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J Korean Med Sci. 2019 Sep 23;34(36):e240. doi: 10.3346/jkms.2019.34.e240.

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

Author information

1
Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea.
2
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
3
Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
4
Department of Neurology, Hankook General Hospital, Jeju, Korea.
5
Department of Neurology, Inje University, Ilsan Paik Hospital, Ilsan, Korea.
6
Department of Neurology, Eulji University, Eulji General Hospital, Seoul, Korea.
7
Department of Neurology, Dong-A University Hospital, Busan, Korea.
8
Department of Neurology, Seoul Medical Center, Seoul, Korea.
9
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
10
Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
11
Department of Neurology, Yeungnam University Medical Center, Daegu, Korea.
12
Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
13
Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea.
14
Department of Neurology, Jeju National University Hospital, Jeju, Korea.
15
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
16
Asan Medical Center, Clinical Research Center, Seoul, Korea.
17
Department of Translational Science and Molecular Medicine and Mercy Health Hauenstein Neurosciences, Michigan State University College of Human Medicine, Michigan, United States.
18
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. braindoc@snu.ac.kr.

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.

KEYWORDS:

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

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