Relationship between sex and age characteristics, comorbid status, and dynamics of recovery in the acute period of stroke in patients living in the Arkhangelsk region

Abstract

BACKGROUND: The global burden of stroke continues to rise and is the third leading cause of disability worldwide. The factors that influence the dynamics of recovery and functional outcomes in the acute period of stroke remain not fully understood. AIM: To examine the relationship between sex–age characteristics, comorbid status, and dynamics of the functional state in the acute period of stroke in patients living in the Arkhangelsk region. MATERIALS AND METHODS: A retrospective cohort study was conducted. The sex–age structure of patients, functional status according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at hospital admission and discharge, and its dynamics during the hospitalization period were assessed. The relationship between FS and sex–age characteristics, stroke type, and concomitant diseases was analyzed. The dynamics of recovery were assessed using the rate of decline in NIHSS and mRs scores. RESULTS: The treatment results of 1,617 patients with stroke (male, n=968; female, n=649) mean age, 63.8±11.4 years) discharged from the neurological department in 2017–2020 were analyzed. Initially, more women experienced disability (p 0.001); however, their dynamics of recovery in the acute period of stroke were better than those of men. With increasing age, the rate of decline in the scores of the rating scales decreased. The best dynamics of recovery were observed in patients with atherothrombotic and lacunar types of stroke, and patients with cardioembolic stroke recovered the slowest. A high comorbidity burden was associated with poor functional outcomes. Independent associations were identified between the presence of atrial fibrillation, cerebral atherosclerosis, chronic heart failure, and a higher mRs score upon admission. At the time of discharge, atrial fibrillation, chronic heart failure, arterial hypertension, and coronary heart disease were independently associated with high mRs scores, and the presence of cerebral atherosclerosis was associated with lower mRs scores. CONCLUSION: Women recovered better, despite greater disability upon admission. Age and comorbidity burden served as reasons limiting the rate of recovery. Atrial fibrillation, chronic heart failure, coronary heart disease and arterial hypertension were the main comorbidities associated with worse functional outcomes at discharge. The results can be used to predict early functional outcomes in patients with stroke.