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In-Hospital and Post-Discharge Recovery after Acute Ischemic Stroke: a Nationwide Multicenter Stroke Registry-base Study

Journal of Korean Medical Science 2019년 34권 36호 p.240 ~ 240
 ( Jang Min-Uk ) - Hallym University College of Medicine Department of Neurology

 ( Kang Ji-Hoon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
 ( Kim Beom-Joon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
 ( Hong Jeong-Ho ) - Keimyung University Dongsan Medical Center Department of Neurology
 ( Yeo Min-Ju ) - Hankook General Hospital Department of Neurology
 ( Han Moon-Ku ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology
 ( Lee Byung-Chul ) - Hallym University College of Medicine Department of Neurology
 ( Yu Kyung-Ho ) - Hallym University College of Medicine Department of Neurology
 ( Oh Mi-Sun ) - Hallym University College of Medicine Department of Neurology
 ( Choi Kyung-Chan ) - Hallym University College of Medicine Department of Neurology
 ( Lee Sang-Hwa ) - Hallym University College of Medicine Department of Neurology
 ( Hong Keun-Sik ) - Inje University Ilsan Paik Hospital Department of Neurology
 ( Cho Yong-Jin ) - Inje University Ilsan Paik Hospital Department of Neurology
 ( Park Jong-Moo ) - Eulji University Eulji General Hospital Department of Neurology
 ( Cha Jae-Kwan ) - Dong-A University Hospital Department of Neurology
 ( Kim Dae-Hyun ) - Dong-A University Hospital Department of Neurology
 ( Park Tai-Hwan ) - Seoul Medical Center Department of Neurology
 ( Lee Kyung-Bok ) - Soonchunhyang University College of Medicine Department of Neurology
 ( Lee Soo-Joo ) - Eulji University School of Medicine Eulji University Hospital Department of Neurology
 ( Lee Jun ) - Yeungnam University Medical Center Department of Neurology
 ( Kim Joon-Tae ) - Chonnam National University Hospital Department of Neurology
 ( Kim Dong-Eog ) - Dongguk University Ilsan Hospital Department of Neurology
 ( Choi Jay-Chol ) - Jeju National University Hospital Department of Neurology
이준영 ( Lee June-Young ) - Korea University college of Medicine Department of Biostatistics
 ( Lee Ji-Sung ) - Asan Medical Center Clinical Research Center
 ( Gorelick Philip B. ) - Michigan State University College of Human Medicine Department of Translational Science and Molecular Medicine
 ( Bae Hee-Joon ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurology

Abstract


Background: Using data from a large national stroke registry, we aimed to investigate the incidence and determinants of in-hospital and post-discharge recovery after acute ischemic stroke and the independence of their occurrence.

Methods: In-hospital recovery was defined as an improvement of 4 points or > 40% in the National Institutes of Health Stroke Scale (NIHSS) score from admission to discharge. Post-discharge recovery was defined as any improvement in the modified Rankin Scale (mRS) score from discharge to 3 months after stroke onset. Two analytic methods (multivariate and multivariable logistic regression) were applied to compare the effects of 18 known determinants of 3-month outcome and to verify whether in-hospital and post-discharge recovery occur independently.

Results: During 54 months, 11,088 patients with acute ischemic stroke meeting the eligibility criteria were identified. In-hospital and post-discharge recovery occurred in 36% and 33% of patients, respectively. Multivariate logistic regression with an equality test for odds ratios showed that 7 determinants (age, onset-to-admission time, NIHSS score at admission, blood glucose at admission, systolic blood pressure, smoking, recanalization therapy) had a differential effect on in-hospital and post-discharge recovery in the way of the opposite direction or of the same direction with different degree (all P values < 0.05). Both in-hospital and post-discharge recovery occurred in 12% of the study population and neither of them in 43%. The incidence of post-discharge recovery in those with in-hospital recovery was similar to that in those without (33.8% vs. 32.7%, respectively), but multivariable analysis showed that these 2 types of recovery occurred independently.

Conclusion: Our findings suggest that, in patients with acute ischemic stroke, in-hospital and post-discharge recovery may occur independently and largely in response to different factors.

키워드

Registries; Stroke; Brain Infarction: Recovery of Function; Prognosis
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