Functional predictor variables in the acute period of stroke in patients living in the Arctic macroregion: multivariate modeling findings

Abstract

BACKGROUND: Functional status at the onset of stroke is an important component that determines treatment and rehabilitation tactics.

AIM: To study the relationship between gender and age characteristics, type of stroke, comorbid status, travel time to the hospital and the severity of the functional state at the time of hospitalization in patients with stroke living in the Arkhangelsk region.

MATERIALS AND METHODS: The study included 5221 people in the acute period of stroke. In a retrospective longitudinal two-center study, factors influencing the patient’s functional status at the time of hospitalization were studied: gender, age, type of stroke, concomitant diseases, travel time to the hospital. Multivariate analyzes were performed on models assessing outcome by mean National Institutes of Health Stroke Scale (NIHSS) score as relative risk (RR) using Poisson regression; using median regression for NIHSS score; median regression for the modified Rankin scale (mRs) score.

RESULTS: With increasing age, the number of NIHSS scores increased, significantly in patients in groups over 70. The median mRs score was higher by 1.2 (95% CI: 0.60–1.81) in patients over 90 years of age relative to younger ones. In women, the average NIHSS score was 1.11 times higher relative to men (95% CI: 1.08–1.13), but the median mRs score was 0.2 lower (95% CI: 0.08–0.33). The mean NIHSS value in patients with hemorrhagic stroke was 1.3 times (95% CI: 1.24–1.34) higher than this indicator in patients with cardioembolic stroke, the median mRs score in patients with hemorrhagic stroke was 0.7 higher (95% CI: 0.46–1.04). As travel time increased, the mean NIHSS and median mRs scores decreased. Arterial hypertension increased the average NIHSS score by 1.16 times (95% CI: 1.09–1.23), obesity by 1.16 times (95% CI: 1.10–1.21), chronic heart failure in 1.13 times (95% CI: 1.10–1.16), chronic kidney disease by 1.12 times (95% CI: 1.09–1.16), cancer by 6% (95% CI: 1.01–1.10) and coronary heart disease by 3% (95% CI: 1.00–1.05). In the presence of diabetes mellitus, the mean NIHSS value decreased by 4% (95% CI: 1.01–1.06). When assessed by mRS, only the presence of chronic heart failure increased the median score by 0.2 (95% CI: 0.05–0.35).

CONCLUSION: The main predictors of the severity of the functional status at the time of hospitalization, which appeared in all models, were female gender, elderly and senile age, hemorrhagic stroke and chronic heart failure. The studied predictors are not the same in significance and degree of influence when assessing the outcome on different scales.

Keywords

stroke / predictors of functional status / multivariate analysis / Arctic macro-region

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