Age‐specific clinical characteristics and outcome in patients over 60 years old with large hemispheric infarction

Abstract

ObjectiveWe aimed to investigate age‐specific clinical characteristics in patients aged >60 years with large hemispheric infarction (LHI).MethodsWe prospectively enrolled consecutive patients with LHI. Patients were divided into two groups: ≤60 vs. >60 years, and demographics, vascular risk factors, clinical feature, in‐hospital treatment, 3‐month mortality, and unfavorable outcome (defined as a mRS score of 4–6) rate were compared.ResultsOf the 256 cases included, 140 (54.7%) were older than 60 years. Compared with the younger, the older patients had higher rates of hypertension (66.4% vs. 31.0%), coronary heart disease (19.3% vs. 2.6%), atrial fibrillation (53.6% vs. 31.0%; all p < 0.001), more history of stroke (21.4% vs. 5.2%, p < 0.001), less history of rheumatic heart disease (16.4% vs. 30.1%, p = 0.009), and alcohol consumption (12.1% vs. 21.6%, p = 0.043). Cardio‐embolism is the most common stroke etiology regardless of age (55.7% and 38.8%, respectively). Furthermore, the elderly less frequently received decompressive hemicraniectomy (4.3% vs. 15.5%, p = 0.005) and mechanical ventilation (7.9% vs. 16.4%, p = 0.035) and had a higher frequency of stroke‐related complication (83.6% vs. 66.4%, p = 0.001). A total of 26 (18.6%) older patients and 15 (12.9%) younger patients died during hospitalization (p = 0.221), and 59 (42.1%) older patients and 35 (30.2%) younger patients died at 3 months (p = 0.061). Patient aged >60 years had significantly higher unfavorable outcome rate at 3 months (adjusted odds ratio, OR 4.30, 95% confidence interval [CI] 2.08–8.88; p < 0.05]. However, older age is not independently associated with 3‐month mortality (42.1% vs. 30.2%, p = 0.095 [log‐rank test]).ConclusionsLarge hemispheric infarction patients over 60 years old were a little more than those aged ≤60 years and constitute more than half of those suffered from malignant brain edema and two thirds of in‐hospital death and 3‐month mortality. The elderly had more cardio‐origin risk factors, received less aggressive hospital treatment, and showed higher risk of unfavorable outcome than the younger.

Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome

“…Detailed methods for data collection were described in our previous study. 9,12 We collected baseline data including age, gender, living environment (rural or urban), admission delay, baseline systolic and diastolic blood pressure, and serum glucose on admission. Initial stroke severity was assessed by using the National Institutes of Health Stroke Scale (NIHSS) score.…”

“…Vascular risk factors surveyed in the present study included hypertension, diabetes mellitus, dyslipidemia, coronary heart disease, atrial fibrillation, rheumatic heart disease, previous stroke/transient ischemic attack (TIA), and current smoking and alcohol consumption, which have been elaborated upon in a previous study. 9,12 In-hospital treatments analyzed in our study included thrombolysis, DHC, mechanical ventilation, osmotic agents (such as mannitol), antiplatelet agents, anticoagulants, antihypertensives, statins, and antidiabetics. DHC was conducted according to the eligibility and exclusion criteria from the pooled analysis of three European randomized trials.…”