ตัวแปรพยากรณ์ผลลัพธ์ระยะยาวด้านความสามารถของผู้ป่วยโรคหลอดเลือดสมองในระยะเฉียบพลัน
ตัวแปรพยากรณ์ผลลัพธ์ระยะยาวด้านความสามารถของผู้ป่วยโรคหลอดเลือดสมองในระยะเฉียบพลัน
Keywords:
activities of daily living, functional outcome, long-term outcome, predictor, strokeAbstract
Objective: To evaluate long-term functional outcomes and predictive variables for good and poor functional outcomes in acute stroke patients.
Study design: A retrospective study.
Setting: Stroke ward and units, Maharat Nakhon Ratchasima Hospital.
Subjects: Stroke patients with acute stroke between January 1 and December 31, 2015.
Method: We recorded patients’ characteristic data: age, sex, premorbid status, diagnosis, comorbidities and complications, neurological examination, management, rehabilitation consultation, length of stay and functional level on admission using Barthel index (BI) score from electronic medical records. Long-term functional outcomes were evaluated with BI score at least 6 months after stroke onset by telephone interview and reviewing medical records. The predictors of long-term functional outcomes were determined with stepwise multiple logistic regression analysis.
Results: Nine hundred and seven patients were included in the present study. Of the 907 patients, 191 (21%) died during acute stroke admission, 117 (13%) died after and 210 (23%) were lost to follow-up and could not be contacted. There were 4 variables that were significantly correlated with good functional outcomes after multiple logistic regression analysis. Subjects aged < 55, Muscle power of the affected side grade > 2, normal consciousness and male gender had adjusted odds ratios of 11.46, 5.88, 5.15 and 3.88 respectively. Five variables that were correlated with poor functional outcomes were: muscle power grade 0-1, aged over 65, impaired consciousness, more than 3 comorbidities and admission BI score below 50. These resulted in adjusted odds ratios of 4.96, 4.85, 2.79, 2.33 and 2.13 respectively.
Conclusion: Long-term functional outcomes of stroke patients were associated with age, muscle power of the affected side, level of consciousness, gender, number of comorbidities and admission BI score.
References
Suwanwela NC. Stroke epidemiology in Thailand. J Stroke 2014; 16(1):1-7.
Suwanwele NC, Poungvarin N, the Asian Stroke Advisory Panel. Stroke burden and stroke care system in Asia. Neurol India 2016; 64:46-51.
Suksathien R. Accessibility to medical rehabilitation service for acute stroke at Maharat Nakhon Ratchasima Hospital: Related factors and outcomes. J Thai Rehabil Med 2014;24(2):37- 43.
Frankel MR, Morgenstern LB, Kwiakowski T, et al. Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial. Neurology 2000;55:952-9.
Saver JL, Altman H. Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset. Stroke 2012;43(6):1537-41.
Andersen KK, Andersen ZJ, Olsen TS. Predictors of early and late case-fetality in a nationwide Danish study of 26,818 patients with first-ever ishemic stroke. Stroke 2011:42:2806-12.
Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49(12):1373-9.
Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Md Med J 1965;14:56-61.
Korner-Bitensky N, Wood-Dauphinee S. Barthel index information elicited over the telephone. Is it reliable? Am J Phys Med Rehabil 1995;74(1):9-18.
Della Pietra GL, Savio K, Oddone E, Reggiani M, Monaco F, Leone MA. Validity and reliability of the Barthel index administered by telephone. Stroke 2011;42:2077-9.
Tangcharoen T, Vathesatogkit P, Wareesangthip K, Suwanwela NC, Deerochanawong C, Kunjara R, et al. A retrospective cohort of all-cause mortality in the Thai patients with established cardiovascular diseases. In preparation.
Andersen KK, Olsen TS, Dehlendorff C, Hammersgaard LP. Hemorrhagic and ischemic strokes compared stroke severity, mortality and risk factors. Stroke 2009;40:2068-72.
Chindaprasirt J, Sawanyawisuth K, Chattakul P, Limpawattana P, Tiamkao S, Aountri P, et al. Age predicts functional outcome in acute stroke patients with rt-PA treatment. ISRN Neurology 2013;
Andersen KK, Andersen ZJ, Olsen TS. Predictors of early and late case-fatality in a nationwide Danish study of 26 818 patients with first-ever ischemic stroke. Stroke 2011;42:2806-12.
Bagg S, Pombo AP, Hopman W. Effect of age on functional outcomes after stroke rehabilitation. Stroke 2002;33:179-85.
Ween JE, Alexander MP, D’Esposito M, Roberts M. Factors predictive of stroke outcome in a rehabilitation setting. Neurology 1996;47:388-92.
Kimberly WT, Lima FO, O’Connor S, Furie KL. Sex differences and hemoglobin levels in relation to stroke outcomes. Neurology 2013;80:719-24.
Niewada M, Kobayashi A, Sandercock PA, Kamiński B, Członkowska. A. A; International Stroke Trial Collaborative Group. Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the international stroke trial. Neuroepidemiology 2005;24:123-8.
Zhou G, Nie S, Dai L, Wang X, Fan W. Sex differences in stroke case fatality: a meta-analysis. Acta Neurol Scand 2013;128:1-8.
Varona JF, Bermejo F, Guerra JM, Molina JA. Long-term prognosis of ischemic stroke in young adults. J Neurol 2004;251:1507-14.
Saposnik G, Kapral MK, Liu Y, Hall R, O’Donnell M, Raptis S, et al. IScore: A risk score to predict death early after hospitalization for an acute ischemic stroke. Circulation 2011;123:739-49.
Bill O, Zufferey P, Faouzi M, Michel P. Sever stroke: patient profile and predictors of favorable outcome. J Thromb Haemost 2013;11:92-9.
