Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome

Tan, Chong-Tin; Zhao, Lili; Dai, Chengcheng; Liang, Yi; Liu, Huan; Zhong, Yuke; Liu, Guohui; Mo, Lijuan; Den, Fen; Liu, Xi; Chen, Lifen

doi:10.1177/17474930221145259

Cited by 8 publications

(3 citation statements)

References 35 publications

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“…In addition, the enrollment of people who developed END within 7 days after cerebral infarction. Importantly, consistent with earlier studies, END was strongly associated with adverse outcomes [21,22] . Univariate and multifactorial analyses in this study showed that baseline NIHSS, infectious events, and HALP scores were independent factors for the occurrence of END in elderly patients with AIS.…”

Section: Discussionsupporting

confidence: 89%

Clinical application of HALP score to predict early neurological deterioration in elderly acute cerebral infarction patients

Xie

Liang

et al. 2023

Preprint

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Background: Early neurological deterioration (END) may be associated with poor prognosis in elderly AIS patients. The objective of this study was to examine the relationship between a composite biomarker HALP score and END, to identify patients at risk for poor neurological function. METHODS: This study retrospectively examined elderly patients with AIS admitted to Nanjing Drum Tower Hospital from January 2016 to December 2021. NIHSS were collected within 7 days of admission. END was defined as a 2 point increase in NIHSS within 7 days.. the formula for HALP score was lymphocytes (/L) ×hemoglobin (g/L) ×albumin (g/L) / platelets (/L). Multivariate logistic regression was used to construct a prediction model for HALP score, ROC curves and calibration graphs were computed. Results: A total of 431 elderly AIS patients were included, with END accounting for 34.34%. Univariate analysis showed that age, baseline NIHSS score, white blood cell count, lymphocyte count, hemoglobin, triglycerides, HALP score, CRP, Hcy, Lp-PLA2, infectious events and death events differed between the two groups (P < 0.05). Multifactorial logistic regression analysis revealed that HALP score (OR 0.965, 95% CI 0.943 to 0.988, P=0.003) and baseline NIHSS score (OR 1.169, 95% CI 1.119 to 1.220, P<0.001) were good at predicting END. The area under the ROC curve for HALP score <27.69 and NIHSS score >5.5 was 0.727 (95CI: 0.676-0.778); 0.868 (95CI: 0.834-0.903), respectively, and the combined AUC was 0.883 (95%CI: 0.850-0.916). Additionally, HALP score was significantly negatively correlated with baseline NIHSS (r=-0.411, P<0.001) and admission day 7 NIHSS (r=-0.348, P<0.001), respectively. More often the lower HALP score, the higher END percentage and the worse 90-day functional outcomes. Conclusion: A low HALP score at admission is associated with the occurrence of END within one week in elderly AIS patients, which may help clinicians to identify high-risk END patients early.

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Section: Discussionsupporting

confidence: 89%

Clinical application of HALP score to predict early neurological deterioration in elderly acute cerebral infarction patients

Xie

Liang

et al. 2023

Preprint

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“…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 8.22fold increased risk of poor functional outcome, which is consistent with previous studies [4,25,[42][43][44]. Diabetes is confirmed as an independent risk factor for ischemic stroke and may be associated with poor outcomes in previous studies [45,46].…”

Section: Discussionsupporting

confidence: 88%

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

et al. 2023

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Objectives This study aimed to assess the epidemiological features and explore the potential risk factors for early neurological deterioration (END) in patients with acute single small subcortical infarction (SSSI) who underwent antiplatelet therapy without carotid artery stenosis. Materials & methods Patients with SSSI, as confirmed by cranial magnetic resonance imaging (MRI), who were hospitalized within 48 h after the onset of symptoms were enrolled. END was mainly defined as increment in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 2 points or any new neurological deficit. Poor functional outcome was defined as modified Rankin Scale (mRS) score of > 2 points at 3-month after the onset. The association of END with multiple indicators was assessed at the early stage of admission using multivariate logistic regression analysis, and adjusted odds ratios (aORs) were calculated. Results A total of 280 patients were enrolled from June 2020 to May 2021, of whom, END occurred in 44 (15.7%) patients (median age, 64 years; 70.5% male), while END occurred during sleep in 28 (63.6%) patients. History of hypertension (aOR: 4.82, p = 0.001), infarction in internal capsule (aOR: 3.35, p = 0.001), and elevated level of low-density lipoprotein cholesterol (LDL-C; aOR: 0.036, p = 0.0016) were significantly associated with the risk of END. Patients with END (aOR: 5.74, p = 0.002), history of diabetes (aOR: 2.61, p = 0.020), and higher NIHSS scores at discharge (per 1-score increase, aOR: 1.29, p = 0.026) were associated with the poor functional outcome at 3-month after the onset. Conclusion Patients with a history of hypertension, infarction in internal capsule or a higher level of LDL-C were found to be at a higher risk of END.

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“…This makes a paper by Tan et al 15 in this issue particularly relevant. They studied 638 lacunar stroke patients, 16.9% of whom developed END.…”

mentioning

confidence: 96%

The global burden of stroke

Markus¹

2023

International Journal of Stroke

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Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome

Cited by 8 publications

References 35 publications

Clinical application of HALP score to predict early neurological deterioration in elderly acute cerebral infarction patients

Clinical application of HALP score to predict early neurological deterioration in elderly acute cerebral infarction patients

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

The global burden of stroke

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