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

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

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

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.

Keyword

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