Predictors of short-term improvement of ischemic stroke

Objectives – Several studies have sought factors predictive of early neurological deterioration during acute stroke; however, no study carried out a systematic search for factors capable of predicting early improvement. This investigation is aimed at identifying the variables associated with short-term neurological improvement in patients with ischemic stroke not undergoing thrombolysis. Methods – Two-hundred and fifty-two patients with ischemic stroke were retrospectively examined (mean age 76.7±10.6 years, 120 males, median delay of admission 8 hours). Stroke severity was assessed both on admission and at discharge (median stay 4 days) by the National Institutes of Health Stroke Scale (NIHSS). Improvement was defined as a difference between initial and final assessment (NIHSS) >= the median value (2 points). Thus, 127 patients improved (mean change +3.8 points) and 125 did not (mean change -1.4 points). Results – During the first 48 hours of hospitalization 263 clinical, laboratory, instrumental and therapeutic variables were collected. These were preliminarily compared between two subgroups of patients, improved and non-improved, that were matched for initial NIHSS score, and 17 possible predictors of improvement were found. The subsequent multivariable analysis led to the identification of 4 factors independently associated with improvement [odds ratio, 95% confidence interval]: total anterior circulation syndrome (TACS) [0.20, 0.10-0.39, P<0.0001], aphasia [3.58, 1.89-6.77, P=0.0001], average systolic blood pressure [0.98 per mmHg, 0.96-0.99, P=0.002], and age [0.97 per year, 0.94-0.99, P=0.02]. Conclusions – The ischemic strokes that are not TACS, with aphasia, with normal/low blood pressure, or occurring in younger subjects, may have a significant tendency to short-term improvement.