Predictors of fatal outcome in patients with acute ischemic stroke

Background. Acute stroke is one of the main causes of long-term disability and mortality. Hemorrhagic transformation (HT) is a severe complication of acute ischemic stroke (AIS), which may be fatal. Purpose – to analyze the risk factors of AIS with fatal outcome. Materials and Methods. 81 patients with AIS were examined at the neurological department of St. Panteleimon Hospital. The subjects were divided into 2 groups: group 1 – 57 patients with AIS; group 2 – 24 individuals with AIS who died. All individuals underwent examination, Glasgow Coma Scale, NIHSS (National Institutes of Health Stroke Scale), complete and biochemical blood tests, coagulogram, ECG and EchoCG. Head CT and ASPECTS (Alberta Stroke Program Early CT score) assessment were performed to determine the localization and extent of acute ischemic stroke. Results. All individuals were admitted with impaired consciousness and focal cerebral symptoms (hemiplegia, hemihypesthesia, aphasia, dysarthria, hemianopsia) depending on the area of the lesion. Heart rate (HR) was significantly higher in patients in group 2 (p = 0.006). Patients in group 2 had a more severe condition, reflected in a lower Glasgow Coma Scale score (p = 0.017). Hemorrhagic transformation was significantly more frequent in patients of group 2 (group 1 = 17.5%; group 2 – 54.2%; p = 0.008), which was observed in more than half of patients. Contrast-enhanced CT scans visualized hypodense areas without clear contours, heterogeneous due to hyperdense linear inclusions. CT angiography showed thromboses mainly in the basin of the left (group 1 – 36.8%; group 2 – 37.5%; p = 0.955) and right middle cerebral artery (group 1 – 36.8%; group 2 – 41.7%; p = 0.683). Evaluating on the ASPECTS scale, group 1 received 5.7 ± 3.4 points, while in group 2 – 6.6 ± 2.4 (p = 0.537). Conclusions. Hemorrhagic transformation is an independent risk factor that reduces the chances of survival in patients with AIS (group 1 = 17.5%; group 2 – 54.2%; p = 0.008). Significantly higher levels of glucose (p = 0.045), AST (p = 0.040), and sodium (p = 0.035) and higher HR (p = 0.006) were diagnosed in persons who died. The increase in these indicators in patients with AIS can be considered a predictor of adverse disease outcome.