Investigation on pathogenesis and influencing factors of poor outcome in patients with wake-up stroke

Abstract

Objective To explore pathogenesis and influencing factors of poor outcome in patients with wake-up stroke. Methods In this prospective study, patients with acute ischemic stroke who were hospitalized in the Department of Neurology of the Second Affiliated Hospital of Xuzhou Medical University from October 2016 to December 2017 were continuously collected. All patients were divided into wake-up stroke group and non-wake-up stroke group according to the onset time. The clinical data of demographics, vascular risk factors, imaging examination, laboratory examination of the two groups were collected to identify the pathogenesis of wake-up stroke. Followed up to six months of onset, the patients were divided into poor outcome (modified Rankin Scale (mRS) score >2) and good outcome (mRS score 0-2) subgroups according to mRS score. Multivariate Logistic regression analysis was used to determine the influencing factors of poor outcome in patients with wake-up stroke. Results A total of 178 patients with acute ischemic stroke were enrolled in the study, including 42 patients (23.60%) in the wake-up stroke group and 136 patients (76.40%) in the non-wake-up stroke group. Followed up to six months of onset, 11 patients lost, and 167 patients were followed up finally. There were 40 patients (23.95%) in the wake-up stroke group, including 17 patients (42.50%) with poor outcome and 23 patients (57.50%) with good outcome. There were 127 patients (45.64%) in the non-wake-up stroke group, including 32 patients (25.20%) with poor outcome and 95 patients (74.80%) with good outcome. The difference of poor outcome between the two groups was statistically significant (χ2=4.393, P=0.036). Comparison of the demographic and baseline data of the wake-up stroke group and the non-wake-up stroke group showed that the differences between variables such as atrial fibrillation and double-dose hypertension were statistically significant. Univariate analysis showed that there were statistically significant differences in vascular risk factors, Trial of Org 10172 in Acute Stroke Treatment etiology, stroke severity, number of stroke lesions, treatment patterns, and number of cerebral microbleeds between the poor and good outcome subgroups. Multivariate Logistic regression analysis showed that the moderate to severe stroke (odds ratio (OR)=3.838, 95% confidence interval (CI) 2.162-5.890, P=0.018), the number of lesions in cerebral microbleeds (OR=2.113, 95%CI 1.291-2.868, P=0.049) were independent risk factors for poor outcome of wake-up stroke. Intravenous thrombolysis (OR=0.427, 95%CI 0.242-0.615, P=0.036) was an independent protective factor for poor outcome of wake-up stroke. Conclusions The onset of wake-up stroke is closely related to atrial fibrillation and reverse scoop hypertension with higher incidence of poor outcome. Early adequate imaging screening and stroke severity assessment have important reference to guide clinical treatment and predict outcome. Key words: Stroke; Pathogenesis; Outcome; Influencing factors