Age‐specific clinical characteristics and outcome in patients over 60 years old with large hemispheric infarction. Issue 12 (22nd November 2018)

• Record Type: Journal Article
• Authors: Li, Jie; Zhang, Ping; Tao, Wendan; Yi, Xingyang; Zhang, Jing; Wang, Chun
• Is Part Of: Brain and behavior. Volume 8:Issue 12(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-11-22
• Subjects: decompressive hemicraniectomy -- elderly -- large hemispheric infarction -- outcome; Neurology -- Periodicals; Neurosciences -- Periodicals; Psychology -- Periodicals; Psychiatry -- Periodicals; 616.8005
• DOI: 10.1002/brb3.1158
• Languages: English
• ISSNs: 2162-3279

Abstract

Abstract: Objective: We aimed to investigate age‐specific clinical characteristics in patients aged >60 years with large hemispheric infarction (LHI). Methods: We prospectively enrolled consecutive patients with LHI. Patients were divided into two groups: ≤60 vs. >60 years, and demographics, vascular risk factors, clinical feature, in‐hospital treatment, 3‐month mortality, and unfavorable outcome (defined as a mRS score of 4–6) rate were compared. Results: Of the 256 cases included, 140 (54.7%) were older than 60 years. Compared with the younger, the older patients had higher rates of hypertension (66.4% vs. 31.0%), coronary heart disease (19.3% vs. 2.6%), atrial fibrillation (53.6% vs. 31.0%; all p < 0.001), more history of stroke (21.4% vs. 5.2%, p < 0.001), less history of rheumatic heart disease (16.4% vs. 30.1%, p = 0.009), and alcohol consumption (12.1% vs. 21.6%, p = 0.043). Cardio‐embolism is the most common stroke etiology regardless of age (55.7% and 38.8%, respectively). Furthermore, the elderly less frequently received decompressive hemicraniectomy (4.3% vs. 15.5%, p = 0.005) and mechanical ventilation (7.9% vs. 16.4%, p = 0.035) and had a higher frequency of stroke‐related complication (83.6% vs. 66.4%, p = 0.001). A total of 26 (18.6%) older patients and 15 (12.9%) younger patients died during hospitalization ( p = 0.221), and 59 (42.1%) older patients and 35 (30.2%) younger patients died at 3 months ( p = 0.061). Patient aged >60 years had significantly higher unfavorable outcome rate at 3 months (adjusted odds ratio, OR 4.30, 95% confidence interval [CI] 2.08–8.88; p < 0.05]. However, older age is not independently associated with 3‐month mortality (42.1% vs. 30.2%, p = 0.095 [log‐rank test]). Conclusions: Large hemispheric infarction patients over 60 years old were a little more than those aged ≤60 years and constitute more than half of those suffered from malignant brain edema and two thirds of in‐hospital death and 3‐month mortality. The elderly had more cardio‐origin risk factors, received less aggressive hospital treatment, and showed higher risk of unfavorable outcome than the younger. Abstract : Early decompressive hemicraniectomy (DHC) reduces mortality among patients 60 years of age or younger with space‐occupying large hemispheric infarction (LHI). However, whether patients older than 60 years might also benefit from surgery remains unclear. Meanwhile, the impact of age on outcome has not been well studied in LHI. In the present study, we performed an interesting prospective study comparing differences between patients older and younger than 60 years with LHI. We found that LHI patients over 60 years old were a little more than those aged ≤60 years and constitute more than half of those suffered from malignant brain edema and two thirds of in‐hospital death and 3‐month mortality. The elderly had more cardio‐origin risk factors, received less aggressive hospital treatment, and showed higher risk of unfavorable outcome than the younger. Early management of cardiovascular risk should be enhanced in the elderly for prevention of LHI while aggressive treatment needs more evidence.