Potential risk factors predicting functional outcome and mortality at 90-day follow-up in patients with acute ischemic stroke receiving intravenous thrombolysis at Sanpasitthiprasong Hospital

Abstract

Background: Clinical outcomes of intravenous thrombolysis depend on various factors. Disability and death are the major unfavorable consequences after treatment. This is the first study conducted to evaluate the risk factors related to the outcomes at Sanpasithiprasong Hospital.
Objective: To examine predictors of disability and mortality in stroke patients who received intravenous thrombolysis at 90-day follow-up at a referral tertiary hospital.
Methods: In this retrospective cohort study, sociodemographic and clinical data of 306 stroke patients treated with recombinant tissue plasminogen (rt-PA/Alteplase) from January 2013 to December 2019 were obtained through medical record reviews. Outcomes included death and disability measured by the Modified Rankin Scale (MRS) at 90 days after intravenous thrombolysis treatment. Univariate and multivariate logistic regression was used to examine factors associated with mortality and outcome after 90 days.
Results: Favorable outcome had been observed 168 (54.9%), moderate unfavorable outcome was 72 (23.9%), unfavorable outcome was seen 85 (21.2%). Significant outcome prognostic factors according to multivariable regression analysis were NIHSS (OR 2.30, P-value=0.029, 95% CI: 1.091-4.840), Nicardipine use in high blood pressure (OR 2.55, P-value=0.013, 95% CI: 1.220-5.335), and intracerebral hemorrhage (ICH) (OR 3.5 P-value=0.018, 95% CI: 1.977-7.8). The predictive factors for the death were NIHSS (OR 18.75, P-value = 0.014, 95% CI: 1.799-195.385) and chronic renal failure (CRF) (OR 8.52, P-value=0.05, 95% CI: 1.815-89.125).
Conclusion: The NIHSS, high blood pressure with nicardipine use could be independent factors predictive outcome in stroke patients who had been treated with thrombolysis. Moreover, the high NIHSS on arrival and CRF possibly were the predictors for the death in similar setting patients. These factors should be evaluated and closely monitored.