Potential Risk and Protective Factors for In-Hospital Mortality in Hyperacute Ischemic Stroke Patients

超急性缺血性腦中風病患住院中死亡之潛在危險因子及保護因子

李建勳(Chien-Hsun Li) ； 許錦田(Gim-Thean Khor) ； 陳俊鴻(Chun-Hung Chen) ； 黃柏穎(Poyin Huang) ； 林瑞泰(Ruey-Tay Lin)

《The Kaohsiung Journal of Medical Sciences》 24卷4期 (2008/04) Pp. 190-196

摘要

In the era of thrombolytic therapy for hyperacute ischemic stroke, most investigators have focused their attention on the factors influencing mortality and functional outcomes in patients treated with thrombolysis, but very few have focused on these factors among patients not receiving thrombolysis. The aim of this study was to investigate the prognostic factors for mortality in all hyperacute stroke patients with or without thrombolysis. In 2005, we enrolled 101 ischemic stroke patients (43 females, 58 males; mean age, 68 years) who were transported to the emergency department (ED) within 4 hours of symptom onset. The overall in-hospital mortality rate was 17.8% (18/101). According to t test analysis, age (p=0.034), time interval from neurologist consultation (p＜0.0001) and ED to ward admission (p =0.001), Glasgow coma scale (GCS) (p=0.001), National Institutes of Health Stroke Scale (NIHSS) (p＜0.0001) and the sum of major risk factors of cerebrovascular disease (CVD) (p＜0.0001) were significantly different between mortality and survivor groups. Further x^2 test analysis revealed significant differences in the presenting consciousness disturbance (p=0.001), place of attack (p=0.04), and referral transportation (p=0.008) between these groups. In conclusion, old age, delay between neurologist consultation and ward admission, severity of stroke, and multiple risk factors of CVD are significant risk factors for in-hospital mortality. Conversely, being free of initial consciousness disturbance, living in an urban area, and having direct transportation to a stroke center are protective factors in survivors. The concept of ”brain attack” should be re-emphasized among ED physicians. The interconnection between stroke centers and emergency medical systems (EMS) should be more tightly built to promote timely management for hyperacute stroke care.

關鍵字

超急性缺血性腦中風 ； 死亡率 ； 保護因子 ； 危險因子 ； 存活者

並列摘要

In the era of thrombolytic therapy for hyperacute ischemic stroke, most investigators have focused their attention on the factors influencing mortality and functional outcomes in patients treated with thrombolysis, but very few have focused on these factors among patients not receiving thrombolysis. The aim of this study was to investigate the prognostic factors for mortality in all hyperacute stroke patients with or without thrombolysis. In 2005, we enrolled 101 ischemic stroke patients (43 females, 58 males; mean age, 68 years) who were transported to the emergency department (ED) within 4 hours of symptom onset. The overall in-hospital mortality rate was 17.8% (18/101). According to t test analysis, age (p=0.034), time interval from neurologist consultation (p＜0.0001) and ED to ward admission (p =0.001), Glasgow coma scale (GCS) (p=0.001), National Institutes of Health Stroke Scale (NIHSS) (p＜0.0001) and the sum of major risk factors of cerebrovascular disease (CVD) (p＜0.0001) were significantly different between mortality and survivor groups. Further x^2 test analysis revealed significant differences in the presenting consciousness disturbance (p=0.001), place of attack (p=0.04), and referral transportation (p=0.008) between these groups. In conclusion, old age, delay between neurologist consultation and ward admission, severity of stroke, and multiple risk factors of CVD are significant risk factors for in-hospital mortality. Conversely, being free of initial consciousness disturbance, living in an urban area, and having direct transportation to a stroke center are protective factors in survivors. The concept of ”brain attack” should be re-emphasized among ED physicians. The interconnection between stroke centers and emergency medical systems (EMS) should be more tightly built to promote timely management for hyperacute stroke care.

並列關鍵字

hyperacute ischemic stroke ； mortality ； protective factor ； risk factor ； survival