[The effect of tobacco smoking on clinimetric evaluation of stroke patients].

Tobacco smoking is recognized as the risk factor of stroke, however its effect on the risk of recurrent cerebrovascular events is not well clarified.

OBJECTIVE

To evaluate the effect of tobacco smoking on results of clinimetric scoring of stroke patients and association with results of routine laboratory tests. The study included 431 stroke patients (409--ischemic stroke, 22--with hemorrhagic transformation of ischemic stroke). After admission to Emergency Room all stroke patients were examined clinically and scored according to National Institute of Health Stroke Scale (NIHSS). Then, 7 days after stroke onset NIHSS scoring was repeated and patients were scored in Rankin and GOS scales (Glasgow Outcome Scale). Everyday activity was assessed in Barthel scale 30, 90, 180 and 360 days after stroke onset. Moreover, computer tomography scans and laboratory tests were performed including hematology, glucose, fibrinogen, CRP and D-dimers concentrations. In smokers with ischemic stroke we have found trend (p = 0.0695) in decreasing of NIHSS scoring in comparison with non-smokers. The assessment in Rankin scale performed 7 days after stroke onset showed better neurological state of smokers with stroke (p < 0.01) in comparison with non-smokers and in ex-smokers with ischemic stroke (p < 0.05) comparing to non-smokers. Smokers with stroke (ischemic and with hemorrhagic transformation) had higher (p < 0.01) scoring in GOS 7 days after onset of symptoms in comparison with non-smokers. Ex-smokers with ischemic stroke had higher (p < 0.05) scores in GOS than nonsmokers. Tobacco smoking had no effect on clinimetric evaluation of patients with hemorrhagic transformation of ischemic stroke. Smoking was associated with lower levels of glucose, fibrinogen and D-dimers and higher hematocrit in ischemic stroke patients.

CONCLUSIONS

The clinical course of the early phase of ischemic stroke was benign in smokers comparing to non-smokers. Better results of clinimetric evaluation and lower mortality of smokers with ischemic stroke may be related to lower levels of glucose, fibrinogen and D-dimers. Tobacco smoking had no effect on long-term clinimetric evaluation of patients both with ischemic stroke and hemorrhagic transformation. In smokers with hemorrhagic transformation higher mortality was associated with increased D-dimers concentration.