J Korean Med Sci.
2019 Sep;34(36):e240. 10.3346/jkms.2019.34.e240.
In-Hospital and Post-Discharge Recovery after Acute Ischemic Stroke: a Nationwide Multicenter Stroke Registry-base Study
- Jang MU
- Kang J
- Kim BJ
- Hong JH
- Yeo MJ
- Han MK
- Lee BC
- Yu KH
- Oh MS
- Choi KC
- Lee SH
- Hong KS
- Cho YJ
- Park JM
- Cha JK
- Kim DH
- Park TH
- Lee KB
- Lee SJ
- Lee J
- Kim JT
- Kim DE
- Choi JC
- Lee J
- Lee JS
- Gorelick P
- Bae HJ
- Affiliations
-
- 1Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea.
- 2Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. braindoc@snu.ac.kr
- 3Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
- 4Department of Neurology, Hankook General Hospital, Jeju, Korea.
- 5Department of Neurology, Inje University, Ilsan Paik Hospital, Ilsan, Korea.
- 6Department of Neurology, Eulji University, Eulji General Hospital, Seoul, Korea.
- 7Department of Neurology, Dong-A University Hospital, Busan, Korea.
- 8Department of Neurology, Seoul Medical Center, Seoul, Korea.
- 9Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
- 10Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
- 11Department of Neurology, Yeungnam University Medical Center, Daegu, Korea.
- 12Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
- 13Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea.
- 14Department of Neurology, Jeju National University Hospital, Jeju, Korea.
- 15Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
- 16Asan Medical Center, Clinical Research Center, Seoul, Korea.
- 17Department of Translational Science and Molecular Medicine and Mercy Health Hauenstein Neurosciences, Michigan State University College of Human Medicine, Michigan, United States.
- KMID: 2458646
- DOI: http://doi.org/10.3346/jkms.2019.34.e240
Abstract
- BACKGROUND
Using data from a large national stroke registry, we aimed to investigate the incidence and determinants of in-hospital and post-discharge recovery after acute ischemic stroke and the independence of their occurrence.
METHODS
In-hospital recovery was defined as an improvement of 4 points or > 40% in the National Institutes of Health Stroke Scale (NIHSS) score from admission to discharge. Post-discharge recovery was defined as any improvement in the modified Rankin Scale (mRS) score from discharge to 3 months after stroke onset. Two analytic methods (multivariate and multivariable logistic regression) were applied to compare the effects of 18 known determinants of 3-month outcome and to verify whether in-hospital and post-discharge recovery occur independently.
RESULTS
During 54 months, 11,088 patients with acute ischemic stroke meeting the eligibility criteria were identified. In-hospital and post-discharge recovery occurred in 36% and 33% of patients, respectively. Multivariate logistic regression with an equality test for odds ratios showed that 7 determinants (age, onset-to-admission time, NIHSS score at admission, blood glucose at admission, systolic blood pressure, smoking, recanalization therapy) had a differential effect on in-hospital and post-discharge recovery in the way of the opposite direction or of the same direction with different degree (all P values < 0.05). Both in-hospital and post-discharge recovery occurred in 12% of the study population and neither of them in 43%. The incidence of post-discharge recovery in those with in-hospital recovery was similar to that in those without (33.8% vs. 32.7%, respectively), but multivariable analysis showed that these 2 types of recovery occurred independently.
CONCLUSION
Our findings suggest that, in patients with acute ischemic stroke, in-hospital and post-discharge recovery may occur independently and largely in response to different factors.
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