Early neurological deterioration in acute ischemic stroke patients after intravenous thrombolysis with alteplase predicts poor 3-month functional prognosis - data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

Abstract

Background We aimed to investigate the risk factors of early neurological deterioration (END) after intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and the relationship between END and poor 3-month functional outcomes. Methods Patients who accepted intravenous recombinant rt-PA were enrolled continuously. END was defined as an increase in National Institute of Health Stroke (NIHSS) score ≥ 4 points or death within 24 hours after intravenous thrombolysis. The modified Rankin Scale (mRS) score was recorded to evaluate the functional outcome of stroke, and the poor 3-month prognosis was defined as an mRS score ≥ of 3. Univariate and multivariate analyses were used to analyze the risk factors of END. The relation between END and 3-month functional outcome was analyzed by multivariate logistic regression analysis. Results A total of 1107 patients (mean age, 63.42 ± 11.33 years; 673 males) were included in the final analysis, and 81(7.32%) patients had END. In multivariate analysis, the serum glucose level was significantly associated with END; the odds ratio was 1.10 (95% CI 1.03 to 1.18, p = 0.004). The multivariate logistic analysis showed END has a notable association with the poor 3-month functional recovery even after adjusting for confounding factors; the adjusted OR was 8.25 (95% CI 3.77 to 18.03, p < 0.0001). Conclusions The initial serum glucose level might be an independent risk factor of END, and END might predict a poor 3-month prognosis.

Risk factors for early neurologic deterioration in single small subcortical infarction without carrier artery stenosis: predictors at the early stage

“…In our study, patients with END, history of diabetes and NIHSS score at discharge are associated with poor functional outcome at 3-month follow-up. Patients suffered from END during the stroke course would have 8.22-fold increased risk of poor functional outcome, which is consistent with previous studies [ 4 , 25 , 42 – 44 ]. Diabetes is confirmed as an independent risk factor for ischemic stroke and may be associated with poor outcomes in previous studies [ 45 , 46 ].…”

Very early neurological deterioration after thrombolysis in patients with acute ischemic stroke

“…This study revealed that VEND had a significant detrimental impact on 3-month functional outcomes, in concordance with previous findings for END. 29,30 Of note, this study further revealed that VEND significantly predicted poor outcomes in both minor and non-minor stroke patients. A prior study showed that 12% of patients who received thrombolysis therapy for acute minor ischemic stroke due to large vessel occlusion developed ischemic END and 48% of the END occurred within 2 h, which was associated with worse 3-month functional outcomes even after rescue thrombectomy.…”

Prognostic nomogram for the outcomes in acute stroke patients with intravenous thrombolysis

“…They suggested that the accuracy of the nomogram needs to be improved. A recent study led by Wang yongjun group identified serum glucose level is an independent risk factor in the poor 3-month functional recovery in stroke patients with the univariate and multivariate logistic regression study ( Che et al, 2022 ). Mehta et al also used the logistic regression study to find DM, dyslipidemia, baseline NIHSS, random blood sugar, dense cerebral artery sign, age and glucose level on admission were predicting factors in poor outcome ( Mehta et al, 2017 ).…”