BACKGROUND AND PURPOSE Cerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia. METHODS Oservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003-2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0-2) and death at 90 days. RESULTS Patients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age <50 years (relative risk [RR], 1.56), signs of acute infarct (RR, 1.29), hyperdense artery sign (RR, 1.39), blood glucose >128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P<0.05). Patients with moderate/severe CED had lower odds to achieve functional Independence (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.23 to 0.55) and higher odds of death at 90 days (aOR, 2.54; 95% CI, 2.14 to 3.02). CONCLUSIONS In patients with extensive ischemia, the most important predictors for moderate/ severe CED were age <50, high blood glucose, signs of acute infarct, hyperdense artery on baseline scans, and decreased level of consciousness. CED was associated with worse functional outcome and a higher risk of death at 3 months.

中文翻译：

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严重半球综合征患者的脑水肿：发病率、危险因素和结果——来自 SITS-ISTR 的数据。

背景和目的 缺血性卒中的脑水肿 (CED) 会恶化预后，如果保守治疗，大约 70% 的严重 CED 患者会死亡。我们的目的是描述广泛缺血患者 CED 的发生率、危险因素和结果。方法 基于中风治疗安全实施的观察性研究 - 国际中风治疗登记处 (2003-2019)。基线严重半球综合征 (SHS) 和 24 小时持续性半球综合征 (pSHS) 定义为美国国立卫生研究院卒中评分 (NIHSS) >15。结果是通过神经影像学检测到的中度/重度 CED、功能独立性（改良 Rankin 量表 0-2）和 90 天时的死亡。结果 患者 (n=8,560) 出现 SHS 并在 24 小时内发展为 pSHS；82.2% 接受了静脉溶栓 (IVT)，10.5% 接受了 IVT+血栓切除术，7. 仅 3% 血栓切除术。中位年龄为 77 岁，NIHSS 为 21 岁。在有 CED 数据的 7,949 名患者中，3,780 名 (47.6%) 患有任何 CED，2,297 名 (28.9%) 患有中度/重度 CED。在多变量分析中，年龄 <50 岁（相对风险 [RR]，1.56）、急性梗塞体征（RR，1.29）、高密度动脉体征（RR，1.39）、血糖 >128.5 mg/dL（RR，1.21）和意识水平下降（RR，1.14）与中度/重度 CED 相关（所有 P <0.05）。中度/重度 CED 患者实现功能独立的几率较低（调整后的优势比 [aOR]，0.35；95% 置信区间 [CI]，0.23 至 0.55）和 90 天时死亡的几率较高（aOR，2.54；95%置信区间，2.14 至 3.02）。结论 在广泛缺血患者中，中度/重度 CED 最重要的预测因素是年龄 <50 岁、高血糖、急性梗死征象、基线扫描显示动脉高密度，意识水平下降。CED 与更差的功能结果和更高的 3 个月死亡风险相关。