Correlation Analysis Between Comorbidity And Functional Recovery After Stroke In Middle-aged And Elderly Patients With Acute Ischemic Stroke

Objective:To analyze the correlation between the comorbidity of middle-aged patient with cerebral infarction and functional rehabilitation after apoplexy and define the influence factors of comorbidity on prognosis of cerebral infarction and their correlation,and discus the comorbidity state of the middle-aged patients with acute ischemic stroke and the relationship between NIHSS after hospital discharge for apoplexy and mRS three months later.Methods : 264 patients with acute ischemic stroke over 45 years old hospitalized in our neurology department from January 2016 to June 2018 were collected with foresight.Their clinical information,CIRS,comorbidity index,severity index,NIHSS of hospitalization and discharge,and improved Rankin scale three months later were collected.The relationship between comorbidity state of patients and functional recovery of apoplexy three months later was analyzed.Results:(1)Baseline information: the average age of 264 patients with cerebral infarction in the study was(68.66±10.70)years old,including 141 men and 123 women.There were 50 middle-aged patients in 45-60 years old and 214 patients ≥ 60 years old.The median score of admission NIHSS and discharge NIHSS were 6(4-11)and 3(1-8)respectively;the severity index was(0.67±0.36);the comorbidity index was(3.30±1.83);and the median score of CIRS was 9(6-13).The CIRS scores were as follows :0% of patients with score 0(0);83.33%(220)with score 1-14;10.986%(29)with score 15-18;and 5.681%(15)with score ≥19.The comorbidity of 264 patients with cerebral infarction and hypertension was 72.73%(192 cases),41.88%(98 cases)with diabetes,50.00% with coronary heart disease(132 cases),34.85% with atrial fibrillation(92 cases),and anxiety and depression.The total disease rate was 56.82%(150 cases),20.08%(53 cases)with pulmonary infection and 12.12%(32 cases)with epilepsy(2)For relevant parameters of patients and CIRS score hierarchy: The age of the medium and heavy patients had the significant difference with the mild patients(p=0.002).By comparing with different CIRS hierarchy,NIHSS as hospitalization,NIHSS as discharging and mRS three months later had the significant difference.The heavy group was significantly greater than the medium group and mild group(p<0.001).The comorbidity index and severity index in the medium group and heavy group were significantly higher than the mild group,showing the significant difference(p<0.001).(3)As discharging from the hospital,the factors of improvement: different CIRS score groups had the significant difference in the improvement rate.The improvement rate of CIRS core in the mild and medium groups was significantly higher than the heavy group(p=0.003).The improvement rate of different age groups had no statistical difference(p=0.476).The comorbidity index(p=0.49)and severity index(p=0.21)of the improvement group and non-improvement group had no statistical significance.(4)The comparison on the neural functional recovery three months later: the improvement rate of the mild and medium groups in CIRS was significantly higher than the heavy group(P<0.001).The improvement rate of different age groups also had the statistical difference(p=0.007).The comorbidity index and severity index in the group with good prognosis and poor prognosis had the significant difference(P<0.001).(5)Correlation analysis: CIRS,hypertension,auricular fibrillation,age,NIHSS as hospitalization,NIHSS as discharging,hospitalization time,comorbidity index,and severity index were significantly related to mRS of patients after three months of morbidity.Conclusions:(1)Comorbidity state of middle-aged patients with cerebral infarction had the close relationship with NIHSS after discharging for apoplexy and mRS three months later.(2)Patients with the small CIRS,younger age,as well as lower comorbidity index and severity index had the favorable prognosis.(3)CIRS,hypertension,auricular fibrillation,age,NIHSS as hospitalization,NIHSS as discharging,hospitalization time,comorbidity index,and severity index were related to mRS after three months of morbidity.The higher score showed the poorer prognosis.