Factors associated with favorable outcomes in acute severe stroke patients: A real‑world, national database study

Kasemsap,Narongrit; Vorasoot,Nisa; Kongbunkiat,Kannikar; Tiamkao,Somsak; Boonsawat,Watchara; Sawanyawisuth,Kittisak

doi:10.3892/br.2022.1557

Factors associated with favorable outcomes in acute severe stroke patients: A real‑world, national database study

Authors:
- Narongrit Kasemsap
- Nisa Vorasoot
- Kannikar Kongbunkiat
- Somsak Tiamkao
- Watchara Boonsawat
- Kittisak Sawanyawisuth
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Affiliations: Department of Medicine and North‑Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Published online on: July 22, 2022 https://doi.org/10.3892/br.2022.1557
Article Number: 74
Copyright: © Kasemsap et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Thrombolytic therapy is useful in severe stroke, but it increases the risk of intracerebral hemorrhage. In addition, it may have limited use in resource‑limited due to a lack of trained neurologists and equipment to perform CT scans. There are limited data available from studies of national databases on stroke outcomes and predictors of severe stroke. This study, therefore, aimed to evaluate acute severe ischemic stroke outcomes in a real‑world setting. Additionally, predictors of favorable stroke outcomes were explored using a retrospective cohort. Data were extracted from the National Health Security Office (NHSO) in Thailand. The inclusion criteria were: Aged ≥18 years or older, diagnosis of acute severe ischemic stroke (defined by an admission National Institutes of Health Stroke Scale score of 15‑24), and available data on stroke outcomes. Outcomes were evaluated at discharge using a modified Rankin score at discharge. Factors associated with good outcomes were determined using multivariate logistic regression analysis. During the study period, 268 severe stroke patients met the inclusion criteria. Of those, 38 (14.18%) had good outcomes at discharge. A total of 223 patients received intravenous recombinant tissue plasminogen activator (83.21%). Of those, 38 (17.04%) had favorable outcomes. A predictive model for good outcomes revealed two independent factors: Male sex and atrial fibrillation with adjusted odds ratios (95% confidence interval) of 2.30 (1.10‑4.82) and 0.38 (0.16‑0.91), respectively. Predictors for good stroke outcomes in severe stroke patients included rtPA treatment, atrial fibrillation, and male sex.

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