Document Detail


Severe stroke: patient profile and predictors of favourable outcome.
MedLine Citation:
PMID:  23140236     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Severe stroke carries a high rate of mortality and morbidity. The aims of this study are to determine the characteristics of patients that initially presented with severe ischaemic stroke, and to identify acute and subacute predictors of favourable clinical outcome in these patients. Methodology: An observational cohort study, Acute STroke Registry and Analysis of Lausanne (ASTRAL), was analysed, and all patients presenting with severe stroke - defined as a National Institute of Health Stroke Scale (NIHSS) ≥ 20 on admission - were compared with all other patients. In a multivariate analysis, associations with demographic, clinical, pathophysiological, metabolic and neuroimaging factors and were determined. Furthermore, we analysed predictors of favourable outcome (modified Rankin scale (mRS) ≤3 at three months) in the subgroup of severe stroke patients. Results: Out of 1,915 consecutive patients, 243 (12.7%) presented with severe stroke. This was significantly associated with cardio-embolic stroke mechanism (OR 1.74, 95%CI 1.19-2.54), unknown stroke onset (OR 2.35, 95%CI 1.14-4.83), more neuroimaging signs of early ischaemia (mostly CT, OR 2.65, 95%CI 1.79-3.92), arterial occlusions on acute imaging (OR 27.01, 95%CI 11.5-62.9), fewer chronic radiological infarcts (OR 0.43, 95%CI 0.26-0.72), lower haemoglobin concentration (OR 0.97, 95%CI 0.96-0.99), and higher white cell count (OR 1.05, 95%CI 1.00-1.11). In the 68 (28%) patients with favourable outcomes despite presenting with severe stroke, this was predicted by lower age (OR 0.94, 95%CI 0.92-0.97), preceding cerebrovascular events (OR 3.00, 95%CI 1.01-8.97), hypolipemic pre-treatment (OR 3.82, 95%CI 1.34-10.90), lower acute temperature (OR 0.43, 95%CI 0.23-0.78), lower subacute glucose concentration (OR 0.74, 95%CI 0.56-0.97), and spontaneous or treatment-induced recanalisation (OR 4.51, 95%CI 1.96-10.41). Conclusion: Severe stroke presentation is predicted by multiple clinical, radiological and metabolic variables, several of which are modifiable. Predictors in the 28% of patients with favourable outcome despite presenting with severe stroke include hypolipemic pretreatment, lower acute temperature, lower glucose levels at 24 hours and arterial recanalisation. © 2012 International Society on Thrombosis and Haemostasis.
Authors:
O Bill; P Zufferey; M Faouzi; P Michel
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-12
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  -     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 International Society on Thrombosis and Haemostasis.
Affiliation:
Neurology Service, Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
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