Functional status at 30 and 90 days after mild ischaemic stroke.

IF 2.6 1区医学

Journal of Investigative Medicine Pub Date : 2022-04-26 DOI:10.1136/svn-2021-001333

Hannah Gardener, Leo A Romano, Eric E Smith, Iszet Campo-Bustillo, Yosef Khan, Sofie Tai, Nikesha Riley, Ralph L Sacco, Pooja Khatri, Heather M Alger, Brian Mac Grory, Deepak Gulati, Navdeep S Sangha, Karin E Olds, Curtis G Benesch, Adam G Kelly, Scott S Brehaut, Amit C Kansara, Lee H Schwamm, Jose G Romano

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Abstract

Background/objective: This study compares the global disability status of patients who had a mild ischaemic stroke at 30 and 90 days poststroke, as measured by the modified Rankin Scale (mRS), and identifies predictors of change in disability status between 30 and 90 days.

Methods: The study population included 1339 patients who had a ischaemic stroke enrolled in the Mild and Rapidly Improving Stroke Study with National Institutes of Health (NIH) stroke score 0-5 and mRS measurements at 30 and 90 days. Outcomes were (1) Improvement defined as having mRS >1 at 30 days and mRS 0-1 at 90 days OR mRS >2 at 30 days and mRS 0-2 at 90 days and (2) Worsening defined as an increase of ≥2 points or a worsening from mRS of 1 at 30 days to 2 at 90 days. Demographic and clinical characteristics at hospital arrival were abstracted from medical records, and regression models were used to identify predictors of functional improvement and decline from 30 to 90 days post-stroke. Significant predictors were mutually adjusted in multivariable models that also included age and stroke severity.

Results: Fifty-seven per cent of study participants had no change in mRS value from 30 to 90 days. Overall, there was moderate agreement in mRS between the two time points (weighted kappa=0.59 (95% CI 0.56 to 0.62)). However, worsening on the mRS was observed in 7.54% of the study population from 30 to 90 days, and 17.33% improved. Participants of older age (per year OR 1.02, 95% CI 1.00 to 1.03), greater stroke severity (per NIH Stroke Scale (NIHSS) point at admission OR 1.17, 95% CI 1.03 to 1.34), and those with no alteplase treatment (OR 1.72, 95% CI 1.11 to 2.69) were more likely to show functional decline after mutual adjustment.

Discussion: A quarter of all mild ischaemic stroke participants exhibited functional changes between 30 and 90 days, suggesting that the 30-day outcome may insufficiently represent long-term recovery in mild stroke and longer follow-up may be clinically necessary.

Trial registration number: NCT02072681.

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轻度缺血性卒中后30和90天的功能状态

背景/目的本研究比较了轻度缺血性卒中患者在卒中后30天和90天的整体残疾状况，通过改良的兰金量表（mRS）进行测量，并确定了30至90天残疾状况变化的预测因素天。方法研究人群包括1339名缺血性卒中患者，他们参加了美国国立卫生研究院（NIH）的轻度和快速改善卒中研究，在30天和90天时进行了卒中评分0-5和mRS测量。结果是：（1）改善定义为30天时mRS>1，90天时mRS 0-1，或30天时mPRS>2，90天后mRS 0-2；（2）恶化定义为增加≥2分或从30天时的mRS 1恶化到90天时的2。从医疗记录中提取住院时的人口统计学和临床特征，并使用回归模型来确定30至90岁时功能改善和下降的预测因素中风后几天。在包括年龄和中风严重程度的多变量模型中，显著的预测因素相互调整。结果57%的研究参与者在30至90天内mRS值没有变化。总体而言，两个时间点之间的mRS存在中度一致性（加权kappa=0.59（95%CI 0.56至0.62））。然而，在30至90岁的研究人群中，有7.54%的人观察到mRS恶化天数改善17.33%。年龄较大（每年OR 1.02，95%CI 1.00至1.03）、卒中严重程度较高（入院时根据NIH卒中量表（NIHSS）评分OR 1.17，95%置信区间1.03至1.34）和未接受阿替普酶治疗的参与者（OR 1.72，95%CI 1.11至2.69）在相互调整后更有可能出现功能下降。讨论四分之一的轻度缺血性中风参与者在30至90天之间表现出功能变化，这表明30天的结果可能不足以代表轻度中风的长期恢复，临床上可能需要更长的随访时间。试验注册号NCT02072681。

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

Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL

自引率

0.00%

发文量

111

期刊介绍： Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.