Association Of Syndrome Factors With Disease Prognosis In Acute Ischemic Stroke

ObjectivePrevious studies have suggested that the functional outcome of stroke patients may be related to syndrome factors.However,due to different specific populations and different regions,current researches have shown inconsistent results on this topic.The aim of this study was to disclose the association of syndrome factors with disease prognosis in patients with ischemic stroke,to explore the factors affecting the prognosis and try to reveal the relationship between different syndrome elements and key variables affecting prognosis of acute ischemic stroke.MethodsIt was a prospective,observational study,conducted in the Department of neurology of the Second Clinical College of Guangzhou University of Chinese Medicine(the Second Affiliated Hospital of Guangzhou University of Chinese Medicine)from June 2019 to September 2019.Patients with acute ischaemic stroke(within 14 days of onset)were eligible.Information such as syndrome factors defined by the Diagnostic Scale of Syndrome Factors of Ischemic Stroke,initial neurological status assessed by the national Institutes of Health Stroke Scale(NHISS),stroke classification(major stroke/minor stroke)according to the Boston Acute Stroke Imaging Scale(BASIS)and other baseline data were collected.The prognosis of patients at 90 days was collected by telephone follow-up.Poor outcome was defined as modified Rankin Scale(mRS)score>2.An information database of follow-up patients was established and the relationship between different syndrome factors and prognosis was analyzed by unconditional stepwise Logistic regression.ResulisA total of 193 acute ischemic stroke patients were enrolled in our study and 9 patients lost follow-up.Of the 184 patients with available follow-up data,poor outcome of neurological function(mRS>2)occured in 34.78%(n=64)patients,65.22%(n=120)patients had good prognosis.The main syndromes factors of acute stage ischemic stroke are phlegm-dampness,blood stasis,deficiency of qi and endogenous fire.Univariate and multivariate analysis showed that poor outcome was associated with endogenous wind(P<0.05).Patients with endogenous wind are 2.69 times more likely to have a poor outcome than patients without endogenous wind(OR=2.69,95%CI:1.15-6.30).In stratified analysis,the association of poor outcome with endogenous wind retained statistical significance just in patients with acute ischaemic stroke over 48 hours of onset.Multivariate analysis also showed that poor outcome was also associated with older age(P<0.05),higher NHISS(P<0.05),more severe stroke classification defined by BASIS(P<0.05).Furthermore,we found that endogenous fire and phlegm-dampness were associciated with higher NHISS(P<0.05),and phlegm-dampness was also associated with more severe stroke classification defined by BASIS(P<0.05).ConclusionEndogenous wind syndrome in acute phase of ischemic stroke was associated with a poor outcome within 90 days,especially for patients with a long endogenous wind duration.Older age,higher NHISS score and more severe BASIS classification were also the risk factors of poor outcome.Endogenous fire and phlegm-dampness were associated with higher NHISS,and phlegm-dampness was also associated with more severe stroke classification defined by BASIS.It is suggested that endogenous fire and phlegm-dampness may have potential connection with these factors and affect the prognosis of ischemic stroke synergistically.