Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome

Objective: To identify risk factors for early neurological deterioration (END) in acute lacunar stroke patients and its influence on functional outcome. Methods: Consecutive acute lacunar stroke patients defined by magnetic resonance imaging (MRI) between January 2018 and June 2020 were included in the study. END was defined as any persisting increase in National Institutes of Health Stroke Scale (NIHSS) score of ⩾ 2 points post admission, and favorable outcome was defined as a modified Rankin Scale (mRS) of 0–2 at discharge. Univariable and multivariable logistic regression were performed to identify risk factors related to END, as well as the influence of END on functional outcome. Results: Among a total of 638 lacunar stroke patients (420 males (65.8%), median age 66 years (interquartile range (IQR): 56–74)), 108 (16.9%) developed END, and 94.4% (102/108) of the END occurred within 72 h post admission. Admission NIHSS score (adjusted odds ratio (aOR) 1.132, 95% confidence interval (CI) 1.046–1.225, p = 0.002), female (aOR 2.752, 95% CI 1.277–5.933, p = 0.010), admission systolic blood pressure (SBP) (160–179 mm Hg) (aOR 9.395, 95% CI 4.310–20.479, p < 0.001) and admission SBP (⩾180 mm Hg) (aOR 16.030, 95% CI 5.991–42.891, p < 0.001) were significantly associated with END. Delay time from onset to admission (aOR 0.995, 95% CI 0.990–1.000, p = 0.031), SBP dropping (⩾20 mm Hg) within 3 days or when END occurred (aOR 0.037, 95% CI 0.016–0.086, p < 0.001) and thalamic lacunar infarction (aOR 0.098, 95% CI 0.012–0.827, p = 0.033) were inversely associated with END. END (aOR 12.374, 95% CI 6.881–22.254, p < 0.001) and higher admission NIHSS score (aOR 1.488, 95% CI 1.359–1.629, p < 0.001) predicted unfavorable outcome at discharge. Conclusion: END in lacunar stroke patients is common and is associated with unfavorable outcome. Admission high SBP is a potentially modifiable risk factor for prevention of END, but this needs further investigation.