Risk factors for malignant middle cerebral artery infarction: a comparison of young and middle-aged and elderly patients

Abstract

Objective To investigate the risk factors for malignant middle cerebral artery infarction (MMI) in different age groups. Methods Patients with middle cerebral artery infarction were analyzed retrospectively. They were divided into a young and middle-aged group (<60 years) and an elderly group (≥60 years). The demography and vascular risk factors, stroke etiologies, baseline blood pressure, drug use before onset and common blood test results in patients with MMI and non-MMI were compared in general cases and each age group. Multivariate logistic regression analysis was used to determine the independent risk factors for MMI. Results A total of 912 patients with middle cerebral artery infarction were enrolled, including 299 females (32.79%) and 613 males (67.21%); 401 young and middle-aged patients (43.97%) and 511 elderly patients (56.03%); 159 patients in the MMI group (17.43%), and 753 (82.57%) in the non-MMI group. Multivariable logistic regression analysis showed that hypertension (odds ratio [OR]6.962, 95% confidence interval [CI]1.349-35.934; P=0.021) and NIHSS score (OR 1.551, 95% CI 1.384-1.737; P<0.001) were the independent risk factors for MMI. Subgroup analysis showed that NIHSS score (OR 1.402, 95% CI 1.239-1.588; P<0.001) was an independent risk factor for MMI in young and middle-aged patients; hypertension (OR 10.752, 95% CI 1.213-95.295; P=0.033), diastolic blood pressure (OR 1.080, 95% CI 1.002-1.164; P=0.044), and NIHSS score (OR 1.504, 95% CI 1.281-1.765; P<0.001) were the independent risk factor for MMI in the elderly patients, while systolic blood pressure (OR 0.938, 95% CI 0.893-0.986; P=0.011) was an independent protective factor. Conclusions The baseline NIHSS score was an independent risk factor for MMI in each age group. Hypertension and diastolic blood pressure were the independent risk factors for MMI in the elderly patients, while systolic pressure was an independent protective factor. Therefore, timely NIHSS assessment and appropriate hypertension management had important significance for the prevention and treatment of MMI. Key words: Stroke; Brain Ischemia; Infarction, Middle Cerebral Artery; Severity of Illness Index; Hypertension; Blood Pressure; Risk Factors; Age Factors