Factors related to therapeutic outcomes of intravenous thrombolysis in stroke patients with different severity

Abstract

To investigate the factors related to therapeutic outcomes of intravenous thrombolysis in patients with acute ischemic stroke (AIS) of different severity. Clinical data of patients with AIS treated with intravenous thrombolysis in the Second Affiliated Hospital, Zhejiang University School of Medicine between June 2009 and December 2013 were retrospectively reviewed. According to National Institutes of Health Stroke Scale (NIHSS), patients were categorized as mild stroke (≤8, n=134), moderate stroke (9-15, n=121) and severe stroke(≥16, n=110). The good outcome was defined as modified Rankin Scale ≤ 2. The factors related to functional outcomes and hemorrhagic transformation (HT) were analyzed and compared among 3 groups. Among 365 enrolled patients, good outcomes in 3 groups were 78.4% (105/134), 47.9% (58/121) and 24.5%(27/110), respectively. In patients with mild stroke, age (OR=0.937, 95%CI: 0.898-0.978; P=0.003), baseline NIHSS (OR=0.732, 95%CI:0.564-0.950; P=0.019), onset to needle time (ONT) within 270 min (OR=4.109, 95%CI:1.441-11.719; P=0.008) independently predicted good outcome, while baseline glucose (OR=1.326, 95%CI:1.009-1.743; P=0.043) was independently associated with parenchymal hematoma (PH). In patients with moderate stroke, age (OR=0.954, 95%CI: 0.924-0.984; P=0.003) and baseline NIHSS (OR=0.760, 95%CI: 0.619-0.933; P=0.009) independently predicted good outcome, while atrial fibrillation (OR=3.307, 95%CI: 1.140~9.596; P=0.028) and systolic pressure (OR=0.967, 95%CI: 0.943~0.991; P=0.008) was independently associated with hemorrhagic infaction. Atrial fibrillation (OR=36.972, 95%CI: 1.770-772.462; P=0.02) was independently associated with PH. In patients with severe stroke, baseline NIHSS (OR=0.808, 95%CI:0.677-0.963; P=0.018) independently predicted good outcome, while no independent risk factors of HT was found. For different severity of AIS patients, the related factors of functional outcome and HT after thrombolysis were different.