Risk factors for acute ischemic stroke following intravenous thrombolysis: a 2-center retrospective cohort study

Background: The risk factors associated with in-hospital poor neurological function after intravenous thrombolysis in patients with acute ischemic stroke (AIS) is of major public health interest. The aim of the present study was to screen for risk factors associated with in-hospital poor neurological function after intravenous thrombolysis in patients with acute AIS. Methods: This was a population-based cohort study. A total of 878 AIS patients who were admitted to advanced stroke centers of 2 Grade A tertiary hospitals in China between January 2018 and January 2020, and who had undergone intravenous thrombolysis therapy, were included in the present study. Baseline and treatment data of participant were collected. Poor neurological function was defined as National Institutes of Health Stroke Scale (NIHSS) score >= 16 on day 7 after onset, indicating stroke severity. Univariable and multivariable analyses were used to screen out factors associated with the endpoint. Results: After multivariable analysis, risk factors, such as age [odds ratio (OR): 1.099, 95% confidence interval (95% CI): 1.052-1.194, P<0.001], NIHSS2 (NIHSS score immediately after thrombolysis, OR: 1.286, 95% CI: 1.201-1.377, P<0.001), total cholesterol (CHOL; OR: 1.614, 95% CI: 1.036-2.514, p<0.05), urea nitrogen (UREA; OR: 1.205, 95% CI: 1.045-1.390, P<0.05), computed tomography 24 h after thrombolysis (CT2; OR: 6.153, 95% CI: 2.696-14.045, P<0.001), and lower limb deep venous thrombosis (LDVT; OR: 4.398, 95% CI: 1.560-12.398, P<0.05) were found to be associated with poor neurological function. Lipid regulation (OR: 0.065, 95% CI: 0.02-0.215, P<0.001) and high-density lipoprotein cholesterol (HDL-C; OR: 0.038, 95% CI: 0.007-0.202, P<0.001), were found to be protective factors to avoid poor neurological function. Conclusions: Age, NIHSS2, CHOL, UREA, CT2, and LDVT were found to be risk factors of poor neurological function after thrombolysis for MS. Lipid regulation and HDL-C were found to be protective factors of poor neurological function.