Predictors of poor outcome in embolic stroke of undetermined source.

OBJECTIVE

To identify the clinical predictors of death or disability at discharge.

METHODS

We retrospectively reviewed all ischemic stroke patients admitted to the stroke unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia, from February 2016 - July 2018. We applied the Cryptogenic Stroke/ESUS International Working Group Embolic stroke of undetermined source (ESUS) criteria. We compared patients with poor outcomes (death or modified Rankin Scale [mRS] score more than 2 ) to those with favorable outcomes. Multivariate logistic regression was used to identify predictors of poor outcome. The regression model included age more than 60 years, gender, body mass index more than 25 kg/meter square, smoking history, comorbidities, previous ischemic/transient ischemic attack, pre-stroke mRS score more than 1, National Institutes of Health Stroke Scale (NIHSS) score at admission more than 5, pre-stroke antiplatelet use, and thrombolysis treatment.

RESULTS

Out of 147 patients who met the ESUS criteria, 28.8% had poor outcomes. Predictors of poor outcome were NIHSS score more than 5 (odds ratio [OR] 11.1, 95% confidence interval [CI] 4.4-28.2), pre-stroke mRS score more than 1 (OR 3.7, 95% CI 1.14-11.59), and age more than 60 years (OR 2.4, 95% CI 1.14-5.22).

CONCLUSION

A significant proportion of ESUS patients were dead or disabled at discharge. Poor outcome was more in older patients with pre-stroke functional disability and moderate to severe stroke.