title: Predictors of in-hospital mortality and the risk of symptomatic intracerebral hemorrhage after thrombolytic therapy with recombinant tissue plasminogen activator in acute ischemic stroke.
abstract: Recombinant tissue-plasminogen activator (rt-PA) therapy improves functional outcome in patients with acute ischemic stroke (AIS) but is associated with serious complications, including symptomatic intracerebral hemorrhage (sICH). This study aimed to determine the independent predictors of in-hospital mortality (IHM) and the risk of sICH after rt-PA therapy. A total of 1007 patients (mean age, 72 ± 12 years; 52% women; mean National Institutes of Health Stroke Scale [NIHSS] score, 11.6 ± 5.6) with AIS treated with rt-PA were enrolled in this study during a 42-month period beginning in November 2007. Univariate and multivariate regression analyses were performed to estimate the predictors of IHM. Eighty-three of the 1007 patients (8.2%) died during hospitalization (mean duration of hospitalization, 10 ± 1.8 days). Logistic regression estimated the following independent predictors for IHM: age ≥80 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.0; P = .031), aphasia (OR, 2.0; 95% CI, 1.1-3.4; P = .017), altered consciousness (OR, 3.6; 95% CI, 2.0-6.2; P < .001), hypertension (OR, 4; 95% CI, 1.4-11.6; P = 0.012), sICH (OR, 5.9; 95% CI, 2.9-11.9; P < 0.001), and pneumonia during hospitalization (OR, 3.0; 95% CI, 1.8-5.0; P < .001). After rt-PA therapy, 58 patients (5.8%) sustained sICH, 16 (28%) of whom died. Increased age (P = .008), higher NIHSS score (P = .011), and atrial fibrillation (P = .025) were correlated with sICH. The findings from this study may help clinicians estimate the prognosis and risk of sICH in patients with AIS treated with rt-PA.
authors.affiliation: Department of Neurology, Schleswig-Holstein University Hospital, Lübeck, Germany. Electronic address: Mohamed.al-khaled@neuro.uni-luebeck.de.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Khaled
authors.affiliation: Institute of Social Medicine, University of Lübeck, Lübeck, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Matthis
authors.affiliation: Department of Neurology, Schleswig-Holstein University Hospital, Lübeck, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Eggers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011994:Recombinant Proteins; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator