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

Authors
  • Jang, Min Uk1
  • Kang, Jihoon2
  • Kim, Beom Joon2
  • Hong, Jeong Ho3
  • Yeo, Min Ju4
  • Han, Moon Ku2
  • Lee, Byung Chul1
  • Yu, Kyung Ho1
  • Oh, Mi Sun1
  • Choi, Kyung Chan1
  • Lee, Sang Hwa1
  • Hong, Keun Sik5
  • Cho, Yong Jin5
  • Park, Jong Moo6
  • Cha, Jae Kwan7
  • Kim, Dae Hyun7
  • Park, Tai Hwan8
  • Lee, Kyung Bok9
  • Lee, Soo Joo10
  • Lee, Jun11
  • And 7 more
  • 1 Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea. , (North Korea)
  • 2 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. , (North Korea)
  • 3 Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea. , (North Korea)
  • 4 Department of Neurology, Hankook General Hospital, Jeju, Korea. , (North Korea)
  • 5 Department of Neurology, Inje University, Ilsan Paik Hospital, Ilsan, Korea. , (North Korea)
  • 6 Department of Neurology, Eulji University, Eulji General Hospital, Seoul, Korea. , (North Korea)
  • 7 Department of Neurology, Dong-A University Hospital, Busan, Korea. , (North Korea)
  • 8 Department of Neurology, Seoul Medical Center, Seoul, Korea. , (North Korea)
  • 9 Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea. , (North Korea)
  • 10 Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea. , (North Korea)
  • 11 Department of Neurology, Yeungnam University Medical Center, Daegu, Korea. , (North Korea)
  • 12 Department of Neurology, Chonnam National University Hospital, Gwangju, Korea. , (North Korea)
  • 13 Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea. , (North Korea)
  • 14 Department of Neurology, Jeju National University Hospital, Jeju, Korea. , (North Korea)
  • 15 Department of Biostatistics, Korea University College of Medicine, Seoul, Korea. , (North Korea)
  • 16 Asan Medical Center, Clinical Research Center, Seoul, Korea. , (North Korea)
  • 17 Department of Translational Science and Molecular Medicine and Mercy Health Hauenstein Neurosciences, Michigan State University College of Human Medicine, Michigan, United States. , (United States)
  • 18 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. [email protected] , (North Korea)
Type
Published Article
Journal
Journal of Korean medical science
Publication Date
Sep 23, 2019
Volume
34
Issue
36
Identifiers
DOI: 10.3346/jkms.2019.34.e240
PMID: 31538419
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © 2019 The Korean Academy of Medical Sciences.

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