Abstract
BackgroundSevere stroke patients have poor clinical outcome which may be associated with development of multiple organ dysfunction syndrome (MODS). Therefore, the aim of our study was to investigate independent risk factors for development of MODS in severe stroke patients.MethodsNinety seven severe stroke patients were prospective recruited from Jan 2011 to Jun 2015. The development of MODS was identified by Sequential Organ Failure Assessment (SOFA) score (score ≥ 3, at least two organs), which was assessed on day 1, 4, 7, 10 and 14 after admission. Baseline characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow coma score (GCS) and cerebral imaging parameters were collected at admission. Cox regression was performed to determine predictors for the development of MODS. Medical complications after admission and in-hospital mortality were also investigated.Results33 (34%) patients were in MODS group and 64 (66%) were in non-MODS group within 14 days after admission. Patients in MODS group had more smoker (51.5% vs 28.1%, p = 0.023), higher NIHSS score (23.48 ± 6.12 vs 19.81 ± 4.83, p = 0.004), higher APACHE II score (18.70 ± 5.18 vs 15.64 ± 4.36, p = 0.003) and lower GCS score (6.33 ± 2.48 vs 8.14 ± 2.73, p = 0.002). They also had higher rate of infarction in multi vascular territories (36.4% vs 10.9%, p = 0.003). The most common complication in all patients was pulmonary infection, while complication scores were comparable between two groups. Patients with MODS had higher in-hospital mortality (69.7% vs 9.4%, p = 0.000). In Cox regression, NIHSS score (RR = 1.084, 95% CI 1.019–1.153) and infarction in multi vascular territories (RR = 2.345 95% CI 1.105–4.978) were independent risk factors for development of MODS.ConclusionsIn acute phase of stroke, NIHSS score and infarction in multi vascular territories predicted MODS in severe stroke patients. Moreover, patients with MODS had higher in-hospital mortality, suggesting that early identification of MODS is critical important.
Highlights
Advances in prevention and treatment over the last two decades, stroke remains the major cause of disability and mortality worldwide
Severe stroke patients have poor clinical outcome which may be associated with development of multiple organ dysfunction syndrome (MODS)
The development of MODS was identified by Sequential Organ Failure Assessment (SOFA) score, which was assessed on day 1, 4, 7, 10 and 14 after admission
Summary
Advances in prevention and treatment over the last two decades, stroke remains the major cause of disability and mortality worldwide. Severe strokes account for 2%-12.7% of all ischemic strokes, and are associated with poor short-term and long-term outcome.[1, 2] They are usually termed as malignant middle cerebral artery infarctions (MI-MCA) if total MCA territory is infarcted.[3] The mortality of severe stroke patients is about 36.5% at discharge and 45% at one year follow-up.[2] Only 28% of severe stroke patients present with favorable outcome at 3 months after stroke (modified Rankin scale score of 3).[2] In addition, patients with severe stroke have a higher risk of neurological deterioration and requiring management in intensive care unit (ICU) because of focal edema with herniation and systemic complications, which could increase hospitalization costs.[4]. Severe stroke patients have poor clinical outcome which may be associated with development of multiple organ dysfunction syndrome (MODS). The aim of our study was to investigate independent risk factors for development of MODS in severe stroke patients.
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