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• Arq. Neuro-Psiquiatr. 52 (2) • June 1994 • https://doi.org/10.1590/S0004-282X1994000200004   copy

Clinical factors adversely affecting early outcome after brain infarction

Determinantes clínicos do risco de vida na fase aguda do infarto cerebral

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

PURPOSE AND METHODS: One-hundred-and-nine consecutive patients admitted during the acute phase of a CT-confirmed brain infarction (BI) were studied. Putative adverse influence of demographic and stroke risk factors, previous medical history, clinical presentation, initial and follow-up neurological examination, initial general evaluation, laboratory findings, chest X-ray and electrocardiographic findings, treatment, and topography and etiology of the ischemic insult was analysed. The end-point for assessment was early death (within 30 days). Statistical analysis was performed with univariate analysis and multiple regression. RESULTS: The main adverse factors related to an increased death risk during the first 30 days were, in decreasing order of importance: coma 48-72 hours after admission; stroke occuring in already hospitalized patients; Babinski sign on admission; minor degrees of impairment of consciousness 48-72 hours after admission; stroke related to large artery atherothrombosis and to embolism; a history of early impairment of consciousness; cardiac failure on admission. In 53 lucid patients on admission, only a history of congestive heart failure (CHF) was associated with a reduced survival rate. In 56 patients with impaired consciousness, the presence of a Babinski sign increased death risk, but the main factor predicting a high case-fatality rate was the persistence of consciousness disturbances after48-72 hours. CONCLUSIONS: The presence of impairment of consciousness, especially coma, 2-3 days after disease onset, and a history of CHF greatly increase the early case fatality rate in patients with acute BI presenting with or without consciousness disturbances at admission, respectively. The use of a prognostic algorythm considering these few variables seems to predict the approximate 30-day fatality rates.

cerebral infarction; coma; death; prognosis; insuficiência cardíaca

Foram estudados 109 pacientes internados na fase aguda do infarto encefálico. Foi investigada a possível influência prognostica adversa de diversos aspectos da história epidemiológica e médica, apresentação clínica, exame neurológico de admissão e seqüencial, exame clínico geral, exames radiológicos, laboratoriais e eletrocardiograma, tratamento, topografia e mecanismo etiopatogênico da lesão isquêmica sobre o risco de vida nos primeiros 30 dias de doença. Foram feitas análises estatísticas de univariância e regressão múltipla. RESULTADOS: Os primeiros fatores prognósticos adversos encontrados foram: coma 48-72 horas após a admissão; infarto intra-hospitalar; sinal de Babinski ao exame inicial; graus menores de depressão da consciência; infarto por aterotrombose de grandes vasos ou porembolização; história de alteração precoce da consciência; falência cardíaca à admissão. Em pacientes lúcidos à internação (53 casos), somente história de insuficiência cardíaca associou-se a aumento da mortalidade. Em 56 casos com alteração da consciência, a presença do sinal de Babinski aumentou o risco de vida, mas o principal fator adverso foi a persistência do distúrbio de consciência após 48-72 horas. CONCLUSÕES: A presença de depressão da consciência, em especial o coma, 2-3 dias após o início da doença, e história de insuficiência cardíaca aumentam grandemente o risco de vida na fase aguda do infarto cerebral. A utilização de um algoritmo prognóstico simples considerando estas variáveis torna mais objetiva a previsão do risco de vida após o infarto.

heart failure; infarto cerebral; coma; morte; prognóstico

Clinical factors adversely affecting early outcome after brain infarction

Determinantes clínicos do risco de vida na fase aguda do infarto cerebral

Charles André; Sérgio A. P. Novis

M.D. From the Department of Neurology, Hospital Universitário Clementino Fraga Filho (HUCFF), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro

SUMMARY

PURPOSE AND METHODS: One-hundred-and-nine consecutive patients admitted during the acute phase of a CT-confirmed brain infarction (BI) were studied. Putative adverse influence of demographic and stroke risk factors, previous medical history, clinical presentation, initial and follow-up neurological examination, initial general evaluation, laboratory findings, chest X-ray and electrocardiographic findings, treatment, and topography and etiology of the ischemic insult was analysed. The end-point for assessment was early death (within 30 days). Statistical analysis was performed with univariate analysis and multiple regression.

RESULTS: The main adverse factors related to an increased death risk during the first 30 days were, in decreasing order of importance: coma 48-72 hours after admission; stroke occuring in already hospitalized patients; Babinski sign on admission; minor degrees of impairment of consciousness 48-72 hours after admission; stroke related to large artery atherothrombosis and to embolism; a history of early impairment of consciousness; cardiac failure on admission. In 53 lucid patients on admission, only a history of congestive heart failure (CHF) was associated with a reduced survival rate. In 56 patients with impaired consciousness, the presence of a Babinski sign increased death risk, but the main factor predicting a high case-fatality rate was the persistence of consciousness disturbances after48-72 hours.

CONCLUSIONS: The presence of impairment of consciousness, especially coma, 2-3 days after disease onset, and a history of CHF greatly increase the early case fatality rate in patients with acute BI presenting with or without consciousness disturbances at admission, respectively. The use of a prognostic algorythm considering these few variables seems to predict the approximate 30-day fatality rates.

Key words: cerebral infarction, coma, death, heart failure (congestive), prognosis.

RESUMO

Foram estudados 109 pacientes internados na fase aguda do infarto encefálico. Foi investigada a possível influência prognostica adversa de diversos aspectos da história epidemiológica e médica, apresentação clínica, exame neurológico de admissão e seqüencial, exame clínico geral, exames radiológicos, laboratoriais e eletrocardiograma, tratamento, topografia e mecanismo etiopatogênico da lesão isquêmica sobre o risco de vida nos primeiros 30 dias de doença. Foram feitas análises estatísticas de univariância e regressão múltipla.

RESULTADOS: Os primeiros fatores prognósticos adversos encontrados foram: coma 48-72 horas após a admissão; infarto intra-hospitalar; sinal de Babinski ao exame inicial; graus menores de depressão da consciência; infarto por aterotrombose de grandes vasos ou porembolização; história de alteração precoce da consciência; falência cardíaca à admissão. Em pacientes lúcidos à internação (53 casos), somente história de insuficiência cardíaca associou-se a aumento da mortalidade. Em 56 casos com alteração da consciência, a presença do sinal de Babinski aumentou o risco de vida, mas o principal fator adverso foi a persistência do distúrbio de consciência após 48-72 horas.

CONCLUSÕES: A presença de depressão da consciência, em especial o coma, 2-3 dias após o início da doença, e história de insuficiência cardíaca aumentam grandemente o risco de vida na fase aguda do infarto cerebral. A utilização de um algoritmo prognóstico simples considerando estas variáveis torna mais objetiva a previsão do risco de vida após o infarto.

Palavras-chave: infarto cerebral, coma, morte, insuficiência cardíaca (congestiva), prognóstico.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aknowledgements - We wish to thank Drs. Ayrton R. Massaro and Maurice B. Vincent for critical review of the text.

Aceite: 7-outubro-1993.

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Publication Dates

  • Publication in this collection
    19 Jan 2011
  • Date of issue
    June 1994
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