Factors associated with mortality rates in acute ischemic stroke patients after rt-PA administration in Saraburi hospital
Keywords:
acute stroke, stroke outcomes, mortality, risk factorAbstract
Ischemic stroke is a main Thai public health issue and leading cause of death in both men and women. The information on precise predictors of in-hospital stroke mortality is insufficient but often requested in clinical practice. Therefore, we aimed to study the significant factors that increasing mortality tPA given acute ischemic stroke patients. This was retrospective study using data from all patients that was diagnosed acute ischemic stroke and was given tPA admitted in Saraburi stroke unit between 2015 and 2021. All baseline characteristics and complications data were analyzed using univariate and multivariate binary logistic regression analysis to estimate crude and adjusted odds ratio (OR). Total 287 patients diagnosed with acute ischemic stroke were included in this analysis (52.9% older than 60 years, 55.3% men). The mortality rate at the stroke unit was 13% and median stay of deceased patients was 5 days. In non-survivor group the median NIHSS score was 17 higher than in NIHSS 10 in survivor group. Etiology of stroke by TOAST classification, 55.3% was cardio-embolic stroke followed by 34.2% large artery atherosclerosis, most common sites is MCA (81.6%). Main factors that increased risk of in-hospital death as following MCA with an OR of 6.10 (95%CI 6.10 –17.16), AOC with an ORs 4.89(95% CI 1.60-14.93), given IV antihypertensive before tPA with OR 3.89 (95%CI 1.50-10.11), also swollen dysfunction and gaze disturbance. Complications increased mortality as following pneumonia with OR 9.77 (95%CI4.49-21.27), intracranial hemorrhage with ORs 3.41 (95% CI 1.64-7.09), progressive stroke with an OR 7.75 (95%CI 3.24-18.51) brain herniation with ORs 16.33(95%CI 4.64-57.51), and arrythmia with an OR 4.34 (95%CI 2.14-8.82). These results might help physicians planning the care team management, recognizing the need for intensified monitoring and providing the information to help in the communication with family members or care-giver.
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