Factors Associated with Clinical Outcomes of Acute Ischemic Stroke Patients at Phimai Hospital, Nakhon Ratchasima Province
Keywords:
Acute ischemic stroke, Clinical outcome, Thrombolytic therapy (rt-PA)Abstract
This study aimed to investigate factors associated with clinical outcomes of acute ischemic stroke. Methods: An analytical cross-sectional study using retrospective data collection was conducted among patients diagnosed with acute ischemic stroke from October 1, 2022, to September 30, 2023. A total of 613 patients were included in the analysis. Multivariate logistic regression analysis was performed at p-value <0.05, with results presented as adjusted odds ratios (adjusted OR) and 95% confidence intervals (95% CI).
Results: The mean age of patients was 65.68 years (S.D. = 13.46) The majority had hypertension 60.69% and were admitted through referral systems 55.63%. Only 26.26% of patients arrived at the hospital within 270 minutes, and merely 4.73% received thrombolytic therapy. Poor clinical outcomes (mRS >2) were observed in 23.82% of patient. Multivariate logistic analysis identified eight factors associated with poor clinical outcomes (mRS >2): Age >80 years (adjusted OR = 2.01, 95% CI: 1.00-4.05, p = 0.049) Hospital arrival beyond 270 minutes (adjusted OR = 2.18, 95% CI: 1.08-4.41, p = 0.031) Dysarthria (adjusted OR = 1.94, 95% CI: 1.12-3.39, p = 0.019) Motor weakness (adjusted OR = 3.33, 95% CI: 1.49-7.45, p <0.001) Non-minor stroke (adjusted OR = 14.41, 95% CI: 7.98-26.03, p <0.001) absence thrombolytic therapy (rt-PA) (adjusted OR = 3.52, 95% CI: 1.17-10.61, p = 0.026) In-hospital complications (adjusted OR = 2.87, 95% CI: 1.52-5.43, p = 0.001) and Hospital stay >3 days (adjusted OR = 5.13, 95% CI: 2.48-10.59, p <0.001)
Therefore, strengthen the referral system and Fast Track Stroke network is recommended to ensure timely hospital arrival and increase access to rt-PA therapy. Public awareness of stroke warning signs through the BEFAST mnemonic should be promoted for early recognition and prompt transfer. Furthermore, in-hospital care protocols should be improved to reduce complications and length of stay.
References
Li XY, Kong XM, Yang CH, Cheng ZF, Lv JJ, Guo H, et al. Global, regional, and national burden of ischemic stroke, 1990-2021: an analysis of data from the global burden of disease study 2021. EClinicalMedicine. 2024; 75: 102758.
Tiamkao S, Ienghong K, Cheung LW, Celebi I, Suzuki T, Apiratwarakul K. Stroke incidence, rate of thrombolytic therapy, mortality in Thailand from 2009 to 2021. Open Access Maced J Med Sci. 2022; 9(E): 110-5.
สำนักงานพัฒนานโยบายสุขภาพระหว่างประเทศ. รายงานภาระโรคและการบาดเจ็บของประชากรไทย พ.ศ. 2562. นนทบุรี: สำนักงานพัฒนานโยบายสุขภาพระหว่างประเทศ; 2566. หน้า 25-6.
Matsuo R, Yamaguchi Y, Matsushita T, Hata J, Kiyuna F, Fukuda K, et al. Association Between Onset-to-Door Time and Clinical Outcomes After Ischemic Stroke. Stroke. 2017; 48(11): 3049-56.
Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology. 2000; 55(11): 1649-55.
Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012; 379(9834): 2364-72.
Wannarong T, Chotik-Anuchit S, Nilanont Y. Factors associated with hospital arrival time in acute stroke. Journal of the Medical Association of Thailand. 2019; 102(5): 547-53.
Wongwiangjunt S, Komoltri C, Poungvarin N, Nilanont Y. Stroke awareness and factors influencing hospital arrival time: a prospective observational study. J Med Assoc Thai. 2015; 98(3): 260-4.
Nilanont Y, Nidhinandana S, Suwanwela NC, Hanchaiphiboolkul S, Pimpak T, Tatsanavivat P, et al. Quality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study. J Stroke Cerebrovasc Dis. 2014; 23(2): 213-9.
Ratanakorn D, Keandoungchun J, Sittichanbuncha Y, Laothamatas J, Tegeler CH. Stroke fast track reduces time delay to neuroimaging and increases use of thrombolysis in an academic medical center in Thailand. J Neuroimaging. 2012; 22(1): 53-7.
สมศักดิ์ เทียมเก่า. 13 ปี เส้นทางการเรียนรู้และพัฒนา Stroke Fast Track ของประเทศไทย. วารสารวิจัยระบบสาธารณสุข. 2566; 17(1): 191-9.
Vorasoot N, Kasemsap N, Kongbunkiat K, Peansukwech U, Tiamkao S, Sawanyawisuth K. Impact of Hospital Level on Stroke Outcomes in the Thrombolytic Therapy Era in Northeast Thailand: A Retrospective Study. Neurol Ther. 2021; 10(2): 727-37.
Jantasri S, Tiamkao S, Sirikarn P. Effectiveness of Intravenous Recombinant Tissue Plasminogen Activator (rtPA) for Acute Ischemic Stroke in Udonthani Hospital versus Node-rtPA Community Hospitals. Thai Journal of Neurology. 2020; 36(4): 34-57.
Torres-Aguila NP, Carrera C, Muiño E, Cullell N, Cárcel-Márquez J, Gallego-Fabrega C, et al. Clinical Variables and Genetic Risk Factors Associated with the Acute Outcome of Ischemic Stroke: A Systematic Review. J Stroke. 2019; 21(3): 276-89.
Hsieh FY, Bloch DA, Larsen MD. A simple method of sample size calculation for linear and logistic regression. Stat Med. 1998; 17(14): 1623-34.
Hu M, Zhu Y, Chen Z, Li W, Li L, Li Y, et al. Relationship between mean blood pressure during hospitalization and clinical outcome after acute ischemic stroke. BMC Neurol. 2023; 23(1): 156.
Gao X, Zhang J, Peng Y, Fan H, Chen M, Xu T, et al. Admission clinical characteristics and early clinical outcomes among acute ischemic stroke patients. J Biomed Res. 2012; 26(3): 152-8.
Al Alawi AM, Al Busaidi I, Al Shibli E, Al-Senaidi AR, Al Manwari S, Al Busaidi I, et al. Health outcomes after acute ischemic stroke:retrospective and survival analysis from Oman. Ann Saudi Med. 2022; 42(4): 269-75.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): e344-e418.
Strambo D, Zambon AA, Roveri L, Giacalone G, Di Maggio G, Peruzzotti-Jametti L, et al. Defining minor symptoms in acute ischemic stroke. Cerebrovasc Dis. 2015; 39(3-4): 209-15.
Lee EJ, Kim SJ, Bae J, Lee EJ, Kwon OD, Jeong HY, et al. Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke. PLoS One. 2021; 16(3): e0247829.
Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology. 2021; 20(10): 795-820.
Hanchaiphiboolkul S, Poungvarin N, Nidhinandana S, Suwanwela NC, Puthkhao P, Towanabut S, et al. Prevalence of stroke and stroke risk factors in Thailand: Thai Epidemiologic Stroke (TES) Study. Journal of the Medical Association of Thailand. 2011; 94(4): 427.
Songsrichainun P, Tiamkao S. Incidence, Mortality Rate and Rate of Thrombolytic Therapy of Acute Stroke in Northeastern Thailand from 2017-2022. Journal of the Medical Association of Thailand. 2024; 107(1): S16-S23.
Barlas RS, Clark AB, Bettencourt-Silva JH, Sawanyawisuth K, Kongbunkiat K, Kasemsap N, et al. Pneumonia and Risk of Serious Adverse Outcomes in Hospitalized Strokes in Thailand. J Stroke Cerebrovasc Dis. 2019; 28(6): 1448-54.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Journal of Health Science and Community Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของวารสารวิทยาศาสตร์สุขภาพและการสาธารณสุขชุมชน (Journal of Health Science and Community Public Health)
ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับวิทยาลัยการสาธารณสุขสิรินธรจังหวัดขอนแก่น และคณาจารย์ท่านอื่นๆในวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใดๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
