Major complications associated with unfavorable outcome in right-sided large hemisphere infarctions: A single-center study

Abstract

Objectives: To identify the major complications independently associated with unfavorable outcomes in right-sided large hemisphere infarction (RLHI) patients.

Methods: We retrospectively enrolled consecutive patients admitted within 24 h with the diagnosis of RLHI. The unfavorable outcome was defined as a modified Rankin Scale score of 4-6 at 3 months. Univariate and multivariate analyses were performed to identify the major complications independently associated with 3-month unfavorable outcomes.

Results: Of the 171 cases with RLHI included, 126 (73.7%) had unfavorable outcomes at 3 months: A total of 64 (37.4%) cases died, and 62 (36.3%) lived with severe disability. Stroke-related complications occurred in 168 (98.2%) patients during hospitalization. The five most common stroke-related complications were pulmonary infection (75.4%), electrolyte disorder (61.4%), hypoalbuminemia (49.1%), malignant brain edema (MBE) (48.5%), and hemorrhagic transformation (48.0%). RLHI patients with unfavorable outcomes had more frequent MBE (58.7% vs. 21.4%, p < .001), pulmonary infection (86.5% vs. 42.9%, p < .001), gastrointestinal bleeding (46.8% vs. 28.6%, p = .038), electrolyte disorder (68.3% vs. 40.5%, p = .001), acute renal failure (32.5% vs. 4.8%, p < .001), and hypoalbuminemia (61.1% vs. 11.9%, p < .001) than patients with favorable outcome. Multivariate analyses suggested that only MBE (adjusted OR 4.06, 95% confidence interval [CI] 1.14-14.48, p = .031), pulmonary infection (adjusted OR 4.69, 95%CI 1.48-14.85, p = .009), and hypoalbuminemia (adjusted OR 6.58, 95%CI 1.74-24.86, p = .005) were independently associated with 3-month unfavorable outcome in patients with RLHI.

Conclusions: Most of the RLHI patients have at least one stroke-related complication during hospitalization, and nearly three-quarters suffered unfavorable outcomes. Only MBE, pulmonary infection, and hypoalbuminemia are independently associated with 3-month unfavorable outcome.

Keywords: complication; large hemispheric infarction; outcome; right hemisphere.