Ninety-day poor prognosis profile in acute ischemic stroke patients

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  • 急性期虚血性脳卒中患者における90日後の重篤な転帰の予測因子

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<p>Background and Purpose: Although the proportion of good outcomes has increased with the development of acute reperfusion therapy in patients with ischemic stroke, not a few patients still have poor outcomes. The purpose of this study was to determine whether poor outcomes can be predicted in ischemic stroke patients by information available at the time of emergency arrival. Methods: Using a prospective, follow-up study of patients with ischemic stroke or transient ischemic attack who were admitted within 7 days of onset between April 2014 and December 2019 (n=2,144), age, sex, premorbid modified Rankin scale (mRS) score, and National Institutes of Health Stroke Scale (NIHSS) score on admission were assessed as predictors of a poor outcome (90-day mRS score 5 or 6). A factor or combination of factors that predicted a poor outcome in more than 80% was defined as a poor prognosis profile (PPP). Results: After excluding those with a premorbid mRS score of 5 and failure to complete follow-up, 2,106 patients (median 77 years, male 58%) were studied. A total of 289 (14%) patients had poor outcomes. On multivariate analysis, age (per 10-year increase, OR 1.8, 95% CI 1.5–2.1), premorbid mRS score (1.3, 1.2–1.5), and NIHSS score (per 5-point increase, 2.2, 2.0–2.4) were independently associated with a poor outcome. A combination of age 80 years or older and NIHSS score of 26 or more predicted a poor outcome in 84% of patients, corresponding to a PPP. Conclusion: Poor outcomes at 90 days can be predicted by age and the NIHSS score on admission.</p>

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