Statistical evaluation of stroke risk factors on NIHSS and MRS

Year 2025, Volume: 42 Issue: 1, 63 - 68, 28.03.2025

Menşure Zühal Barak , Gizem Gül Koç , Pınar Bengi Boz

Abstract

Stroke is the second leading cause of death and the third leading cause of disability worldwide with a global prevalence estimated at 0.2% . It also significantly contributes to healthcare costs. Ischemic strokes, which result from disrupted cerebral blood flow, make up approximately 80–85% of all stroke cases. Key risk factors for stroke include hypertension, diabetes mellitus, heart disease, hyperlipidemia, smoking, and lifestyle factors. This study investigated the impact of stroke risk factors and lesion localization on stroke severity, as measured by the NIHSS scale, and patient independence at discharge, as evaluated by the Modified Rankin Scale (MRS). The analysis included 159 patients, comprising 82 women (51.6%) and 77 men (48.4%), with a mean age of 68.1±14.2 years, 93.1% of whom were over 45 years old. Stroke types were distributed as follows: 41.5% anterior circulation, 37.1% posterior circulation, and 21.4% lacunar strokes.
The factors affecting the difference between NIHSS values (Delta NIHSS) at admission and discharge were analyzed by univariate and multivariate analysis methods. According to the results of univariate analysis, the presence of hypertension, myocardial infarction, coronary artery and carotid disease, previous insulin use, intravenous-tPA (iv-tPA), intra-arterial-tPA (ia-tPA) and thrombectomy treatments, age, NLR, mean blood pressure and exit MRS values were significantly associated with Delta NIHSS (p<0.05). Multivariate analysis revealed a positive correlation between Delta (∆) NIHSS value and CAD and iv-tPA values and a negative correlation with exit MRS value (p=0.021; p=0.012 and p<0.001 respectively). Our model provides consistent results for the relationship between NIHSS and MRS scores and positive and negative functional outcomes.

Keywords

Stroke, NIHSS Score, Shapiro-Wilk Test, Mann-Whitney U Test, Spearman Rho Test, Regression Analysis

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