2015. Data was analysed using simple and multiple logistic regression analysis. The scoring was analyzed using receiver-operating characteristic (ROC) curve and the cut-off point using area under the curve (AUC).
Results
Multiple logistic regression analysis showed a significant association between mortality of ischemic stroke patients and age (OR: 4.539, 95% CI: 1.974-10.439, p<0.001), random blood glucose (OR: 2.692, 95% CI: 1.580-4.588, p<0.001), non-dyslipidemia (OR: 2.313, 95% CI: 1.395-3.833, p=0.001), complications (OR: 1.609, 95% CI: 1.019-2.540, p=0.041), risk of metabolic encephalopathy (OR: 2.499, 95% CI: 1.244-5.021, p=0.010) and use of ventilators (OR: 17.278, 95% CI: 2.015-148.195, p=0.009).
Conclusions
Age, high random blood glucose level, complications, metabolic encephalopathy risk and the use of ventilators are associated with mortality after ischemic stroke. The predictive mortality score can be used to assess the prognosis of patients with ischemic stroke.
Article Details
The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
References
Sacco RL, Kasner SE, Broderick JP, et al. On behalf of the American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Nutrition, Physical Activity and Metabolism . An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:2064-89. doi: 10.1161/STR.0b013e318296aeca.
Kementerian Kesehatan RI. Riset kesehatan dasar (Riskesdas 2013). Jakarta; Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan RI; 2013.
Pinzon R. Profil stroke: gambaran tentang pola demografi, faktor resiko, gejala klinik, dan luaran klinis pasien stroke. Yogyakarta: Betha Grafika; 2014.
Carter AM, Catto AJ, Mansfield MW, et al. Predictive variables for mortality after acute ischemic stroke. Stroke 2007;38:1873-80. doi: 10.1161/strokeaha.106.474569.
Mogensen UB, Olsen TS, Andersen KK, et al. Cause-specific mortality after stroke: relation to age, sex, stroke severity, and risk factors in a 10-year follow-up study. J Stroke Cerebrovasc Dis 2013;22:e59–65.
Ivanov A, Ambreen M, Korniyenko A. Permissive hypertension in acute ischemic stroke: is it a myth or reality? J Am Coll Cardiol 2015;Suppl.10S:A1344.
Aksoy D, Inanir A, Ayan M, Cevik B, et al. Predictor of mortality and morbidity in acute ischemic stroke. Arch Neuropsychiatry 2013;50: 40-4.
Çomoðlu SS, Çilliler AE, Güven H. Erythrocyte sedimentation rate: can be a prognostic marker in acute ischemic stroke. Turkish J Cerebrovasc Dis 2013; 19:18-22. doi: 10.5505/tbdhd.2013. 32042.
Kasner SE. Clinical interpretation and use of stroke scales.Lancet Neurol 2006;5:603–12.
Fan J, Upadhye S, Worster A. Understanding receiver operating characteristic (ROC) curves. Can J Emerg Med 2006;8:19-20.
Fonarow GC, Reeves MJ, Zhao X, et al. Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation 2010;121:879-91.
Piironen K, Putaala J, Rosso C, et al. Glucose and acute stroke.Stroke 2012;43:898-902.
Sohail, A, Khatri IA, Mehboob N. Effect of dyslipidemia on severity and outcome of stroke using mRS scores in Northern Pakistani population. RMJ 2013:384;345-50;
Muhammad D, Javed M, Sheikh GA. Acute ischemic stroke; correlation between higher total cholesterol level and high Barthel index score in patients. Professional Med J 2015;22:276-80.
Ogata T, Kamouchi M, Matsuo R, et al. Gastrointestinal bleeding in acute ischemic stroke: recent trends from the Fukuoka Stroke Registry. Cerebrovasc Dis Extra 2014;4:156–64.
Poisson SN, Johnston SC, Josephson SA. Urinary tract infections complicating stroke: mechanisms, consequences, and possible solutions. Stroke 2010;414:e180-4.
Rodrigues B, Staff I, Fortunato G, et al. Hyponatremia in the prognosis of acute ischemic stroke. Stroke Cerebrovasc Dis 2014;23:850-4. doi: 10.1016/j.jstrokecerebrovasdis.2013.07.011.
Zhang Y, Churilov L, Meretoja A, et al. Elevated urea level is associated with poor clinical outcome and increased mortality post intravenous tissue plasminogen activator in stroke patients. J Neurol Sci 2013;332:110-5. doi: 10.1016/j.jns.2013.06.030.
Mayer SA, Copeland D, Bernardini GL, et al. Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke 2000;31:2346-53.
Myint PK, Bachmann MO, Loke YK, et al. Important factors in predicting mortality outcome from stroke: findings from the Anglia Stroke Clinical Network Evaluation Study. Age Ageing 2017;46:83–90. doi: 10.1093/ageing/afw175.