Comorbidity Burden and Early In-Hospital Outcomes After Intravenous Thrombolysis for Acute Ischemic Stroke

IF 2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice Pub Date : 2026-10-15 DOI:10.1155/ijcp/5517923

Sharbanu Battakova, Marina Grigolashvili, Dmitry Kasatkin, Irina Kadyrova, Yelena Shayakhmetova, Mira Beisembayeva, Shynar Muratbekova, Ivan Turkevich, Alina Koshelyuk

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引用次数: 0

Abstract

Background

The prognostic relevance of comorbidity burden in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) remains uncertain. This study examined the association between four comorbidity indices and early in-hospital outcomes.

Methods

This single-center retrospective study included 106 patients with AIS treated with IVT between January and December 2024. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI; 1987 and 2011 versions) and the Elixhauser Comorbidity Index (ECI; 2009 and 2017 versions). The primary outcome was unfavorable functional status at discharge, defined as a modified Rankin scale (mRS) score of 3–6. Multivariable logistic regression was used to identify factors associated with the primary outcome, and receiver operating characteristic (ROC) analyses assessed the discriminatory performance of the indices. Mortality comparisons were exploratory because only 10 in-hospital deaths occurred.

Results

The median age was 68 years, and 60 patients (56.6%) were men. Unfavorable functional outcome (mRS 3–6) occurred in 73 patients (68.9%). Higher admission National Institutes of Health Stroke Scale (NIHSS) scores and glucose levels were independently associated with unfavorable functional status at discharge, whereas none of the four comorbidity indices remained significant after multivariable adjustment. The comorbidity indices showed limited to modest discriminatory performance, with an AUC of 0.645 (95% CI 0.531–0.760) for CCI 1987. Hemorrhagic transformation (HT) occurred exclusively in patients with an unfavorable outcome and was more frequent among nonsurvivors. Exploratory comparisons also showed higher prestroke mRS, admission NIHSS, CCI 1987, and CCI 2011 scores among nonsurvivors; no multivariable mortality analysis was performed.

Conclusions

None of the evaluated comorbidity indices was independently associated with functional status at hospital discharge. Their discriminatory performance was modest, whereas admission stroke severity and glucose level showed stronger associations with short-term outcome. Given the retrospective single-center design, modest sample size, and limited number of deaths, the findings should be considered exploratory and hypothesis-generating and require confirmation in larger prospective studies.

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急性缺血性脑卒中静脉溶栓后的合并症负担和早期住院结果

背景急性缺血性卒中（AIS）患者静脉溶栓治疗（IVT）的合并症负担与预后的相关性尚不确定。本研究考察了四种合并症指数与早期住院结果之间的关系。方法本研究为单中心回顾性研究，纳入2024年1月至12月106例AIS患者行IVT治疗。采用Charlson共病指数（CCI； 1987年和2011年版本）和Elixhauser共病指数（ECI； 2009年和2017年版本）评估共病负担。主要转归是出院时的不良功能状态，定义为修改的Rankin量表（mRS）评分为3-6分。采用多变量逻辑回归来确定与主要结局相关的因素，并采用受试者工作特征（ROC）分析评估指标的歧视性表现。死亡率比较是探索性的，因为只有10例院内死亡发生。结果中位年龄68岁，男性60例（56.6%）。73例（68.9%）患者出现不良功能结局（mRS 3-6）。入院时较高的美国国立卫生研究院卒中量表（NIHSS）评分和血糖水平与出院时不良的功能状态独立相关，而在多变量调整后，四项合并症指标均不显著。合并症指数显示出有限的适度歧视性表现，1987年CCI的AUC为0.645 （95% CI 0.531-0.760）。出血性转化（HT）仅发生在预后不良的患者中，而在非幸存者中更为常见。探索性比较还显示，非幸存者卒中前mRS、入院NIHSS、CCI 1987和CCI 2011评分较高；未进行多变量死亡率分析。结论所有评估的合并症指标均与出院时的功能状态无关。他们的歧视性表现是适度的，而入院时中风严重程度和血糖水平与短期预后有更强的关联。考虑到回顾性单中心设计、适度的样本量和有限的死亡人数，研究结果应被视为探索性和假设生成，需要在更大的前瞻性研究中得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Clinical Practice 医学-医学：内科

CiteScore

5.30

自引率

0.00%

发文量

274

审稿时长

3-8 weeks

期刊介绍： IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.