Clinical factors adversely affecting early outcome after brain infarction.
OBJECTIVE
One-hundred-and-nine consecutive patients admitted during the acute phase of a CT-confirmed brain infarction (BI) were studied. Putative adverse influence of demographic and stroke risk factors, previous medical history, clinical presentation, initial and follow-up neurological examination, initial general evaluation, laboratory findings, chest X-ray and electrocardiographic findings, treatment, and topography and etiology of the ischemic insult was analysed. The end-point for assessment was early death (within 30 days). Statistical analysis was performed with univariate analysis and multiple regression.


RESULTS
The main adverse factors related to an increased death risk during the first 30 days were, in decreasing order of importance: coma 48-72 hours after admission; stroke occurring in already hospitalized patients; Babinski sign on admission; minor degrees of impairment of consciousness 48-72 hours after admission; stroke related to large artery atherothrombosis and to embolism; a history of early impairment of consciousness; cardiac failure on admission. In 53 lucid patients on admission, only a history of congestive heart failure (CHF) was associated with a reduced survival rate. In 56 patients with impaired consciousness, the presence of a Babinski sign increased death risk, but the main factor predicting a high case-fatality rate was the persistence of consciousness disturbances after 48-72 hours.


CONCLUSIONS
The presence of impairment of consciousness, especially coma, 2-3 days after disease onset, and a history of CHF greatly increase the early case fatality rate in patients with acute BI presenting with or without consciousness disturbances at admission, respectively. The use of a prognostic algorythm considering these few variables seems to predict the approximate 30-day fatality rates.
André
C
C
Department of Neurology, Hospital Universitário Clementino Fraga Filho (HUCFF), Federal University of Rio de Janeiro (UFRJ).
Novis
S A
SA
D000328:Adult; D002544:Cerebral Infarction / Q000401:mortality*; D004569:Electroencephalography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed