Prognostic model of the minimal limitation in everyday life in patients with primary arterial hypertension in acute period of ischemic stroke

Abstract

Objective — investigation of independent prognostic factors of minimal dependence in everyday activities at the end of an acute period of ischemic stroke in patients with primary hypertension by developing of the prognostic mathematical model.Methods and subjects. The neurological and functional status of 150 patients with primary ischemic stroke and primary arterial hypertension in anamnesis was evaluated: 74 (49.3 %) women and 76 (50.7 %) men with mean age of 67.4 ± 0.7 years. Neurological deficit was evaluated by the NIHSS scale. The assessment of everyday life activity was provided by Bartel index. The cognitive status was evaluated by MMSE scale. Diagnosis of hypertension was based on the results of clinical, instrumental examination and medical documentation. We applied daily blood pressure monitoring from the moment of admission every 4 hours for 6 days of acute period. The mean value of SBP, DBP, the maximum values of SBP and DBP and the variability of BP were calculated by using of standard deviation (SD) evaluated for SBP and DBP. Statistical processing of the results was provided by the statistical analysis program of IBM SPSS Statistics 22.Results. On the 21st day the median of the Barthel index values was 75, the minimum value was 20, the maximum — 95, the first quartile — 55, the third quartile — 85 points, only 124 patients with moderate (86) and severe (38) neurological deficit degrees took part in the functional recovery prognostic predictors determining by BI. Of the 159 indicators that characterized the pathology and the results of an additional patient’s examination, 19 variables had a reliable correlation with the BI score on discharge and were selected and involved in logistic regression analysis. According to the step‑by‑step analysis, (13 steps), six independent prognostic factors were determined: the duration of hypertension (B coefficient = 0.22), the variability of systolic blood pressure (SD SBP) during first three days (B = –0.30), viability of diastolic blood pressure (SD DBP) during first three days (В = 0.48), sex (В = –2.46), ММSE in acute period (В = 0.44), higher education (В = 2.11). Constant — 6.76. The obtained model has sensitivity — 93.9 %, specificity — 86.5 % and a diagnostic accuracy of 90.1 %, an area under the ROC curve 0.95 (95 % CI: 0.94 — 0.99). The prognostic factors of minimal dependence in everyday activity at the end of acute period of moderate to severe and severe ischemic stroke were: duration of hypertension, systolic blood pressure and diastolic blood pressure variability during first three days of stroke, MMSE score and higher education.Conclusions. The main direction of therapeutic measures aimed at achieving the minimal functional dependence in the acute period of moderate and severe stroke should be to reduce the variability of both systolic and diastolic blood pressure, especially during first three days, accompanied with measures to improve cognitive status.