Lee Won Chan, Joshi Ashish V, Wang Qin, Pashos Chris L, Christensen Michael C
HERQuLES, Abt Associates Inc, Bethesda, MD 20814-5341, USA.
Adv Ther. 2007 Mar-Apr;24(2):258-68. doi: 10.1007/BF02849893.
The long-term outcomes of hemorrhagic stroke (HS), which includes subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), are not well understood relative to ischemic stroke (IS). This analysis was undertaken to assess short and long-term survival and morbidity of patients with hemorrhagic stroke, as well as risk factors associated with these outcomes. American Medicare beneficiaries >65 y of age in whom SAH, ICH, or IS was diagnosed were identified and followed over 4 y through the use of longitudinal claims data. Primary endpoints consisted of survival, recurrence of stroke, and readmission. A survival analysis estimated long-term survival. Logistic regression and Cox proportional hazards models identified factors associated with recurrence and death. A total of 11,430 patients with SAH (3.0%), ICH (17.1%), or IS (79.9%) were identified. At stroke onset, about 45% of SAH and ICH cohorts had congestive heart failure, about 50% had diabetes, and more than 90% had hypertension. In comparison, 30% of the IS cohort had congestive heart failure, 32%, diabetes, and 75%, hypertension. Acute in hospital mortality rates were 31.9%, 25.6%, and 6.8% for SAH, ICH, and IS, respectively; estimated median survival through 4 y was 256 d for SAH, 353 d for ICH, and 533 d for IS. The recurrence rate was highest among patients with SAH. Those with HS tended to be younger than those with IS and had a greater number of comorbidities at the time of stroke. Among the elderly, patients with HS have a substantially worse prognosis than do those with IS, which highlights the need for more effective treatment of patients with HS.
与缺血性中风（IS）相比，包括蛛网膜下腔出血（SAH）和脑出血（ICH）在内的出血性中风（HS）的长期预后尚不清楚。本分析旨在评估出血性中风患者的短期和长期生存率及发病率，以及与这些预后相关的危险因素。通过纵向理赔数据，识别并随访了年龄>65岁、被诊断为SAH、ICH或IS的美国医疗保险受益人，随访时间超过4年。主要终点包括生存率、中风复发率和再入院率。生存分析估计长期生存率。逻辑回归和Cox比例风险模型确定了与复发和死亡相关的因素。共识别出11430例SAH（3.0%）、ICH（17.1%）或IS（79.9%）患者。在中风发作时，SAH和ICH队列中约45%的患者患有充血性心力衰竭，约50%的患者患有糖尿病，超过90%的患者患有高血压。相比之下，IS队列中30%的患者患有充血性心力衰竭，32%的患者患有糖尿病，75%的患者患有高血压。SAH、ICH和IS的急性住院死亡率分别为31.9%、25.6%和6.8%；SAH患者4年的估计中位生存期为256天，ICH患者为353天，IS患者为533天。SAH患者的复发率最高。HS患者往往比IS患者年轻，中风时合并症更多。在老年人中，HS患者的预后明显比IS患者差，这突出表明需要对HS患者进行更有效的治疗。
