TY - JOUR
T1 - Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy
AU - Leigh, Richard
AU - Zaidat, Osama O.
AU - Suri, Muhammad F.
AU - Lynch, Gwendolyn
AU - Sundararajan, Sophia
AU - Sunshine, Jeffrey L.
AU - Tarr, Robert
AU - Selman, Warren
AU - Landis, Dennis
AU - Suarez, Jose I.
PY - 2004/8
Y1 - 2004/8
N2 - Background and Purpose - Although long-term outcome determinants in acute ischemic stroke (AIS) patients have been defined, less is known about those predicting hyperacute worsening after thrombolytic therapy (TT). We investigated predictors of short-term clinical worsening (National Institutes of Health Stroke Scale [NIHSS] change ≥4 within 24 hours of admission). Methods - We studied 201 AIS patients who received TT within 6 hours of symptom onset. We determined baseline demographics, comorbidities, NIHSS at baseline and at 24 hours after TT, head computed tomography scan before and within 24 hours after TT, and angiographic recanalization in patients treated with intra-arterial (IA) thrombolysis. Significance of relationships was evaluated by t test or Wilcoxon signed rank sum test. Logistic regression model (LRM) was fitted to determine independence of significant variables. Results - Of 201 patients, 13% worsened, 39% improved, and 48% remained unchanged 24 hours after TT. Most patients (72%) received IA thrombolysis. Patients who deteriorated, compared with those who improved, were more likely to have complicating intracranial hemorrhage (ICH; P<0.001), absent recanalization (P=0.026), and higher blood glucose (BG; P=0.049). Hyperglycemia (>150 mg/dL) was greater in patients who worsened even in presence of recanalization (P=0.004, odds ratio [OR] 6.47). LRM showed that adjusted OR for increased risk of bad outcome and mortality for an increase of BG by 50 mg/dL is 1.56 and 1.38, respectively. Conclusions - Hyperglycemia and ICH are independent predictors of hyperacute worsening in AIS patients receiving TT. Although recanalization is the purpose of IA thrombolysis, its impact on clinical improvement may not be apparent without strict BG control.
AB - Background and Purpose - Although long-term outcome determinants in acute ischemic stroke (AIS) patients have been defined, less is known about those predicting hyperacute worsening after thrombolytic therapy (TT). We investigated predictors of short-term clinical worsening (National Institutes of Health Stroke Scale [NIHSS] change ≥4 within 24 hours of admission). Methods - We studied 201 AIS patients who received TT within 6 hours of symptom onset. We determined baseline demographics, comorbidities, NIHSS at baseline and at 24 hours after TT, head computed tomography scan before and within 24 hours after TT, and angiographic recanalization in patients treated with intra-arterial (IA) thrombolysis. Significance of relationships was evaluated by t test or Wilcoxon signed rank sum test. Logistic regression model (LRM) was fitted to determine independence of significant variables. Results - Of 201 patients, 13% worsened, 39% improved, and 48% remained unchanged 24 hours after TT. Most patients (72%) received IA thrombolysis. Patients who deteriorated, compared with those who improved, were more likely to have complicating intracranial hemorrhage (ICH; P<0.001), absent recanalization (P=0.026), and higher blood glucose (BG; P=0.049). Hyperglycemia (>150 mg/dL) was greater in patients who worsened even in presence of recanalization (P=0.004, odds ratio [OR] 6.47). LRM showed that adjusted OR for increased risk of bad outcome and mortality for an increase of BG by 50 mg/dL is 1.56 and 1.38, respectively. Conclusions - Hyperglycemia and ICH are independent predictors of hyperacute worsening in AIS patients receiving TT. Although recanalization is the purpose of IA thrombolysis, its impact on clinical improvement may not be apparent without strict BG control.
KW - Hyperglycemia
KW - Intracerebral hemorrhage
KW - Outcome
KW - Stroke, ischemic
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=3242791869&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=3242791869&partnerID=8YFLogxK
U2 - 10.1161/01.STR.0000132571.77987.4c
DO - 10.1161/01.STR.0000132571.77987.4c
M3 - Article
C2 - 15178819
AN - SCOPUS:3242791869
SN - 0039-2499
VL - 35
SP - 1903
EP - 1907
JO - Stroke
JF - Stroke
IS - 8
ER -