Risk factors for early neurological deterioration in acute ischemic stroke: a case-control study

Background: Early neurological deterioration (END) represents major complication of acute ischemic stroke (AIS) and is associated with high mortality and disability. In the present study, we aimed to identify potential risk factors for early neurological deterioration in patients with AIS. Methods: This was a retrospective and case-control study conducted at Sun Yat-sen University's Fifth Affiliated Hospital. Between January 2021 and October 2022, 358 patients with AIS patients were examined and grouped according to whether they developed END or not. END was defined as an increase of >2 points on the National Institutes of Health Stroke Scale (NIHSS) score within the first week of admission. Baseline characteristics, vascular risk factors, laboratory findings, and neuroimaging were then compared between the END and non-END groups of patients. Results: END was observed in 58 of the 358 patients. The END group of patients showed a significantly higher prevalence of unstable carotid plaques (51.7% vs. 15.3%, p < 0.001) and high NIHSS scores at the time of admission (median 4.0 vs. 2.0, p < 0.001). Key biochemical markers were significantly higher in the END group, including fibrinogen, total cholesterol, low density lipoprotein cholesterin (LDL-cholesterol) and glycosylated hemoglobin A1c (HbA1c). Multivariate analysis confirmed that higher NIHSS scores at the time of admission and unstable carotid plaques were independent prognostic factors of END. Conclusions: Higher NIHSS scores upon admission and the presence of unstable carotid plaques were identified as significant risk factors for END in AIS patients. Identifying these factors may facilitate the early diagnosis of END and improve patient outcomes.