Risk Factors Of Unfavorable Outcome After Intravenous Thrombolysis In Patients With Mild Ischemic Stroke

Background and objective:Currently,stroke is the main cause of death and disability,and about two-thirds of patients with acute ischemic stroke are found to have mild cerebral ischemia.Patients with mild stroke are often excluded from intravenous thrombolysis due to mild symptoms,in mild stroke patients treated with intravenous thrombolysis,about 30% have a poor prognosis.Therefore,in mild stroke patients receiving intravenous thrombolysis,it is of great significance to clarify the risk of adverse outcome to prevent the deterioration of neurological function,and to predict the prognosis of mild stroke patients.Currently,there is a lack of analysis on the related factors of adverse outcomes in mild ischemic stroke patients receiving intravenous thrombolysis.The purpose of this study was to elucidate the efficacy,safety,and outcome of mild ischemic stroke,and to explore the factors associated with early neurologic deterioration,poor prognosis,and hemorrhage transformation after intravenous thrombolysis.Methods:A retrospective analysis was performed on the clinical data of 191 patients who were diagnosed with mild ischemic stroke and received intravenous thrombolysis in the advanced stroke center unit of the first affiliated hospital of jilin university from May 2015 to July 2018.The subjects were divided into the early functional deterioration group(the NIHSS score within 3 days increased by 2 compared with the baseline NIHSS score)and the early functional non-deterioration group according to whether the early neurological functional impairment was worsened or not.According to the prognosis evaluation after intravenous thrombolysis,the quality of life of the patients followed up for 3 months was assessed by the modified Rankin scale(m RS),and the patients were divided into the m RS 0-1 point group with good prognosis and the m RS 2-6 point group with poor prognosis.According to the results of imaging examination,the patients were divided into the HT group and non-HT group after intravenous thrombolysis.Univariate t test or chi-square test and multivariate logistic regression analysis were used to describe the factors related to early deterioration of neurological function,poor prognosis and hemorrhage transformation.Rank sum test was used to compare baseline NIHSS score with 24-hour NIHSS score.Statistical analysis was performed by SPSS 22.0 statistical software,and P < 0.05 was considered statistically significant.Results:(1)Efficacy,safety and outcome of intravenous thrombolysis: Comparison between baseline NIHSS score and the mean of the 24-hour NIHSS score,the mean NHISS score 24 hours later was 2 points lower than that of the baseline NIHSS score(p < 0.001).Intravenous thrombolysis was effective in the overall patients.The rates of symptom improvement(NIHSS reduction > 1)at 4 h and 24 h after intravenous thrombolysis were 55.5% and 63.4%,respectively.The proportion of m RS 0-1 at 3 months was 68.6%,and the incidence of symptomatic intracranial hemorrhage was 1.6%.(2)Early neurologic deterioration factor analysis: single factor analysis found that in the early neurologic deterioration in the group,the baseline NIHSS score(3.59±0.99 VS 2.64±1.09,P<0.001)significantly higher than the other group,the history of coronary heart disease(34.1.4 % VS 19.3%,P = 0.044),hypertension disease(85.4% VS 61.3%,P = 0.005)is higher than the proportion of patients with another group,and the difference is statistically significant.Multivariate Logistic regression analysis showed that baseline NIHSS score(OR 2.243,95%CI 1.513-3.327,P < 0.001),history of coronary heart disease(OR 3.441,95%CI 1.087-10.891,P = 0.036)and history of hypertension(OR 3.091,95%CI 1.064-8.982,P = 0.038)were independent risk factors for early neurological deterioration.(3)factor analysis of poor prognosis: univariate analysis found that in the group with poor prognosis,the proportion of patients with baseline NIHSS score(3.15±1.23 VS 2.68±1.06,P=0.008)was significantly higher than that of the other group,as well as the history of hyperlipidemia(68.3% VS 51.1%,P = 0.026)was higher than that of the other group,and the difference was statistically significant.Multivariate Logistic regression analysis showed that baseline NIHSS score(OR 1.450,95%CI 1.070-1.965,P = 0.016)and history of hyperlipidemia(OR 2.182,95%CI 1.126-4.229,P = 0.021)were independent risk factors of poor prognosis.(4)hemorrhage transformation factor analysis: no risk factors or independent risk factors of the hemorrhage transformation after intravenous thrombolysis were found.Conclusions:Intravenous thrombolysis is safe and effective in patients with mild ischemic stroke;Baseline NIHSS score,history of coronary heart disease,and history of hypertension were independent predictors of early neurologic deterioration;Baseline NIHSS score and history of hyperlipidemia were independent predictors of poor prognosis.