Is visible infarction on computed tomography associated with an adverse prognosis in acute ischemic stroke?
OBJECTIVE
It is unclear whether visible infarction on a CT scan at any time after the stroke is an adverse prognostic factor once other factors such as stroke severity are taken into consideration. We examined whether visible infarction was associated with a poor outcome after stroke using univariate and multivariate analyses, including easily identifiable clinical baseline variables, and adjusting for time from stroke onset to CT.


METHODS
All inpatients and outpatients with an acute ischemic stroke attending our hospital stroke service were examined by a stroke physician and entered into a register prospectively. The CT scan was coded prospectively for the site and size of any relevant recent visible infarct. The patients were followed up at 6 months to ascertain their functional status with the use of the modified Rankin Scale. Analyses of the effect of visible infarction on the outcomes "dead or dependent" or "dead" at 6 months were performed with adjustment for time from stroke to CT, clinical stroke type (lacunar, hemispheric, or posterior circulation), and in a multiple logistic regression model to adjust for confounding baseline variables such as stroke severity.


RESULTS
In 993 patients in the stroke registry, visible infarction increased the risk of being dead or dependent at 6 months (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.9 to 3.3) or dead (OR, 4.5; 95% CI, 2.7 to 7.5), both on its own and after adjustment for time from stroke to CT, stroke symptoms, and other important clinical prognostic variables (OR for death or dependence in the predictive model, 1.5; 95% CI, 1.0 to 2.0; OR for death, 2.4; 95% CI, 1.4 to 4.1).


CONCLUSIONS
Visible infarction on CT is an adverse prognostic indicator (albeit of borderline significance) even after adjustment for stroke severity and time lapse between the stroke and the CT scan.
Wardlaw
J M
JM
Department of Clinical Neurosciences, Western General Hospital NHS Trust, Edinburgh, Scotland, UK. jmw@skull.dcn.ed.ac.uk
Lewis
S C
SC
Dennis
M S
MS
Counsell
C
C
McDowall
M
M
D000208:Acute Disease; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed