Abstract
This study aimed to explore the associations of piracetam use and the clinical characteristics of NIHSS (National Institute of Health Stroke Scale) changes—the importance of which, as prognosis related factors, was previously unnoticed—and analyze the associations of piracetem with NIHSS changes by stratifying clinical characteristics. This observational retrospective study was conducted by enrolling patients based on 2483 stroke registration data cohorts from a 1200-bed regional Tungs’ Taichung MetroHarbor Hospital, located in central Taiwan from 1 January 1 2011 to 31 December 2015. Patients were excluded if they had intravenous a thrombolytic agent within 3 hours of symptoms onset (n = 49), incomplete or erroneous NIHSS scores (n = 953), or transient ischemia stroke (n = 130). Logistic regression model was applied for associating piracetam treatment and clinical characteristics with NIHSS score changes between admission and discharge, and subgroup analysis to assess the conditions under which piracetam can be used. Multivariate analysis revealed NIHSS scores improvement in atrial fibrillation, large-artery atherosclerosis, underweight, current smoker, ex-smoker, and piracetam. Subgroup analysis showed piracetam is beneficial in the following: age ≥75 years olds, males, those of normal weight, those who are obese, ex-smokers, those with hypertension, dyslipidemia, those without diabetes mellitus, nor atrial fibrillation. The selection of the conditions under which piracetam treatment should be given, and clinical characteristics, is important for NIHSS improvement of ischemic stroke patients in Taiwan.
Highlights
Ischemic stroke is a major cause of death in developed countries, and the leading cause of long-term disability in survivors
Once acute ischemic stroke occurred, underweight, current smoker, ex-smoker, atrial fibrillation, and large-artery atherosclerosis were associated with National Institutes of Health Stroke Scale (NIHSS) improvement in addition to piracetam use, based on the multivariate analysis in this study. Another unique feature of this study demonstrated that piracetam is beneficial in the following: age ≥75 years old, male, normal weight or obese, ex-smoker, hypertension, dyslipidemia, no diabetes mellitus, and no atrial fibrillation by subgroup analysis
Even if patients do not meet above conditions, subgroup analysis reveals that piracetam may improve NIHSS score for ischemic stroke patients under the following conditions: age ≥75 years old, male, normal weight, obesity, ex-smoker, hypertension, no diabetes mellitus, dyslipidemia, or no atrial fibrillation
Summary
Ischemic stroke is a major cause of death in developed countries, and the leading cause of long-term disability in survivors. The Ministry of Health and Welfare of Taiwan reported cerebrovascular accidents as the fourth leading cause of death in 2017. A complex series of biochemical reactions occur which may lead to the death of brain cells. Two major types of therapeutic approaches to acute ischemic stroke have been raised [1]. Thrombolytics were suggested because they could act to restore cerebral blood flow. Current effective treatments for acute ischemic stroke are intravenous thrombolytic therapy within 4.5 h of onset and intra-arterial thrombectomy within 6 h of onset [2]. Neuroprotectants were suggested because they target cellular biochemical pathways to preserve brain function, enhance neuronal repair, and promote recovery. There is no conclusive evidence supporting the use of various other drugs claiming neuroprotective effects [2]
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