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A Szczudiik, A Słowik, W Turaj, G Zwolińska, U Wyrwicz-Petkow, K Kasprzyk, M Bosak
Med Sci Monit 2000; 6(1): CR75-80
INTRODUCTION: Prognostic factors following stroke remain to be established.The aim of this study was to determine early prognostic factors related with a 30-day mortality in firstepisode ischemic stroke patients. MATERIALS AND METHODS: The study group comprised 329 consecutive patients,aged between 33 and 99 years (mean age +/- SD 69 +/- 12.6) admitted within 24 hours following their firstsupratentorial ischemic stroke, confirmed either by computer tomography (CT) and/or autopsy. The followingdata were assessed within 24 hours of hospitalization: gender, age, history of diabetes mellitus, historyof ischemic heart disease, obesity, the neurological deficit at entry and after one day, level of consciousnessat entry and after one day, electrocardiographic dysrhythmia at entry, blood pressure at entry and bodytemperature on the first day following stroke. We also assessed particular serum biochemical and hematologicalmarkers including: hematocrit, fibrinogen concentration, platelet count, white blood cell (WBC) count,gamma globulin level, glucose level, cholesterol level, the erythrocyte sedimentation rate (ESR), andcreatinine kinase (CK) level. The end-point for assessment was early death (within 30 days). Statisticalanalysis consisted of univariate analysis and multiple regression. RESULTS: Univariate analysis demonstratedthat an older age, increased neurological deficit at entry and on the next day, decreased consciousnessat entry and on the next day, electrocardiographic dysrhythmia, increased body temperature and glucoselevel, decreased cholesterol level and increased CK level were significantly associated with death after30 days (p < or = 0.05). During multivariate analysis, only a severe neurological deficit (ScandinavianStroke Scale < or = 15 points) both at entry and on the next day (OR = 8.3; 95% CI: 2.83-24.35), decreasedconsciousness within the first 24 hours of hospitalization (OR = 19.2; 95% CI: 2.84-127.77) and electrocardiographicdysrhythmia (OR = 5.2; 95% CI: 2.37-13.77) were associated with death after 30 days. CONCLUSION: A severeneurological deficit lasting 24 hours, decreased consciousness within 24 hours of hospitalization andelectrocardiographic dysrhythmia are the most important indicators of 30-day mortality in patients withfirst-time ischemic stroke.