title: Predictors of in-hospital mortality and dependence at discharge in patients with MCA stroke with intravenous thrombolysis.
abstract: Early risk stratification of mortality and dependence is important for guiding medical decision-making in stroke care. The study aim is to evaluate whether there are any differences between risk factors for in-hospital mortality and dependence at discharge in patients with first-episode ischemic stroke in the middle cerebral artery (MCA) receiving intravenous thrombolysis (IVT) treatment. The study comprised a single-center cohort of patients admitted consecutively for first-episode MCA ischemic stroke. A logistic regression analysis was performed to determine the variables associated with in-hospital mortality and dependence at discharge. We included 169 patients (50.9% women) with a mean age of 64.1 ± 12.9 years and a median National Institute of Health Stroke Scale (NIHSS) score of 13 (range 3-26) at admission. Nineteen patients (11.2%) died as inpatients [the main cause of death was found to be infection (47.4%)]. The independent predictors for in-hospital mortality were: age (OR 1.09, 95% CI 1.03-1.15, p = 0.004) and NIHSS score (>17) at admission (OR 1.17, 95% CI 1.05-1.30, p = 0.004). Two other crude models used to analyze in-hospital mortality (age and symptoms-to-needle time, and age and symptomatic intracerebral hemorrhage) were significant. NIHSS score (>11) at admission (OR 1.29, 95% CI 1.17-1.42, p < 0.001) and large artery atherosclerosis stroke (OR 3.10, 95% CI 1.10-8.76, p = 0.031) were independently associated with dependence at discharge. Overall, the predictors for mortality and dependence in patients with first-episode MCA ischemic stroke treated with IVT were different. This knowledge might help to improve the management of this devastating disease.
authors.affiliation: Department of Neurology, Hospital de Clínicas, Serviço de Neurologia, Universidade Federal do Paraná, Rua General Carneiro, 181-4º andar, Curitiba, PR, 80060-900, Brazil. re_ducci@yahoo.com.br.
authors.forename: Renata Dal-Prá
authors.initials: RD
authors.lastname: Ducci
authors.affiliation: Department of Neurology, Hospital de Clínicas, Serviço de Neurologia, Universidade Federal do Paraná, Rua General Carneiro, 181-4º andar, Curitiba, PR, 80060-900, Brazil.
authors.forename: Marcos Christiano
authors.initials: MC
authors.lastname: Lange
authors.affiliation: Department of Neurology, Hospital de Clínicas, Serviço de Neurologia, Universidade Federal do Paraná, Rua General Carneiro, 181-4º andar, Curitiba, PR, 80060-900, Brazil.
authors.forename: Viviane de Hiroki Flumignan
authors.initials: VHF
authors.lastname: Zétola
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Morbidity; Mortality; Outcome assessment (Health Care); Stroke; Thrombolytic therapy