Analysis and prediction of adverse effects of the acute period of cerebral stroke during martial law

In all countries, during wars, there is an increase in the number of cerebral strokes and mortality from them. Objective — to analyze the short-term outcomes of acute cerebral stroke (ACS) in patients during wartime, to identify factors influencing mortality from the disease and to create a prognostic model of the risk of patient death in the short-term period of the disease. Materials and methods. A total of 319 medical records of patients with ACS during martial law were analyzed. Age, gender, risk factors, stroke structure, and data on the scale assessment of patients’ condition on the first and last day of hospitalisation were taken into account. Statistical data analysis was performed on an Intel-compatible personal computer using SPSS 21.0 software. The risk of mortality was analysed by building univariate and multivariate logistic regression models. Results and discussion. Among the two subgroups of patients (252 with ischaemic (AI) and 67 with haemorrhagic (HI) strokes), 69 (27.5 %) and 31 (46.3 %) died during hospital treatment, respectively. The construction of univariate logistic regression models for predicting the risk of MI death for 15 factor attributes revealed varying degrees of association. Thus, a moderate association was found with age (AUC = 0.71, where 95 % CI 0.65—0.76); hemorrhagic stroke (AUC = 0.60, where 95 % CI 0.54—0.65), where the risk of death is 0.34 times higher (OR 0.34; 95 % CI 0.19—0.60; p < 0.001); neurological scores on the first day of illness: where the critical threshold for the Youden Index was 12 points on the NIHSS scale with a 1.17-fold increase in risk (OR 1.17; 95 % CI 1.12 —1.23; p < 0.001); Rankin Scale with a critical threshold of 4 points with a risk reduction of 8.77 times (OR = 8.77; 95 % CI 3.75—20.5; p < 0.001) per point. A strong statistical association was found for dyslipidaemia (OR = 131, 95 % CI 18—960; p < 0.001); chronic or acute stress the day before (OR = 330, 95 % CI 45—2429; p < 0.001); Glasgow score on the first day of illness (AUC = 0.84, 95 % CI 0.79—0.88) and Barthel index (AUC = 0.89, 95 % CI 0.85—0.92). The area under the ROC curve in the construction of a four-factor model for predicting the risk of death (AUC = 0.97, 95 % CI 0.95—0.99) showed a very strong association with GI, Barthel index on the first day of illness, the presence of dyslipidaemia and stress. Conclusions. The analysis and prediction of adverse outcomes of the acute period of MI performed for 319 patients by building univariate and multivariate logistic regression models revealed a moderate association between the risk of death and age, haemorrhagic stroke, NIHSS score and Rankin Disability Scale on the first day of illness. A strong statistical association exists between fatal outcome and dyslipidaemia, chronic or acute stress before the disease, Glasgow Coma Scale score and Barthel Index on the first day of illness. The obtained results serve as a basis for further development of a functional and organisational model to minimise the risk of mortality in patients with cerebral stroke.