Modifiable Comorbidity as a Risk Factor for DRPs and Unimproved NIHSS Score in Ischemic Stroke Patients
FIRDHA APRILLIA WARDHANI(1*)
(1) Gadjah Mada University
(*) Corresponding Author
Abstract
Drug-related problems are problems that are often encountered in stroke patients because of the complex management of stroke therapy due to comorbidities. Research shows that 90% of stroke patients experience drug-related problems (DRPs). However, there was limited information regarding the effect of comorbidity as both a risk factor for DRPs prevalence and worse outcomes in an ischemic stroke patient. This research was conducted to see whether modifiable comorbidities indeed had a significant impact as a risk factor for DRPs and clinical outcomes in hospitalized ischemic stroke patients at a tertiary hospital in Indonesia during January 2020-October 2021. This study was conducted retrospectively using cross-sectional analysis, with the subject being the patient's medical record. This study found no significant relationship between the presence of comorbidities in patients with the incidence of DRPs. Diabetes mellitus was found to have a significant association with no improvement in NIHSS scores in ischemic stroke patients. In patients with diabetes mellitus, there is an increased risk of non-improvement NIHSS score 2,987 times compared to patients without diabetes mellitus. The second increased risk was the presence of comorbid hypertension (OR 1.361, 95% CI 0.598-3.095, p-value=0.463), and the third was dyslipidemia (OR 1.125, 95% CI 0.505-2.502, p-value=0.774).
Keywords
Full Text:
PDFReferences
Khaku AS, Tadi P. Cerebrovascular Disease. In: StatPearls. StatPearls Publishing; 2021. Accessed July 20, 2021. http://www.ncbi.nlm.nih.gov/books/NBK430927/
Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
Viswam S, Nair G, Thomas B, Shivashankar V. A Prospective Observational Study on Polypharmacy in Geriatrics at A Private Corporate Hospital. Journal of Applied Pharmaceutical Science. 2017;7:162-167. doi:10.7324/JAPS.2017.71024
Permatasari N. Perbandingan Stroke Non Hemoragik dengan Gangguan Motorik Pasien Memiliki Faktor Resiko Diabetes Melitus dan Hipertensi. Jurnal Ilmiah Kesehatan Sandi Husada. 2020;11(1):298-304. doi:DOI: 10.35816/jiskh.v10i2.273
Nahrowi NS, Ong PA, Adam A. Cognitive and Functional Outcome of Patients with Ischemic Stroke at Dr. Hasan Sadikin Hospital Bandung. Althea Medical Journal. 2018;5(2):82-86. doi:10.15850/amj.v5n2.1173
DiPiro JT, Yee GC, Posey M, Haines ST, Nolin TD, Ellingrod V, eds. Stroke. In: Pharmacotherapy: A Pathophysiologic Approach, 11e. 11th ed. McGraw-Hill Education; 2020:38. Accessed March 10, 2021. https://accesspharmacy.mhmedical.com/book.aspx?bookID=2577
Kose E, Maruyama R, Okazoe S, Hayashi H. Impact of Polypharmacy on the Rehabilitation Outcome of Japanese Stroke Patients in the Convalescent Rehabilitation Ward. Journal of Aging Research. 2016;2016:1-8. doi:10.1155/2016/7957825
Kanagala VS, Anusha A, Rao BS, Challa SR, Nalla KS, Gadde RS. A study of medication-related problems in stroke patients: A need for pharmaceutical care. J Res Pharm Pract. 2016;5(3):222-225. doi:10.4103/2279-042X.185750
Hohmann C, Neumann-Haefelin T, Klotz JM, Freidank A, Radziwill R. Drug-related problems in patients with ischemic stroke in hospital. Int J Clin Pharm. 2012;34(6):828-831. doi:10.1007/s11096-012-9690-7
Shukuri A, Tewelde T, Shaweno T. Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia. IBPC. 2019;12:23-31. doi:10.2147/IBPC.S212821
CDC. National Diabetes Statistics Report 2020. Estimates of diabetes and its burden in the United States. Published online 2020:32.
IDF. Diabetic Prevalencies : Fact and Figures. IDF : About Diabetes. Published 2021. Accessed April 1, 2022.
https://idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html
Kemenkes. Tetap Produktif, Cegah dan Atasi Diabetes Mellitus. Infodatin. 2020;20(1):6.
Kemenkes. PENYELENGGARAAN PELAYANAN KESEHATAN LANJUT USIA DI PUSAT KESEHATAN MASYARAKAT. Vol 1663.; 2015:7.
Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019;11(9):2542-2544. doi:10.18632/aging.101931
Westberg SM, Derr SK, Weinhandl ED, et al. Drug Therapy Problems Identified by Pharmacists Through Comprehensive Medication Management Following Hospital Discharge. J Pharm Technol. 2017;33(3):96-107. doi:10.1177/8755122517698975
PERKENI. Petunjuk Praktis Terapi Insulin pada Pasien Diabetes Mellitus. PB PERKENI. 2021;2:70.
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-S33. doi:10.2337/dc21-S002
Garber AJ, Handelsman Y, Grunberger G, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2020 Executive Summary. Endocrine Practice. 2020;26(1):107-139. doi:10.4158/CS-2019-0472
Liu CH, Wei YC, Lin JR, et al. Initial blood pressure is associated with stroke severity and is predictive of admission cost and one-year outcome in different stroke subtypes: a SRICHS registry study. BMC Neurol. 2016;16:27. doi:10.1186/s12883-016-0546-y
Kemenkes. PEDOMAN NASIONAL PELAYANAN KEDOKTERAN TATA LAKSANA STROKE. Vol 342.; 2019:1-82.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12). doi:10.1161/STR.0000000000000211
Sandset EC, Anderson CS, Bath PM, et al. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. European Stroke Journal. Published online May 11, 2021:239698732110121. doi:10.1177/23969873211012133
Levetan CS. Effect of hyperglycemia on stroke outcomes. Endocr Pract. 2014;10 Suppl 2:34-39. doi:10.4158/ep.10.s2.34
Mi D, Wang P, Yang B, Pu Y, Yang Z, Liu L. Correlation of hyperglycemia with mortality after acute ischemic stroke. Therapeutic Advances in Neurological Disorders. 2018;11. doi:10.1177/1756285617731686
Al-Weshahy A, El-Sherif R, Selim KAAW, Heikal A. Short term outcome of patients with hyperglycemia and acute stroke. The Egyptian Journal of Critical Care Medicine. 2017;5(3):93-98. doi:10.1016/j.ejccm.2017.11.003
Ishitsuka K, Kamouchi M, Hata J, et al. High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes. Hypertension. 2014;63(1):54-60. doi:10.1161/HYPERTENSIONAHA.113.02189
Ding M, Fratiglioni L, Johnell K, et al. Atrial fibrillation, antithrombotic treatment, and cognitive aging: A population-based study. Neurology. 2018;91(19):e1732-e1740. doi:10.1212/WNL.0000000000006456
Rouch L, Xia F, Bahorik A, Olgin J, Yaffe K. Atrial Fibrillation is Associated With Greater Risk of Dementia in Older Veterans. Am J Geriatr Psychiatry. 2021;29(11):1092-1098. doi:10.1016/j.jagp.2021.02.038
Zhang A, Deng W, Zhang B, et al. Association of lipid profiles with severity and outcome of acute ischemic stroke in patients with and without chronic kidney disease. Neurol Sci. 2021;42(6):2371-2378. doi:10.1007/s10072-020-04791-x
Elberta F, Ghofir A, Rusdi I. LDL/HDL ratio association with out-patient NIHSS score and Dyslipidemic Drug intake status as Metabolic Syndrome Criteria of ischemic stroke patients at RSUP Dr. Sardjito, Yogyakarta. Journal of the Medical Sciences (Berkala Ilmu Kedokteran). 2018;50(1). doi:10.19106/JMedScieSup005001201804
Yao T, Long Q, Li J, et al. Small dense low-density lipoprotein cholesterol is strongly associated with NIHSS score and intracranial arterial calcification in acute ischemic stroke subjects. Sci Rep. 2020;10(1):7645. doi:10.1038/s41598-020-64715-9
DOI: https://doi.org/10.22146/farmaseutik.v19i2.73924
Article Metrics
Abstract views : 563 | views : 244Refbacks
- There are currently no refbacks.