Prediction of functional consequences of cerebral ischemic stroke one year after its occurrence

T. Cherenko, Yu.L. Heletyuk
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引用次数: 2

Abstract

The aim —  investigation of independent prognostic factors of minimal dependence in everyday activities one year after ischemic stroke by developing a prognostic mathematical model. Materials and methods. The neurological and functional status of 150 patients (74 (49.3 %) women and 76 (50.7 %) men of mean age of (67.4 ± 0.7 years) with primary ischemic stroke and primary arterial hypertension in anamnesis was evaluated. Neurological deficit was evaluated by the NIHSS scale. The assessment of everyday life activity was provided by Bartel index (BI). The cognitive status was evaluated by MMSE scale. Diagnosis of hypertension was based on the results of clinical, instrumental examination and medical documentation. We applied daily blood pressure (BP) monitoring from the moment of admission every 4 hours for 6 days of acute period. The variability of SBP and DBP was determined by calculating the standard deviation for 6 days, as well as for the period from the first to the third and from the third to the sixth day. Results and discussion. A year after stroke, the median of the Barthel index values was 85, the minimum value was 45, the maximum — 100, the first quartile — 75, the third quartile — 95 points. Data on 105 patients with neurological deficit of moderate (82) and severe (23) degrees took part in the determination of the functional recovery prognostic predictors by BI. Of the 161 indicators that characterized the pathology and the results of an additional patient’s examination, 18 variables that had a reliable correlation with the BI score in a year were selected and involved in logistic regression analysis. According to the step­by­step analysis, (10 steps), the independent prognostic factors of minimal dependence in daily activities in a year were determined in patients with moderate and severe ischemic stroke: duration of hypertension (B coefficient = –0.11), thickness of the intima­media complex (B coefficient = –7.62), the MMSE score (B coefficient = 0.19), gender (B coefficient = –2.13), intake of sartans in combination with calcium antagonists or in monotherapy (B coefficient = –1.31), achievement of target BP in antihypertension therapy (its efficiency) (B coefficient = +2.95); constant — 7.43. The obtained model has a sensitivity of 95.3 %, a specificity of 88.9 % and a diagnostic accuracy of 93.4 %, an area under the ROC curve — 0.926 (95 % confidence interval: 0.881 — 0.972). Conclusions. The main tasks at the stage of rehabilitation of patients for achievement of a minimum functional dependence in a year in the case of moderate to severe ischemic stroke is to prevent the progression of the atherosclerotic process, improve cognitive functions and achieve the primary hypertension treatment effectiveness.
缺血性脑卒中发生一年后功能后果的预测
目的:通过建立预后数学模型,研究缺血性脑卒中一年后日常活动依赖性最小的独立预后因素。材料和方法。对150例(女性74例(49.3%),男性76例(50.7%),平均年龄(67.4±0.7岁)的原发性缺血性脑卒中合并原发性动脉高血压患者的神经功能状况进行评价。神经功能缺损采用NIHSS量表评估。日常生活活动评价采用Bartel指数(BI)。采用MMSE量表评估认知状态。高血压的诊断是基于临床,仪器检查和医疗文件的结果。急性期6天,从入院时起每4小时进行每日血压监测。通过计算第6天、第1天至第3天、第3天至第6天的标准差来确定收缩压和舒张压的变异性。结果和讨论。中风后一年,Barthel指数的中位数为85,最小值为45,最大值为- 100,前四分位为- 75,第三四分位为- 95。105例中度(82)和重度(23)神经功能缺损患者的数据参与了BI功能恢复预后预测指标的确定。在表征病理和额外患者检查结果的161个指标中,选择了18个与一年内BI评分有可靠相关性的变量并参与逻辑回归分析。根据分步分析(10步),确定中重度缺血性脑卒中患者一年内日常活动依赖度最小的独立预后因素:高血压持续时间(B系数= -0.11)、内膜-中膜复合体厚度(B系数= -7.62)、MMSE评分(B系数= 0.19)、性别(B系数= -2.13)、沙坦类药物联合钙拮抗剂或单用沙坦类药物的摄入量(B系数= -1.31)、降压治疗达到目标血压(B系数= +2.95);常数- 7.43。该模型的灵敏度为95.3%,特异性为88.9%,诊断准确率为93.4%,ROC曲线下面积为0.926(95%置信区间为0.881 ~ 0.972)。结论。中重度缺血性脑卒中患者康复阶段的主要任务是防止动脉粥样硬化进程的进展,改善认知功能,达到原发性高血压的治疗效果,实现一年内最低程度的功能依赖。
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