Neurological and medical complications in cerebral stroke patients before hospitalization and during admission to the clinic «oberig» stroke center
Objective ‒ to determine the rate of medical and neurological complications in patients with cerebral stroke (CS) before hospitalization and during in-patient treatment at the Stroke Center (SC), as well as to establish independent predictors for new medical complications at the SC, and to develop an appropriate prognostic model.
Materials and methods. The study enrolled 539 patients, 309 (57.3 %) were men and 230 (42.7 %) were women. The age of patients ranged from 20.4 to 95.6 (66.0 [57.9; 75.1]) years. 438 (81.3 %) patients were diagnosed with ischemic stroke (177 (40.4%) ‒ atherothrombotic subtype, 200 (45.7 %) ‒ cardioembolic, 30 (6.9 %) – lacunar, 32 (7.0 %) ‒ stroke of other established or undetermined etiology), 101 (18.7 %) ‒ intracerebral hemorrhage. 109 (20.2%) of the study participants were hospitalized in the hyperacute period, 113 (21.0 %) ‒ in the acute, 199 (36.9 %) ‒ in the early subacute, 36 (6.7 %) ‒ in the late subacute, 82 (15.2%) ‒ in the remote (chronic) period of CS. All patients were evaluated upon admission using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). The method of construction and analysis of logistic regression models was used to quantify the degree of influence of factor features on the risk of complications. The analysis was performed using the package MedCalc v. 19.1.
Results. The total NIHSS score on admission ranged from 0 to 39 (11 [6; 18]). Among the studied patients, 119 (22.1 %) had mild, 218 (40.5 %) – moderate, 114 (21.2 %) – severe, 88 (16.3 %) – very severe CS. Asesed with mRS upon admission, 11 (2.0 %) patients have 0 point, 34 (6.3 %) – 1 point, 58 (10.8 %) – 2 point, 65 (12.1 %) – 3 point,136 (25.2 %) – 4 point, and 235 (43.6 %) – 5 point. Neurological or medical complications before hospitalization occurred in 303 (56.2 %) patients, including 111 (20.6 %) patients with neurological complications and 192 (35.6 %) patients with medical ones. More than one complication was recorded in 52 (9.6 %) persons. The incidence of new neurological and medical complications during the SC stay was significantly lower (p<0.001) than before hospitalization. The independent predictors of new medical complications were CE subtype of IS (OR 2.08; 95 % CI 1.11–3.92), medical complications before admission (OR 2.58; 95 % CI 1.51–4.42), higher initial NIHSS score (OR 1.11; 95 % CI 1.06–1.16 for each additional point), and higher initial mRS (OR 1.62; 95 % CI 1.07–2.48, for each additional point). The predictive model based on the selected set of features has good sensitivity (86.4 %) and moderate specificity (68.4 %). The area under the operating characteristics curve AUC = 0.85 (95 % CI 0.82–0.88), indicates a strong relationship between this set of factorial factors and the risk of medical complications during in-patient treatment at the SC.
Conclusions. Before SC admission, complications, mainly medical, occurred in the majo-rity of the patients. A higher rate of medical complications associated with severe CS, greater dependency, older age, and a longer period from CS onset to SC admission. The incidence of complications at the SC was significantly lower than before the admission, which suggests the benefits of care at a Comprehensive Stroke Unit.
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