J Clin Neurol.  2019 Jan;15(1):54-61. 10.3988/jcn.2019.15.1.54.

Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study

• Kim MS
• Joo MC
• Sohn MK
• Lee J
• Kim DY
• Lee SG
• Shin YI
• Kim SY
• Oh GJ
• Lee YS
• Han EY
• Han J
• Ahn J
• Chang WH
• Kim YH

• KMID: 2451145
• DOI: http://doi.org/10.3988/jcn.2019.15.1.54

Abstract

BACKGROUND AND PURPOSE
Few studies have investigated the relationship between the specific functional factors potentially associated with functional level and stroke recurrence. We conducted a study of patients with noncardioembolic ischemic stroke (NCIS) to determine the functional factors affecting recurrence within the first year.
METHODS
In total, 568 first-ever NCIS patients (age=65.1±17.4 years, mean±SD) were analyzed in a multicenter, prospective cohort study registered from August 2012. Demographic characteristics, past medical history, comorbidities, laboratory data, stroke features in neuroimaging, acute treatments, and medications at discharge were assessed. Functional factors reflecting gross functional impairment, ambulatory function, motor function, activities of daily living, cognition, language ability, swallowing function, mood, and quality of life were comprehensively evaluated in face-to-face assessments using standardized tools at the time of discharge.
RESULTS
The cumulative incidence of stroke recurrence in NCIS was 6.0% (n=34) at 1 year. The period from admission to discharge was 34.4±7.0 days. The independent predictors of stroke recurrence within 1 year in multivariate Cox proportional-hazards regression analyses were 1) age [per-year hazard ratio (HR)=1.04, 95% confidence interval (CI)=0.97-1.06, p=0.048], 2) Charlson Comorbidity Index higher than 2 (HR=1.72, 95% CI=1.26-2.22, p=0.016), 3) modified Rankin Scale score of 3 or more at discharge (HR=1.56, 95% CI=1.22-1.94, p=0.032), and 4) Functional Ambulation Category of 3 or less at discharge (HR=2.56, 95% CI=1.84-3.31, p=0.008).
CONCLUSIONS
In addition to patient age, moderate-to-severe functional impairment requiring the help of others (especially for ambulation) at the time of discharge and the severity of comorbidity were independent predictors of stroke recurrence within 1 year of the first NCIS.

Keyword

comorbidity; disability evaluation; function; recurrence; stroke

MeSH Terms

Activities of Daily Living
Cognition
Cohort Studies*
Comorbidity
Deglutition
Disability Evaluation
Humans
Incidence
Language
Neuroimaging
Prospective Studies
Quality of Life
Recurrence*
Rehabilitation*
Stroke*
Walking

Figure

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  Fig. 1 Patient selection flowchart.

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  Fig. 2 Differences in the recurrence-free survival according to the Kaplan-Meier analysis. Significant differences in recurrence-free survival rate were found for the mRS score (A), the FAC score at discharge (B), and the CCI (C). CCI: Charlson Comorbidity Index, FAC: Functional Ambulatory Category, mRS: modified Rankin Scale.

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