Yonsei Med J.  2014 May;55(3):669-675. 10.3349/ymj.2014.55.3.669.

Long-Term Mortality According to the Characteristics of Early Neurological Deterioration in Ischemic Stroke Patients

• Kim YD
• Song D
• Kim EH
• Lee KJ
• Lee HS
• Nam CM
• Nam HS
• Heo JH

• KMID: 2068676
• DOI: http://doi.org/10.3349/ymj.2014.55.3.669

Abstract

PURPOSE
Although early neurological deterioration (END) during the acute stroke period is known to be associated with poor functional outcomes, there is little data regarding the impact of END on long-term outcomes according to the characteristics of END. The aim of this study was to investigate whether there are differences in long-term mortality according to the characteristics of END among acute ischemic stroke or transient ischemic attack patients.
MATERIALS AND METHODS
END was defined as any increase (> or =1) in National Institute of Health Stroke Scale score within 7 days after admission. We assessed the characteristics of END, such as the etiology and severity of END, as well as recovery after END. The relationship between 30-day or long-term mortality and each characteristic of END was investigated using multiple logistic analysis or Cox regression model.
RESULTS
Among 2820 patients, END was observed in 344 patients (12.2%). After adjustment for age, sex, underlying cardiovascular diseases, stroke severity, and stroke subtypes, END was associated with long-term mortality, whether it was mild or severe and whether or not it was followed by recovery. However, 30-day mortality was strongly related to the severity of END or the absence of recovery after END. Among the causes of END, recurrent stroke and medical illness were related to 30-day mortality, as well as long-term mortality, while brain herniation and intracranial hemorrhagic complications were only associated with 30-day mortality.
CONCLUSION
The results of the present study demonstrated that END is associated with higher mortality and the effects of END on short-term and long-term mortality depend on END characteristics.

Keyword

Cerebral infarction; prognosis; early neurological deterioration

MeSH Terms

Aged
Brain Ischemia/mortality/*physiopathology
Female
Humans
Male
Middle Aged
Prospective Studies
Stroke/mortality/*physiopathology

Figure

• 

  Fig. 1 Frequency of (A) early neurologic deterioration (END) conditions and (B) END with recovery according to the causes of END. ICH, intracerebral hemorrhage.

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  Fig. 2 Adjusted survival curves for long-term mortality in stroke survivors according to (A) severity of early neurologic deterioration (END), (B) presence of recovery after END, and (C) causes of END. ICH, intracerebral hemorrhage.

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