Stroke: high systolic blood pressure, carotid territory involvement and elevated blood sugar levels may increase risk of early deterioration.

Clinical bottom line (level 2b)

  1. More than a third of patients with acute thromboembolic ischaemic stroke deteriorated over the first 48 hours.
  2. Patients with acute thromboembolic ischaemic stroke may be at an increased risk of deterioration over the first 48 hours if they have a high systolic blood pressure at admission, carotid vascular territory involvement or elevated initial glycaemia.
  3. A fifth of patients with acute thromboembolic ischaemic stroke had died at 3 months.
Davalos et al: Neurology 1990; 40: 1865-1869
Expires December 2002

The study

Prospective cohort study with ?objective ?blinded outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, Spain

98 patients (aged , % male) acute thromboembolic ischaemic stroke

Excluded if
  • haemorrhagic infarction
  • TIA before first neurologic evaluation
  • initial neurologic evaluation not within 8 hours of symptom onset
  • no persistence of neurological deficit at entry
  • stupor or coma
  • ongoing or necessary anticoagulant treatment
  • abnormal CT scan
  • presence of neurologic sequale of a previous stroke
  • = 80 years old


    • Patients were treated for associated illnesses and received early rehabilitation. Neither heparin or vitamin K antagonists were given within the first week of the study. 5,000 units of sodium heparin subcutaneously was given prophylactically against pulmonary thromboembolism every 12 hours.

    Multivariate analysis was used to adjust for confounding factors.

    100% followed for 3 months
    Outcomes studied:
  • deterioration during the first 48 hours total Canadian Scale Score dropped 1 or more points
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    deterioration during the first 48 hours 3 months 40/98 40.8%
    (31.1% to 50.6%)
    death 3 months 19/98 19.4%
    (11.6% to 27.2%)

    • Independent predictors of deterioration at 48 hours were high systolic blood pressure at admission (regression coefficient 0.02); carotid vascular territory involvement (regression coefficient 0.78); elevated initial glycaemia (regression coefficient 0.01).

    Comments

    1. No odds ratios or relative risks were given for the independent prognostic factors.

    Citation

    1. Davalos A, Cendra E, Teruel J, et al: Deteriorating ischemic stroke: Risk factors and prognosis. Neurology 1990; 40: 1865-1869
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient ischaemic stroke
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome deterioration