Neurology:癫痫发作独立预测卒中静脉溶栓患者远期预后

Objectives: Data on long-term outcome after IV thrombolysis (IVT) are sparse. Our goals were to 1) estimate annual survival, and 2) evaluate determinants for an unfavorable long-term outcome after IVT for stroke.

Methods: This observational study is based on the IVT registry of the University Hospital Basel. A structured telephone interview was used to ascertain information about long-term outcome (1 year to 10 years after IVT). Primary outcome parameters were 1) death and 2) excellent outcome (modified Rankin Scale scores 0 and 1). Kaplan-Meier survival estimates were calculated. Uni- and multivariate logistic regression analyses were performed to identify variables independently determining long-term outcome.

Results: Two hundred fifty-seven IVT-treated stroke patients were eligible for analysis. Median time of follow-up was 3.0 years (interquartile range 1.0–5.0). Probability of surviving after IVT was 76% after 1 year, 66% after 3 years, and 53% after 4 years. After a median of 3 years, 37% of patients had an excellent outcome. Independent predictors for unfavorable long-term outcome were advanced age (odds ratio [OR] 1.030, 95% confidence interval [CI] 1.002–1.060, p = 0.036), higher stroke severity (OR 1.100, 95% CI 1.012–1.196, p = 0.026), unfavorable 3-month outcome (OR 6.767, 95% CI 3.391–13.503, p < 0.001), and occurrence of epileptic seizures (OR 4.899, 95% CI 1.349–17.793, p = 0.016). Intracranial hemorrhage, comorbidity, sex, initial glucose or C-reactive protein levels, and stroke etiology did not independently influence long-term outcome.

Conclusion: At 3 years after IVT, approximately 1 of 3 stroke patients had an excellent outcome, and 1 of 3 had died. Epileptic seizures seem to have an unfavorable effect on long-term outcome via a mechanism that remains to be clarified.