Association between the Severity of Acute Ischemic Stroke and its Complications after Hospitalization
Keywords:
Stroke, NIHSS, Complications, patients with pneumonia, Urinary Tract InfectionAbstract
Introduction: There are increasing trends of stroke and mortality. The cause of death in the acute phase is often associated with complications after hospitalization. Thus, the author aimed to study the relations between ischemic stroke severity (NIHSS) and the occurrence of complications following the hospitalization in order to improve the treatment systems and investigate risk factors of complications.
Methodology: Data including the baseline characteristics, NIHSS, risk factors, and complications, were collected from 180 stroke patients from October 2020 to June 2022; and analyzed to find out relations and risk factors between the two groups, complications and no complication by using Chi-square and Cox regression-robust analysis. to reflect the RR, and multivariate analysis was conducted to reflect adjusted RR and 95%CI with P-value<0.5. (P-value <0.5).
Result: 66 out of 180 patients developed complications (36.6%). The study found that the median NIHSS of the ‘complications’ group was 11 vs 3 higher than another group with RR 1.09 [95%CI,1.07-1.14], P-value <0.001. When comparing with the group of low NIHSS 0-4, moderate NIHSS 5-15, and severe NIHSS≥16, the study found that the risk increased with RR 3.06 [95%CI, 1.71-5.49], P-value <0.001 and RR 2.67 [95%CI, 1.98-3.60], P-value < 0.001 respectively. Moreover, the risk factors increased in female patients, who were aged over 60, on NG, on foley’s catheter and hospitalized for a long time. Furthermore, the study found that while Pneumonia was associated with male, DM, NG tube and long LOS. Retaining foley’s catheter was associated with Urinary Tract Infection (UTI). The incident of Pneumonia was 4.2% while the incidents of UTI and progressive stroke were 2.32% and 1.32%, respectively.
Conclusion: The NIHSS above its moderate NIHSS level poses a risk of complications after hospitalization, especially in females, aged over 60, on NG, and on foley’s catheter, including a long length of hospital stay.
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กรมควบคุมโรค. กรมควบคุมโรค รณรงค์วันวันอัมพาตโลก ปี 2564 ให้ประชาชน “รู้สัญญาณเตือน โรคหลอดเลือดสมอง เสี้ยวนาทีมีค่าช่วยชีวิต”[อินเตอร์เนต]. 2564 [เข้าถึงเมื่อ20 มิถุนายน 2565]. เข้าถึงได้จากhttps://ddc.moph.go.th/brc/news.php?news=21374&deptcode=brc
มูลนิธิเพื่อการพัฒนานโยบายสุขภาพระหว่างประเทศ สำนักงานพัฒนานโยบายสุขภาพระหว่างประเทศ. การสูญเสียปีสุขภาวะ Disability-Adjusted Life Years: DALYs รายงานภาระโรคและการบาดเจ็บของประชากรไทย พ.ศ. 2557. นนทบุรี: สำนักพิมพ์บริษัทเดอะกราฟิโกซิสเต็มส์จำกัด; 2557
Complications Increase Risk of Dying After Stroke. Emergency Medicine News 26(12):p 24, December 2004.
Bustamante A, Giralt D, García-Berrocoso T, Rubiera M, Álvarez-Sabín J, Molina C, Serena J, Montaner J. The impact of post-stroke complications on in-hospital mortality depends on stroke severity. Eur Stroke J. 2017 Mar;2(1):54-63. doi: 10.1177/2396987316681872. Epub 2016 Nov 28. PMID: 31008302; PMCID: PMC6453178.
Kogan E, Twyman K, Heap J, Milentijevic D, Lin JH, Alberts M. Assessing stroke severity using electronic health record data: a machine learning approach. BMC Med Inform DecisMak. 2020 Jan 8;20(1):8. doi: 10.1186/s12911-019-1010-x. PMID: 31914991; PMCID: PMC6950922.
Zöllner JP, Misselwitz B, Kaps M, Stein M, Konczalla J, Roth C, Krakow K, Steinmetz H, Rosenow F, Strzelczyk A. National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases. Sci Rep. 2020 Mar 2;10(1):3779. doi: 10.1038/s41598-020-60628-9. PMID: 32123219; PMCID: PMC7051974.
Boone M, Chillon JM, Garcia PY, Canaple S, Lamy C, Godefroy O, Bugnicourt JM. NIHSS and acute complications after anterior and posterior circulation strokes. TherClin Risk Manag. 2012;8:87-93. doi: 10.2147/TCRM.S28569. Epub 2012 Feb 27. PMID: 22399853; PMCID: PMC3295625.
Kuo YW, Huang YC, Lee M, Lee TH, Lee JD. Risk stratification model for post-stroke pneumonia in patients with acute ischemic stroke. Eur J CardiovascNurs. 2020 Aug;19(6):513-520. doi: 10.1177/1474515119889770. Epub 2019 Nov 16. PMID: 31735079.
Ding Y, Yan Y, Niu J, Zhang Y, Gu Z, Tang P, Liu Y. Braden scale for assessing pneumonia after acute ischaemic stroke. BMC Geriatr. 2019 Oct 7;19(1):259. doi: 10.1186/s12877-019-1269-x. PMID: 31590645; PMCID: PMC6781366.
Aslanyan S, Weir CJ, Diener HC, Kaste M, Lees KR; GAIN International Steering Committee and Investigators. Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial. Eur J Neurol. 2004 Jan;11(1):49-53. doi: 10.1046/j.1468-1331.2003.00749.x. PMID: 14692888.
Garavelli F, GhelfiAM, Kilstein JG. Usefulness of NIHSS score as a predictor of non-neurological in-hospital complications in stroke. Med Clin (Barc). 2021 Nov 12;157(9):434-437. English, Spanish. doi: 10.1016/j.medcli.2020.07.034. Epub 2020 Oct 14. PMID: 33069388.
กรมสนับสนุนบริการสุขภาพ. รายงานข้อมูลจังหวัดสิงห์บุรี[อินเตอร์เนต]. สิงห์บุรี:กรมสนับสนุนบริการสุขภาพ; 2565 [เข้าถึงข้อมูลเมื่อ 7 สิงหาคม 2565]. เข้าถึงได้จากhttps://3doctor.hss.moph.go.th/main/rp_ampur?region=4&prov=MTc=&provn=4Liq4Li04LiH4Lir4LmM4Lia4Li44Lij4Li1.
สมบัติ มุ่งทวีพงษา.โรคหลอดเลือดสมองและประสาทวิทยาวิกฤติ Cerebrovascular and Critical Care Neurology. ครั้งที่3. กรุงเทพฯ: สำนักพิมพ์มหาวิทยาลัยธรรมศาสตร์; 2565
Jose C Navarro, Ester Bitanga, Nijasri Suwanwela, Hui Meng Chang, Shan Jin Ryu, Yi Ning Huang. Complication of acute stroke: A study in ten Asian countries. Neurology Asia. 2008; 13 : 33 – 39
Leangpanich N, Chuphanitsakun Y, Pakaranodom K, Kerdjarern K, Poonual W. Scoring Of Post Stroke Pneumonia In Uttaradit Hospital. J Multidiscip Healthc. 2019 Nov 15;12:917-923. doi: 10.2147/JMDH.S218654. PMID: 31814729; PMCID: PMC6863128
Dharmasaroja PA, Charernboon T. Clinical Risk Score for Predicting Vascular Dementia after Ischemic Stroke in Thailand. Stroke Res Treat. 2022 Sep 26;2022:1600444. doi: 10.1155/2022/1600444. PMID: 36199625; PMCID: PMC9529475
Badve MS, Zhou Z, van de Beek D, Anderson CS, Hackett ML. Frequency of post-stroke pneumonia: Systematic review and meta-analysis of observational studies. Int J Stroke. 2019 Feb;14(2):125-136. doi: 10.1177/1747493018806196. Epub 2018 Oct 22. PMID: 30346258.
Wästfelt M, Cao Y, Ström JO. Predictors of post-stroke fever and infections: a systematic review and meta-analysis. BMC Neurol. 2018 Apr 23;18(1):49. doi: 10.1186/s12883-018-1046-z. PMID: 29685118; PMCID: PMC5913801.
Colbert JF, Traystman RJ, Poisson SN, Herson PS, Ginde AA. Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016 Oct;25(10):2399-404. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.008. Epub 2016 Jun 28. PMID: 27363622; PMCID: PMC5026915.
Poisson SN, Johnston SC, Josephson SA. Urinary tract infections complicating stroke: mechanisms, consequences, and possible solutions. Stroke. 2010 Apr;41(4):e180-4. doi: 10.1161/STROKEAHA.109.576413. Epub 2010 Feb 18. PMID: 20167905
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