Predictors of in-hospital mortality and dependence at discharge in patients with MCA stroke with intravenous thrombolysis.

Abstract

Early risk stratification of mortality and dependence is important for guiding medical decision-making in stroke care. The study aim is to evaluate whether there are any differences between risk factors for in-hospital mortality and dependence at discharge in patients with first-episode ischemic stroke in the middle cerebral artery (MCA) receiving intravenous thrombolysis (IVT) treatment. The study comprised a single-center cohort of patients admitted consecutively for first-episode MCA ischemic stroke. A logistic regression analysis was performed to determine the variables associated with in-hospital mortality and dependence at discharge. We included 169 patients (50.9% women) with a mean age of 64.1±12.9years and a median National Institute of Health Stroke Scale (NIHSS) score of 13 (range 3-26) at admission. Nineteen patients (11.2%) died as inpatients [the main cause of death was found to be infection (47.4%)]. The independent predictors for in-hospital mortality were: age (OR 1.09, 95% CI 1.03-1.15, p=0.004) and NIHSS score (>17) at admission (OR 1.17, 95% CI 1.05-1.30, p=0.004). Two other crude models used to analyze in-hospital mortality (age and symptoms-to-needle time, and age and symptomatic intracerebral hemorrhage) were significant. NIHSS score (>11) at admission (OR 1.29, 95% CI 1.17-1.42, p<0.001) and large artery atherosclerosis stroke (OR 3.10, 95% CI 1.10-8.76, p=0.031) were independently associated with dependence at discharge. Overall, the predictors for mortality and dependence in patients with first-episode MCA ischemic stroke treated with IVT were different. This knowledge might help to improve the management of this devastating disease.