In:
Cerebrovascular Diseases Extra, S. Karger AG, Vol. 9, No. 3 ( 2019-11-22), p. 129-138
Abstract:
〈 b 〉 〈 i 〉 Background and Purpose: 〈 /i 〉 〈 /b 〉 Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; 〈 i 〉 p 〈 /i 〉 = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; 〈 i 〉 p 〈 /i 〉 = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). D-dimer (5.8 vs. 0.8 µg/mL; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001) and fibrinogen (532 vs. 430 mg/dL; 〈 i 〉 p 〈 /i 〉 = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS.
Type of Medium:
Online Resource
ISSN:
1664-5456
Language:
English
Publisher:
S. Karger AG
Publication Date:
2019
detail.hit.zdb_id:
2651613-5
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