Early neurological deterioration in patients with acute ischemic stroke: a prospective multicenter cohort study

Abstract

Background: There is still no precise knowledge of the causes of progression in patients with acute ischemic stroke (AIS), and we are unable to predict patients at risk. Objective: To explore the frequency, predictive factors, and the prognosis of early neurological deterioration (END) in patients with AIS Methods: In this prospective multicenter observational study, we assessed patients with AIS admitted to 18 hospitals in Henan, China. We defined END as an increase of ⩾2 points in total National Institutes of Health Stroke Scale (NIHSS) score or ⩾1 point in the motor items of the NIHSS within 7 days after admission. Risk factors were analyzed using multivariate logistic regression models. Prognosis was evaluated using the modified Rankin Scale (mRS), with poor prognosis defined as mRS 3–6. Results: A total of 9114 patients with AIS within 24 h of symptom onset were enrolled in the study. END occurred in 1286 (14.1%) patients. The highest incidence (62.5%) of END occurred within 24 h after admission. After adjusting potential confounders, age, body mass index, waist–hip ratio, systolic blood pressure, baseline NIHSS, disabled at baseline, history of atrial fibrillation, diabetes mellitus, intracranial arterial stenosis, infarct location in the lenticulostriate artery area and cerebral watershed, neutrophils, lymphocytes, uric acid, and triglycerides were identified as independent predictors for END. END was significantly associated with poor prognosis at 90 days, and the adjusted OR was 1.74 (95% CI: 1.53–1.97). Conclusion: One in seven hospitalized patients with AIS may experience END within 24 h of onset. The highest incidence of END occurred within 24 h of admission and decreased steeply with time. Easily identifiable risk factors predict END and could help understand the causal mechanisms and thereby prevent END.

Correlation of LP-PLA2 and MMP-9 with the occurrence of early neurological deterioration in patients with acute ischemic stroke

“…The results of this study also showed that a history of diabetes mellitus, baseline NIHSS score, and degree of carotid artery stenosis were associated with the development of END in patients with AIS, and that diabetes mellitus and baseline NIHSS level were independent risk factors for the development of END, which is consistent with previous studies. [27,28] Previous studies have confirmed that CRP and cardiogenic embolism may be risk factors for the development of END, but no significant difference was seen in the present results (P > .05), considering the following aspects. First, after the occurrence of AIS, ischemic brain injury site releases a large number of inflammatory mediators and chemokines, induces the production of CRP, and increases the endothelial permeability of blood vessels and destroys the blood-brain barrier through direct and indirect pathways, aggravating the injury of ischemic brain tissues, and the high and low levels of its indexes respond to the degree of inflammatory response, which plays an important role in the occurrence of atherosclerosis and AIS and the progression of the disease.…”

Machine Learning-based prediction of Early Neurological Deterioration after Thrombolysis in Acute Ischemic Stroke

“…Patients in this study were enrolled from a prospective, multi-center, web-based registry study (ChiCTR2100045258) from January 2021 to January 2022. 14 This registry study enrolled patients with acute ischemic stroke who were admitted to regional stroke centers. Throughout the entire study, information on patients demographics, treatments and prognosis is collected in a standardized manner, and the integrity of the data is monitored monthly by dedicated quality control staff.…”

Microalbuminuria as a Predictor of Early Neurological Deterioration and Poor Functional Outcomes in Acute Ischemic Stroke

“…Studies report a higher prevalence of microalbuminuria in ischemic stroke patients (14%-60%) compared to healthy individuals [ 3 ]. Early neurological deterioration (END), a significant worsening of neurological function within hours or days of a stroke, severely impacts patient outcomes [ 4 , 5 ]. Predictors of END include large infarct size, severe intracranial artery stenosis, specific lesion locations, high low-density lipoprotein cholesterol, and diabetes mellitus [ 6 , 7 ].…”