title: Factors associated with timing of early neurological improvement after thrombolysis for ischaemic stroke.
abstract: BACKGROUND
  Early neurological improvement (ENI) after fibrinolysis for ischaemic stroke is strongly associated with recanalization and favourable outcome. However, it remains unknown why some patients recover within the first hour after treatment (very ENI, VENI) whereas others recover later within 24 h.
  
  
  OBJECTIVE
  The factors associated with the timing of ENI were assessed.
  
  
  METHODS
  Consecutive stroke patients treated with intravenous recombinant tissue plasminogen activator (rt-PA) within 4.5 h after onset in four stroke centres of our geographical area were retrospectively studied. VENI assessed at 1 h and ENI assessed at 24 h post-treatment were defined by National Institutes of Health Stroke Scale (NIHSS) improvement by 40% from baseline.
  
  
  RESULTS
  Of 421 patients, 65 (15%) had VENI and 110 (26%) had ENI. Patients with VENI had significantly lower serum creatinine level than patients with ENI (79 ± 19 vs. 91 ± 35 μmol/l; P = 0.01). After adjustment for age, sex, baseline NIHSS, hypertension and blood glucose level, patients with low serum creatinine level were more likely to have VENI (lowest tertile, odds ratio 3.8, 95% confidence interval 1.5-9.7; intermediate tertile, odds ratio 1.8, 95% confidence interval 0.8-4.3; P for trend <0.01). VENI patients were as likely as ENI patients to have a modified Rankin scale score ≤2 at 3 months.
  
  
  CONCLUSIONS
  Low serum creatinine levels are associated with VENI, suggesting that swiftness of the efficacy of rt-PA or of neurological recovery may depend on renal function.
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: S
authors.initials: S
authors.lastname: Guettier
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: J
authors.initials: J
authors.lastname: Cogez
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Bonnet
authors.affiliation: Neuroradiology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: P
authors.initials: P
authors.lastname: Dean
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: M
authors.initials: M
authors.lastname: Apoil
authors.affiliation: CH Cherbourg, Cherbourg, France.
authors.forename: T
authors.initials: T
authors.lastname: Tchoumi
authors.affiliation: CH Saint Lô, Saint-Lô, France.
authors.forename: L
authors.initials: L
authors.lastname: Dubuc
authors.affiliation: CH Lisieux, Lisieux, France.
authors.forename: J
authors.initials: J
authors.lastname: Arzur
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: V
authors.initials: V
authors.lastname: de la Sayette
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: L-K
authors.initials: LK
authors.lastname: Kouassi
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.
authors.forename: F
authors.initials: F
authors.lastname: Viader
authors.affiliation: Department of Neurology, CHU Côte de Nacre, Université Caen-Normandie, Caen, France.|Inserm U919, Université Caen-Normandie, Caen, France.
authors.forename: E
authors.initials: E
authors.lastname: Touzé
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000097:blood* / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D003404:Creatinine; D010959:Tissue Plasminogen Activator
keywords: prognosis; stroke; thrombolysis; treatment