Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy

Richard Leigh, Osama O. Zaidat, Muhammad F. Suri, Gwendolyn Lynch, Sophia Sundararajan, Jeffrey L. Sunshine, Robert Tarr, Warren Selman, Dennis Landis, Jose Suarez

Research output: Contribution to journalArticle

Abstract

Background and Purpose - Although long-term outcome determinants in acute ischemic stroke (AIS) patients have been defined, less is known about those predicting hyperacute worsening after thrombolytic therapy (TT). We investigated predictors of short-term clinical worsening (National Institutes of Health Stroke Scale [NIHSS] change ≥4 within 24 hours of admission). Methods - We studied 201 AIS patients who received TT within 6 hours of symptom onset. We determined baseline demographics, comorbidities, NIHSS at baseline and at 24 hours after TT, head computed tomography scan before and within 24 hours after TT, and angiographic recanalization in patients treated with intra-arterial (IA) thrombolysis. Significance of relationships was evaluated by t test or Wilcoxon signed rank sum test. Logistic regression model (LRM) was fitted to determine independence of significant variables. Results - Of 201 patients, 13% worsened, 39% improved, and 48% remained unchanged 24 hours after TT. Most patients (72%) received IA thrombolysis. Patients who deteriorated, compared with those who improved, were more likely to have complicating intracranial hemorrhage (ICH; P<0.001), absent recanalization (P=0.026), and higher blood glucose (BG; P=0.049). Hyperglycemia (>150 mg/dL) was greater in patients who worsened even in presence of recanalization (P=0.004, odds ratio [OR] 6.47). LRM showed that adjusted OR for increased risk of bad outcome and mortality for an increase of BG by 50 mg/dL is 1.56 and 1.38, respectively. Conclusions - Hyperglycemia and ICH are independent predictors of hyperacute worsening in AIS patients receiving TT. Although recanalization is the purpose of IA thrombolysis, its impact on clinical improvement may not be apparent without strict BG control.

Original languageEnglish (US)
Pages (from-to)1903-1907
Number of pages5
JournalStroke
Volume35
Issue number8
DOIs
StatePublished - Aug 1 2004
Externally publishedYes

Fingerprint

Thrombolytic Therapy
Stroke
Logistic Models
National Institutes of Health (U.S.)
Odds Ratio
Intracranial Hemorrhages
Nonparametric Statistics
Hyperglycemia
Comorbidity
Head
Tomography
Demography
Mortality

Keywords

  • Hyperglycemia
  • Intracerebral hemorrhage
  • Outcome
  • Stroke, ischemic
  • Thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy. / Leigh, Richard; Zaidat, Osama O.; Suri, Muhammad F.; Lynch, Gwendolyn; Sundararajan, Sophia; Sunshine, Jeffrey L.; Tarr, Robert; Selman, Warren; Landis, Dennis; Suarez, Jose.

In: Stroke, Vol. 35, No. 8, 01.08.2004, p. 1903-1907.

Research output: Contribution to journalArticle

Leigh, R, Zaidat, OO, Suri, MF, Lynch, G, Sundararajan, S, Sunshine, JL, Tarr, R, Selman, W, Landis, D & Suarez, J 2004, 'Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy', Stroke, vol. 35, no. 8, pp. 1903-1907. https://doi.org/10.1161/01.STR.0000132571.77987.4c
Leigh, Richard ; Zaidat, Osama O. ; Suri, Muhammad F. ; Lynch, Gwendolyn ; Sundararajan, Sophia ; Sunshine, Jeffrey L. ; Tarr, Robert ; Selman, Warren ; Landis, Dennis ; Suarez, Jose. / Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy. In: Stroke. 2004 ; Vol. 35, No. 8. pp. 1903-1907.
@article{d3f376e73c3c41d89a76e894e87fa6ed,
title = "Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy",
abstract = "Background and Purpose - Although long-term outcome determinants in acute ischemic stroke (AIS) patients have been defined, less is known about those predicting hyperacute worsening after thrombolytic therapy (TT). We investigated predictors of short-term clinical worsening (National Institutes of Health Stroke Scale [NIHSS] change ≥4 within 24 hours of admission). Methods - We studied 201 AIS patients who received TT within 6 hours of symptom onset. We determined baseline demographics, comorbidities, NIHSS at baseline and at 24 hours after TT, head computed tomography scan before and within 24 hours after TT, and angiographic recanalization in patients treated with intra-arterial (IA) thrombolysis. Significance of relationships was evaluated by t test or Wilcoxon signed rank sum test. Logistic regression model (LRM) was fitted to determine independence of significant variables. Results - Of 201 patients, 13{\%} worsened, 39{\%} improved, and 48{\%} remained unchanged 24 hours after TT. Most patients (72{\%}) received IA thrombolysis. Patients who deteriorated, compared with those who improved, were more likely to have complicating intracranial hemorrhage (ICH; P<0.001), absent recanalization (P=0.026), and higher blood glucose (BG; P=0.049). Hyperglycemia (>150 mg/dL) was greater in patients who worsened even in presence of recanalization (P=0.004, odds ratio [OR] 6.47). LRM showed that adjusted OR for increased risk of bad outcome and mortality for an increase of BG by 50 mg/dL is 1.56 and 1.38, respectively. Conclusions - Hyperglycemia and ICH are independent predictors of hyperacute worsening in AIS patients receiving TT. Although recanalization is the purpose of IA thrombolysis, its impact on clinical improvement may not be apparent without strict BG control.",
keywords = "Hyperglycemia, Intracerebral hemorrhage, Outcome, Stroke, ischemic, Thrombolysis",
author = "Richard Leigh and Zaidat, {Osama O.} and Suri, {Muhammad F.} and Gwendolyn Lynch and Sophia Sundararajan and Sunshine, {Jeffrey L.} and Robert Tarr and Warren Selman and Dennis Landis and Jose Suarez",
year = "2004",
month = "8",
day = "1",
doi = "10.1161/01.STR.0000132571.77987.4c",
language = "English (US)",
volume = "35",
pages = "1903--1907",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy

AU - Leigh, Richard

AU - Zaidat, Osama O.

AU - Suri, Muhammad F.

AU - Lynch, Gwendolyn

AU - Sundararajan, Sophia

AU - Sunshine, Jeffrey L.

AU - Tarr, Robert

AU - Selman, Warren

AU - Landis, Dennis

AU - Suarez, Jose

PY - 2004/8/1

Y1 - 2004/8/1

N2 - Background and Purpose - Although long-term outcome determinants in acute ischemic stroke (AIS) patients have been defined, less is known about those predicting hyperacute worsening after thrombolytic therapy (TT). We investigated predictors of short-term clinical worsening (National Institutes of Health Stroke Scale [NIHSS] change ≥4 within 24 hours of admission). Methods - We studied 201 AIS patients who received TT within 6 hours of symptom onset. We determined baseline demographics, comorbidities, NIHSS at baseline and at 24 hours after TT, head computed tomography scan before and within 24 hours after TT, and angiographic recanalization in patients treated with intra-arterial (IA) thrombolysis. Significance of relationships was evaluated by t test or Wilcoxon signed rank sum test. Logistic regression model (LRM) was fitted to determine independence of significant variables. Results - Of 201 patients, 13% worsened, 39% improved, and 48% remained unchanged 24 hours after TT. Most patients (72%) received IA thrombolysis. Patients who deteriorated, compared with those who improved, were more likely to have complicating intracranial hemorrhage (ICH; P<0.001), absent recanalization (P=0.026), and higher blood glucose (BG; P=0.049). Hyperglycemia (>150 mg/dL) was greater in patients who worsened even in presence of recanalization (P=0.004, odds ratio [OR] 6.47). LRM showed that adjusted OR for increased risk of bad outcome and mortality for an increase of BG by 50 mg/dL is 1.56 and 1.38, respectively. Conclusions - Hyperglycemia and ICH are independent predictors of hyperacute worsening in AIS patients receiving TT. Although recanalization is the purpose of IA thrombolysis, its impact on clinical improvement may not be apparent without strict BG control.

AB - Background and Purpose - Although long-term outcome determinants in acute ischemic stroke (AIS) patients have been defined, less is known about those predicting hyperacute worsening after thrombolytic therapy (TT). We investigated predictors of short-term clinical worsening (National Institutes of Health Stroke Scale [NIHSS] change ≥4 within 24 hours of admission). Methods - We studied 201 AIS patients who received TT within 6 hours of symptom onset. We determined baseline demographics, comorbidities, NIHSS at baseline and at 24 hours after TT, head computed tomography scan before and within 24 hours after TT, and angiographic recanalization in patients treated with intra-arterial (IA) thrombolysis. Significance of relationships was evaluated by t test or Wilcoxon signed rank sum test. Logistic regression model (LRM) was fitted to determine independence of significant variables. Results - Of 201 patients, 13% worsened, 39% improved, and 48% remained unchanged 24 hours after TT. Most patients (72%) received IA thrombolysis. Patients who deteriorated, compared with those who improved, were more likely to have complicating intracranial hemorrhage (ICH; P<0.001), absent recanalization (P=0.026), and higher blood glucose (BG; P=0.049). Hyperglycemia (>150 mg/dL) was greater in patients who worsened even in presence of recanalization (P=0.004, odds ratio [OR] 6.47). LRM showed that adjusted OR for increased risk of bad outcome and mortality for an increase of BG by 50 mg/dL is 1.56 and 1.38, respectively. Conclusions - Hyperglycemia and ICH are independent predictors of hyperacute worsening in AIS patients receiving TT. Although recanalization is the purpose of IA thrombolysis, its impact on clinical improvement may not be apparent without strict BG control.

KW - Hyperglycemia

KW - Intracerebral hemorrhage

KW - Outcome

KW - Stroke, ischemic

KW - Thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=3242791869&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=3242791869&partnerID=8YFLogxK

U2 - 10.1161/01.STR.0000132571.77987.4c

DO - 10.1161/01.STR.0000132571.77987.4c

M3 - Article

C2 - 15178819

AN - SCOPUS:3242791869

VL - 35

SP - 1903

EP - 1907

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 8

ER -