Fatores preditores de óbito e independência funcional em pacientes com acidente vascular cerebral

Abstract

The prognosis after cerebrovascular accident (CVA) can be influenced by several prognostic factors. Thus, identifying them early is essential for the CVA outcome. This dissertation was developed for two manuscripts. The first, entitled "Sociodemographic and clinical factors that predict death in CVA patients", is a prospective and longitudinal study. At admission, sociodemographic and clinical data, including National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (ECG) scores were collected. Pearson's Chi-square test (Posthoc) and Student's t-test characterized the sociodemographic and clinical profile according to the outcome of death and discharge. Through the Multiple Logistic Regression analysis, predictive factors of death after stroke were selected. A total of 49 CVA patients were recruited, with an in-hospital mortality rate of 53.06%. The variables stroke severity (NIHSS) (p<0.001); mechanical ventilation (p=0.04); dysphagia (p=0.01); and respiratory failure (p=0.02) were considered predictors of death after stroke. Previous knowledge about these indicators can help predict the imminent risk of death and guide the team in the proper management of stroke, from the acute phase. The second manuscript entitled ¿Sociodemographic and clinical factors predictors of functional independence in stroke patients¿ related sociodemographic and clinical data (admission) with the functional outcome after stroke. The Mann-Whitney and KruskalWallis tests compared the Functional Independence Measure (FIM) scores with the exploratory variables. Multiple Linear Regression analysis (stepwise method) was applied between the outcome of functional independence (FIM) and the exploratory variables of the study. A total of 23 CVA patients were followed from admission to hospital discharge. According to the MIF, 91.3% of the sample showed modified dependence (19 to 103 points); 8.7% complete independence (104 to 126); and no patient had complete dependence (18). The NIHSS (admission) (p<0.001) and age (p<0.001) variables were considered predictors of functional independence after CVA. Prior knowledge about these prognostic factors is crucial to outline the goals of the rehabilitation protocol and early planning for hospital discharge after stroke