Kaohsiung Journal of Medical Sciences
Volume 24, Issue 4 , Pages 190-196, April 2008

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

  • Chien-Hsun Li

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Gim-Thean Khor

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Chun-Hung Chen

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Poyin Huang

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Ruey-Tay Lin

      Affiliations

    • Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Ruey-Tay Lin, Department of Neurology, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan

Received 7 May 2007; accepted 21 November 2007.

Article Outline

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 χ2 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.

Key Words:  hyperacute ischemic stroke , mortality , protective factor , risk factor , survival

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References 

  1. Brown RD , Whisnant JP , Sicks JD , et al.   Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989 . Stroke . 1996;27:373–380
  2. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group  . Tissue plasminogen activator for acute ischemic stroke . N Engl J Med . 1995;333:1581–1587
  3. Stroke Unit Trialists' Collaboration . Organized inpatient (stroke unit) care for stroke . Cochrane Database Syst Rev . 2000;2: CD000197
  4. Alberts MJ , Hademenos G , Latchaw RE , et al.   Recommendations for the establishment of primary stroke centers . JAMA . 2000;283:3102–3109
  5. Katzan IL , Furlan AJ , Lloyd LE , et al.   Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience . JAMA . 2000;283:1151–1158
  6. Heuschmann PU , Berger K , Misselwitz B , et al.   Frequency of thrombolytic therapy in patients with acute ischemic stroke and the risk of in-hospital mortality: the German Stroke Registers Study Group . Stroke . 2003;34:1106–1113
  7. Heuschmann PU , Kolominsky-Rabas PL , Roether J , et al.   Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy . JAMA . 2004;292:1831–1838
  8. Bateman BT , Schumacher HC , Boden-Albala B , et al.   Factors associated with in-hospital mortality after administration of thrombolysis in acute ischemic stroke patients: an analysis of the nationwide inpatient sample 1999 to 2002 . Stroke . 2006;37:440–446
  9. Dubinsky R , Lai SM . Mortality of stroke patients treated with thrombolysis: analysis of nationwide inpatient sample . Neurology . 2006;66:1742–1744
  10. Elkind MS , Prabhakaran S , Pittman J , et al.   Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke . Neurology . 2007;68:842–848
  11. Leslie AG , Johnston SC . Characteristics of academic medical centers and ischemic stroke outcomes . Stroke . 2001;32:2137–2142
  12. Heuschmann PU , Kolominsky-Rabas PL , Misselwitz B , et al.   Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group . Arch Intern Med . 2004;164:1761–1768
  13. Huang Poyin  , Chen CH , Liu CK , et al.   Eligibility for recombinant tissue plasminogen activator in acute ischemic stroke . Cerebrovasc Dis . 2006;22:423–428
  14. Wolf PA , D'Agostino RB , Belanger AJ , et al.   Probability of stroke: a risk profile from the Framingham study . Stroke . 1991;22:312–318
  15. Steiner MM , Brainin M . The quality of acute stroke units on a nation-wide level: the Austrian Stroke Registry for acute stroke units . European Journal of Neurology . 2003;10:353–360
  16. Anthony F , Randall H , Lawrence W , et al.   Intra-arterial prourokinase for acute ischemic stroke the PROACT II study: a randomized controlled trial . JAMA . 1999;282:2003–2011
  17. Akira O , Etsuro M , Kazuo M , et al.   Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke The Middle Cerebral Artery Embolism Local Fibrinolytic Intervention Trial (MELT) Japan . Stroke . 2007;38:2633–2639
  18. Sacco RL . Risk factors, outcomes, and stroke subtypes for ischemic stroke . Neurology . 1997;40:39–44
  19. Henon H , Durieu I , Lebert F , et al.   Influence of prestroke dementia on early and delayed mortality in stroke patients . J Neurol . 2003;250:10–16
  20. Weimar C , Ziegler A , Konig IR , et al.   Predicting functional outcome and survival after acute ischemic stroke . J Neurol . 2002;249:888–895
  21. Frankel MR , Morgenstern LB , Kwiatkowski T , et al.   Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial . Neurology . 2000;55:952–959
  22. Handschu R , Haslbeck M , Hartmann A , et al.   Mortality prediction in critical care for acute stroke: severity of illness-score or coma-scale . J Neurol . 2005;252:1249–1254
  23. Rordorf G , Koroshetz W , Efird JT , et al.   Predictors of mortality in stroke patients admitted to an intensive care unit . Crit Care Med . 2000;28:1301–1305
  24. Wong KS . Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: a prospective hospital-based study in Asia . Stroke . 1999;30:2326–2330
  25. Sumer MM , Ozdemir I , Tascilar N . Predictors of outcome after acute ischemic stroke . Acta Neurologica Scandinavica . 2003;107:276–280
  26. Holloway RG , Benesch CG , Burgin WS , et al.   Prognosis and decision making in severe stroke . JAMA . 2005;294:725–733

PII: S1607-551X(08)70116-5

doi:10.1016/S1607-551X(08)70116-5

Kaohsiung Journal of Medical Sciences
Volume 24, Issue 4 , Pages 190-196, April 2008

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