Fatores associados à incapacidade por acidente vascular cerebral isquêmico entre dois e três anos do evento

Abstract

Ischemic stroke is a significant cause of death and disability worldwide. The analysis of predictors of functional disability is still incipient in Brazil and lacks short and long-term records to guide health care and management. The objective was to analyze the clinical and sociodemographic factors associated with functional disability in people with ischemic stroke between two and three years after the event. Prospective cohort study, with 241 people with ischemic stroke, followed from 90 days after the stroke until two to three years after the event. Of the 241 participants between two and three years of the ictus, 51 were not located, 35 died and 155 were interviewed. The disability outcome was dichotomized, based on the Rankin score of 0 to 2 (asymptomatic to mild dysfunction) and 3 to 5 (moderate to severe disability). To verify the association of sociodemographic and clinical variables with disability, Pearson's Chi-square test or Fisher's exact test was used. Variables up to 20% were used for multivariate analysis using the robust Poisson Model, the backward procedure and the Akaike Information Criterion to choose the final model. The McNemar test was used to compare the Rankin between 90 days and two to three years of the ictus. At this stage, statistical significance was 5%. The majority had a Rankin of 0 to 2 (62.6%). There was no significant association in the Rankin comparison between follow-up times, but a higher percentage of the sample with mild, moderate, moderately severe and severe disability progressed to a level of lower dysfunction. A higher percentage of asymptomatic patients without significant disability progressed to a worse degree of dysfunction. In the bivariate analysis, there was an association of up to 20% between degree of disability and female sex, employment status, National Institute of Health Stroke Scale (NIHSS), previous stroke, new stroke, high blood pressure and thrombolysis. In the multivariate analysis, the final model showed that people with NIHSS 6 to 13 and ≥14 compared to those with NIHSS ≤5 had 2.35 (95% CI:1.13 – 4.05) times and 4.4 times more moderate to severe disability (95% CI %: 2.09 – 6.83). Without thrombolysis and who suffered a new stroke, they had 3.02 times more (95% CI: 1.32 – 3.74) and 3.82 (95% CI: 1.49 - 3.47) moderate to severe disability. The impact of ischemic stroke on the lives of those affected was demonstrated, as more than 1/3 had moderate to severe disability within two to three years of the stroke. The variables significantly associated with moderate to severe disability were greater neurological deficit (NIHSS between 6 and ≥14), failure to undergo thrombolysis and recurrence of ischemic stroke. In the comparative analysis of disability between follow-up times there was no statistical significance. The study shows the need for advances in the health care network, ensuring the expansion of the supply of thrombolysis, early and continued rehabilitation with a multidisciplinary team and effective policies and interventions aimed at preventing and controlling risk factors for ischemic stroke and early presentation of victims to a health service to minimize the negative repercussions on these people's lives.