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Page 4 of 11 Ghosh et al. Neuroimmunol Neuroinflammation 2018;5:38 I http://dx.doi.org/10.20517/2347-8659.2018.28

onset, and an initial CRP level > 10 mg/dL due to presumed infection.

Outcome measures - the primarily aims of the study were the following: (1) to identify the factors inde-
pendently predicting: i) the severity of stroke; ii) the unfavorable outcome at 30 days post discharge; iii) the
mortality; and iv) the chance of post thrombolysis hemorrhage; and (2) to evaluate the effect of thrombolysis
on the outcome of ischemic stroke patients. The secondary aim was to evaluate the role of biomarkers to pre-
dict the unfavorable outcome and the chance of post thrombolysis hemorrhage and to evaluate the change of
biomarker levels post thrombolysis.

The patient characteristics, comorbid risk factors, and hospital investigations were assessed by Chi-square
test for categorical variables and independent-samples t test and one way analysis of variance for continuous
variables. The variables analyzed were age, gender, body mass index, life conditions, comorbidities, NIHSS
at admission, vascular risk factors, therapy prior to stroke, addictions, pathophysiologic and metabolic fac-
tors. Multivariate logistic regression models estimated the impact of possible determinants of stroke severity
at admission. Differences between groups and effect of patient characteristics on the clinical outcome were
assessed using Chi-square test. Statistical tests were considered significant when the value was ≤ 0.05. Statisti-
cal analyses were performed using the Statistical Package for the Social Sciences (SPSS) 20.0 software version.

RESULTS
Out of 30 patients admitted with first ischemic stroke, 15 patients arrived at the hospital within 4.5 h. Out
of them, 2 patients had NIHSS score > 25, 2 patients had stroke involving > 1/3 cerebral hemisphere, and 1
patient was taking oral anticoagulants for dilated cardiomyopathy - hence they did not receive thrombolysis.
The rest 10 patients were thrombolysed with injection alteplase. The mean time (standard deviation or SD)
of presentation of patients who were thrombolysed was 3.8 (0.7) and 7.8 (2.4) h for the remaining patients.
Twelve patients had a mild stroke, 10 had a moderate stroke and 8 had a severe stroke. Fourteen patients had
mRS score < 2, and 16 had mRS score ≥ 2, among whom 5 patients expired. Three out of ten thrombolysed
patients developed intracerebral hemorrhage, among whom 1 patient expired. During admission, all the cas-
es of AF were already diagnosed and were on anticoagulants as per the current guidelines. The results have
been described in Tables 1-6.

DISCUSSION
Discussion on determinants of stroke severity and outcome
In this study on first-ever ischemic stroke patients, we demonstrated that risk factors such as old age, history
of diabetes, CHADS2 score ≥ 2, and TACS independently affected stroke severity, whereas low EF < 35%,
and TACS, independently predicted the unfavorable outcome (mRS score ≥ 2) and mortality. High mean
arterial blood pressure (MABP) and capillary blood glucose (CBG) at admission were significant predic-
tors for stroke severity, mRS score ≥ 2 and mortality. Female patients had significantly higher incidence of
unfavorable outcome, but female gender was not a significant predictor of stroke severity and mortality.
CHADS2 score significantly predicted the unfavorable outcome, but it was not a significant predictor when
mortality was considered alone. Hypertension, hypercholesterolemia, smoking, ischemic heart disease, and
AF showed a non-significant trend to be more prevalent among patients with severe stroke, unfavorable
outcome and mortality. History of TIA was significantly associated with higher incidence of severe stroke
and mortality. Home medications, living conditions, PACS and PCS did not significantly contribute to the
severity and outcome of the stroke. However, patients of LS had a significantly lesser risk of having an un-
favorable outcome. In the previous population-based studies, old age was found to be a strong independent
[7]
predictor of ischemic stroke severity, outcome and mortality [7,15] . In Corso’s study , patients > 85 years of
age had 2.9 times higher risk for having a severe stroke. In our study, out of 3 patients > 80 years of age, 2
had a severe stroke [odds ratio (OR) = 7 (0.53-91.11), P = 0.16]. Previous reviews reported that female gender