Kammersgaard Lars Peter, Jørgensen H S, Reith J, Nakayama H, Pedersen P M, Olsen T S
Stroke Unit, Hvidovre University Hospital, Copenhagen, Denmark.
Age Ageing. 2004 Mar;33(2):149-54. doi: 10.1093/ageing/afh052.
The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age as an independent predictor of short- and long-term outcome.
In the community-based Copenhagen Stroke Study we recorded admission clinical characteristics in 1197 consecutive stroke patients. Patients were stratified according to age groups on admission. Follow-up was performed at a mean of 7 years after stroke onset. By way of multiple logistic regression and survival analyses very old age was independently related to short- and long-term mortality and nursing home placement independent of other clinical characteristics.
16% of patients were 85 years or older at the time of stroke onset. More of the very old were women (75% versus 50%, P<0.0001), living alone (84% versus 54%, P<0.0001), had atrial fibrillation (37% versus 15%, P<0.0001), had pre-existing disability (29% versus 22%, P = 0.04), and had more severe strokes (Scandinavian Stroke Scale score 31 versus 37 points, P = 0.004). Fewer very old had hypertension (25% versus 34%, P = 0.02) and diabetes (14% versus 22%, P = 0.01). In adjusted multiple regression models, very old age predicted short-term mortality (OR 2.5; 95% CI 1.5-4.2), and discharge to nursing home or in-hospital mortality (OR 2.7; 95% CI 1.7-4.4). Five years after stroke very old age predicted mortality or nursing home placement (OR 3.9; 95% CI 2.1-7.3), and long-term mortality (HR 2.0; 95% CI 1.6-2.5). However, other factors such as onset stroke severity, pre-existing disability and atrial fibrillation were also significant independent predictors of prognosis after stroke.
In this study very old age per se was a strong predictor of outcome and mortality after stroke. Apart from very old age, factors such as prestroke medical and functional status, and onset stroke severity should be taken into consideration when planning treatment and rehabilitation after stroke.
在世界工业化地区，高龄人群预计将在卒中患者群体中占比不断增加。本研究旨在评估卒中发病时年龄在85岁及以上患者的临床特征，并探讨高龄作为短期和长期预后独立预测因素的情况。
在基于社区的哥本哈根卒中研究中，我们记录了1197例连续卒中患者的入院临床特征。患者在入院时按年龄组分层。在卒中发病后平均7年进行随访。通过多因素逻辑回归和生存分析，高龄与短期和长期死亡率以及养老院安置独立相关，且不受其他临床特征影响。
16%的患者在卒中发病时年龄为85岁或以上。高龄患者中女性更多（75%对50%，P<0.0001），独居者更多（84%对54%，P<0.0001），患有房颤者更多（37%对15%，P<0.0001），有既往残疾者更多（29%对22%，P = 0.04），且卒中更严重（斯堪的纳维亚卒中量表评分31分对37分，P = 0.004）。高龄患者中患有高血压（25%对34%，P = 0.02）和糖尿病（14%对22%，P = 0.01）的较少。在调整后的多因素回归模型中，高龄可预测短期死亡率（比值比2.5；95%置信区间1.5 - 4.2），以及出院至养老院或院内死亡率（比值比2.7；95%置信区间1.7 - 4.4）。卒中后5年，高龄可预测死亡率或养老院安置（比值比3.9；95%置信区间2.1 - 7.3），以及长期死亡率（风险比2.0；95%置信区间1.6 - 2.5）。然而，其他因素如发病时卒中严重程度、既往残疾和房颤也是卒中后预后的重要独立预测因素。
在本研究中，高龄本身是卒中后预后和死亡率的有力预测因素。除高龄外，在规划卒中后的治疗和康复时，还应考虑卒中前的医疗和功能状态以及发病时卒中严重程度等因素。
