Evidence map›Paper›PMID 40090964›Full record

ArticleChinese medical journal2025

Clinical course, causes of worsening, and outcomes of severe ischemic stroke: A prospective multicenter cohort study.

Simiao Wu, Yanan Wang, Ruozhen Yuan, Meng Liu, Xing Hua, Linrui Huang, Fuqiang Guo, Dongdong Yang, Zuoxiao Li, Bihua Wu and 9 more

Registry-linked trialAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Chinese medical journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03222024 (Clinical Features, Management and Outcomes of Severe Ischaemic Stroke in Tertiary Hospitals in China), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03222024 completednot on this map

Clinical Features, Management and Outcomes of Severe Ischaemic Stroke in Tertiary Hospitals in China: a Multi-centre Prospective Observational Study

Typeobservational_patient_registrySponsorWest China HospitalRan2017 to 2020Enrolled2,500ConditionsSevere Ischaemic Stroke, Malignant Ischaemic StrokeArmsroutine medical care
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Simiao WuDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Yanan WangDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Ruozhen YuanDepartment of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
Meng LiuDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Xing HuaDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Linrui HuangDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Fuqiang GuoDepartment of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China.
Dongdong YangDepartment of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China.
Zuoxiao LiDepartment of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
Bihua WuDepartment of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 634700, China.
Chun WangDepartment of Neurology, People's Hospital of Deyang City, Deyang, Sichuan 618000, China.
Jingfeng DuanDepartment of Neurology, Mianyang Central Hospital, Mianyang, Sichuan 621000, China.
Tianjin LingDepartment of Neurology, The First People's Hospital of Ziyang, Ziyang, Sichuan 641300, China.
Hao ZhangDepartment of Neurology, Jiangyou People's Hospital, Jiangyou, Sichuan 621000, China.
Shihong ZhangDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Bo WuDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Cairong ZhuDepartment of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Craig S AndersonThe George Institute for Global Health, Sydney, NSW 2050, Australia.
Ming LiuDepartment of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSevere stroke has high rates of mortality and morbidity. This study aimed to investigate the clinical course, causes of worsening, and outcomes of severe ischemic stroke.

methodsThis prospective, multicenter cohort study enrolled adult patients admitted ≤30 days after ischemic stroke from nine hospitals in China between September 2017 and December 2019. Severe stroke was defined as a score of ≥15 on the National Institutes of Health Stroke Scale (NIHSS). Clinical worsening was defined as an increase of 4 in the NIHSS score from baseline. Unfavorable functional outcome was defined as a modified Rankin scale score ≥3 at 3 months and 1 year after stroke onset, respectively. We performed Logistic regression to explore baseline features and reperfusion therapies associated with clinical worsening and functional outcomes.

resultsAmong 4201 patients enrolled, 854 patients (20.33%) had severe stroke on admission. Of 3347 patients without severe stroke on admission, 142 (4.24%) patients developed severe stroke in hospital. Of 854 patients with severe stroke on admission, 33.95% (290/854) experienced clinical worsening (median time from stroke onset: 43 h, Q1-Q3: 20-88 h), with brain edema (54.83% [159/290]) as the leading cause; 24.59% (210/854) of these patients died by 30 days, and 81.47% (677/831) and 78.44% (633/807) had unfavorable functional outcomes at 3 months and 1 year respectively. Reperfusion reduced the risk of worsening (adjusted odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.12-0.49, P  <0.01), 30-day death (adjusted OR: 0.22, 95% CI: 0.11-0.41, P  <0.01), and unfavorable functional outcomes at 3 months (adjusted OR: 0.24, 95% CI: 0.08-0.68, P <0.01) and 1 year (adjusted OR: 0.17, 95% CI: 0.06-0.50, P  <0.01).

conclusionsApproximately one-fifth of patients with ischemic stroke had severe neurological deficits on admission. Clinical worsening mainly occurred in the first 3 to 4 days after stroke onset, with brain edema as the leading cause of worsening. Reperfusion reduced the risk of clinical worsening and improved functional outcomes. REGISTRATION: ClinicalTrials.gov , NCT03222024.

Indexed as

Brain IschemiaIschemic StrokeStrokeAgedAged, 80 and overFemaleHumansMaleMiddle AgedProspective StudiesBrain edemaClinical courseClinical worseningOutcomesReperfusionSevere stroke

Identifiers

PMID40090964
PMCPMC12233928

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.