Effects of Early Neurological Deterioration in Acute Ischemic Stroke on Multiple Dimensions of Functional Outcomes Using Propensity Score Matching Analysis

Background: Early neurological deterioration (END) is common in acute ischemic stroke (AIS), but its effect on functional outcomes is not well understood. The aim of the present study was to explore the effects of END on multiple dimensions of functional outcomes.Methods: In the present study, 256 patients with AIS were analyzed. All patients were followed up for 1 year. We used the modified Rankin Scale (mRS) to assess body function impairment, the Lawton activities of daily living scale to assess activity limitations, and the reintegration to normal living index (RNLI) to assess participation restrictions. Brain magnetic resonance imaging was performed to identify acute infarcts and preexisting abnormalities, such as white matter lesions, medial temporal lobe atrophy, microbleeds, and silent lacunae. To reduce the effects of a lack of randomization, we conducted a propensity score analysis. Results: The study sample consisted of 185 men (72.3%) and 71 women (27.7%). Sixty-one patients (23.8%) had END. Before matching, patients with END had higher levels of small artery-type stroke, higher National Institutes of Health Stroke Scale scores on arrival, higher systolic blood pressure on admission, and larger infarct volumes. After matching, there were no significant differences between the two groups in any clinical or neuroimaging variables, except for stroke subtype and cortical region infarct. Logistic regression analysis revealed that END was a significant predictor of poor mRS (odds ratio [OR], 3.829; 95% confidence interval [CI], 1.367–10.723, p = 0.011) and poor RNLI (OR, 2.777; 95% CI, 1.133–6.806, p = 0.026) scores after adjusting for confounding factors.Conclusions: END is relatively common in AIS, with an incidence of 23.8%. END might be able to predict poor functional outcomes, including body function impairment and reduced social participation.