Identification of Prognostic Factors for Thrombolytic Therapy in Patients with Acute Stroke – Analysis of the SITS Registry

Czech version

Authors: M. Bar ¹; P. Kadlecová ²; D. Václavík ³; J. Neumann ⁴; O. Škoda ⁵; R. Mikulík ⁶
Authors‘ workplace: Neurologická klinika LF OU a Fakultní nemocnice Ostrava ¹; Mezinárodní centrum klinického výzkumu (ICRC), FN u sv. Anny v Brně ²; Neurologické oddělení, Iktové centrum Vítkovické nemocnice a. s., Ostrava ³; Neurologické oddělení, Krajská zdravotní, a. s. – Nemocnice Chomutov, o. z. ⁴; Neurologické oddělení, Nemocnice Jihlava a Neurologická klinika 3. LF UK a FN Královské Vinohrady, Praha ⁵; Mezinárodní centrum klinického výzkumu (ICRC), Neurologická klinika LF MU a FN u sv. Anny v Brně ⁶
Published in: Cesk Slov Neurol N 2012; 75/108(4): 426-431
Category: Original Paper

Overview

Determination of predictors of a favourable outcome in patients treated with thrombolytic therapy for acute stroke, analysis of the SITS (Safe Implementation of Treatments in Stroke) Registry.

Background:
Identification of predictors of a favourable outcome in stroke patients treated with thrombolysis might help in determining their prognosis and individualizing treatment. The aim of our study was to identify predictors of a favourable outcome in stroke patients treated with systemic thrombolysis.

Method:
We analyzed data entered in the SITS Registry (Safe Implementation of Treatments in Stroke) in the Czech Republic between February 2003 and February 2010. Univariate and multivariate regressive analyses were used to identify predictors of a favourable outcome as defined by the modified Rankin scale 0–1 at 3 months.

Results:
Overall in the Czech Republic, 3,053 patients were treated with intravenous thrombolysis. A total of 462 (15%) patients died and 1,308 (43%) achieved a favourable outcome. Symptomatic intracerebral haemorrhages (as per the SITS definition) were observed in 62 (2%) patients. Multivariate analyses identified the following characteristics to be significantly associated with a favourable outcome: age (10-year increments) – OR 0.90, 95% CI (0.83–0.97); systolic blood pressure (10 mmHg increments) – OR 0.92, 95% CI (0.88–0.97); stroke severity at baseline measured by NIHSS score (5-point increments) – OR 0.52, 95% CI (0.47–0.56); glucose (5 mmol/L increments) – OR 0.61, 95% CI (0.51–0.73) and diagnosis of embolic etiology of stroke (I63.4 according to the International Classification of Diseases) – OR 0.75, 95% CI (0.62–0.90).

Conclusion:
In our study, we identified several important prognostic predictors determining a clinical outcome of stroke patients treated with intravenous thrombolysis in the Czech Republic. Knowledge of these predictors allows clinicians to predict patient prognosis and manage risk factors.

Key words:
ischemic stroke – intravenous thrombolysis – predictors – outcome

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