Outcomes after Early Neurological Deterioration and Transitory Deterioration in Acute Ischemic Stroke Patients
Outcomes after Early Neurological Deterioration and Transitory Deterioration in Acute Ischemic Stroke Patients
复制标题
DOI：
10.1159/000447130
复制
发表时间：
2016-12-01
影响因子：
2.9
通讯作者：
Indredavik, Bent
中科院分区：
文献类型：
--
作者：
Helleberg, Bernt Harald;Ellekjaer, Hanne;Indredavik, Bent
背景与目的：早期神经功能恶化（END）发生在10-40%的急性缺血性卒中（AIS）患者中，并与更差的结局相关。最近治疗的改进可能降低了END的患病率。一个单一的早期控制或重复观察已被应用于检测END接近发生，以改善与END相关的不良结局，因为临床干预可能仍然有效。通过重复观察发现的恶化可能是暂时的或导致END。我们的目的是研究END和暂时性恶化（TD）后的结局。方法：对急性缺血性脑卒中患者从入院至72 h共进行12次斯堪的纳维亚卒中量表（SSS）评分。END定义为从入院至72 h任何关键SSS项目降低≥ 2分。早期恶化事件定义为72小时内两次连续评估之间的相似恶化，TD定义为无END患者的早期恶化事件。主要结局指标为90天时改良兰金量表测量的END和TD与稳定患者相比功能结局恶化（包括死亡）的比值比（OR）。结果：共纳入368例患者。13.9%有END，28.3%有TD。与稳定患者相比，两个恶化组在12周时的结局更差，OR为35.1死亡/依赖（95% CI 8.8-140）和5.8 END患者死亡的OR为2.3（95% CI 1.1-4.8），TD患者死亡的OR为1.9（95% CI 0.5-6.3）。与稳定患者相比，END患者的LOS延长了6.4天（p < 0.001），TD患者的LOS延长了1.1天（p = 0.014）。结论：我们发现END和更差的结局之间有很强的相关性，与稳定患者相比，TD甚至使死亡/依赖的OR增加了一倍。因此，通过频繁观察发现的早期恶化事件具有临床意义，此类频繁观察可能会检测到足够接近发生的恶化，以便应用潜在有效的治疗。(C)2016 S. Karger AG，巴塞尔
Background and Purpose: Early neurological deterioration (END) occurs in 10-40% of acute ischemic stroke (AIS) patients and has been associated with worse outcome. Recent improvements in treatment may have reduced the prevalence of END. A single early control or repeated observations have been applied to detect END close to occurrence, in order to improve the poor outcome associated with END, as clinical interventions may still be effective. Deterioration detected through repeated observations may be transitory or lead to END. Our aim was to study outcome after END and transitory deterioration (TD). Methods: In acute ischemic stroke patients, key Scandinavian Stroke Scale (SSS) items were scored 12 times from admission to 72 h. END was defined as >= 2 point decrease in any key SSS item from admission to 72 h. Early deterioration episode was defined as similar worsening between two consecutive assessments within 72 h, and TD as early deterioration episode in patients without END. Main outcome measures were odds ratios (OR) for worse functional outcome (including death) measured by modified Rankin scale at 90 days for END and TD compared with stable patients. Results: 368 patients were included. 13.9% had END and 28.3% had TD. Both deterioration groups were associated with worse outcome at 12 weeks compared with stable patients, with ORs of 35.1 (95% CI 8.8-140) for death/dependency and 5.8 (95% CI 1.8-19.4) for death in END patients and ORs of 2.3 (95% CI 1.1-4.8) for death/dependency and 1.9 (95% CI 0.5-6.3) for death in patients with TD. LOS increased by 6.4 days for END (p < 0.001) and 1.1 days for TD (p = 0.014) compared with stable patients. Conclusion: We found a strong association between END and worse outcome, and even TD doubled the OR for death/dependency compared to stable patients. Early deterioration episodes identified through frequent observations are therefore clinically significant and such frequent observations may detect worsening sufficiently close to occurrence for potentially effective treatment to be applied. (C) 2016 S. Karger AG, Basel