Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Swiss Med Wkly. 2010 May 1;140(17-18):254-9. doi: 10.4414/smw.2010.12919.
The study set out to identify clinical, laboratory and radiological predictors of early mortality after an acute ischaemic stroke (AIS) and to analyse medical and neurological complications that caused death.
A total of 479 consecutive patients (mean age 63+/-14 years) with AIS underwent stroke examination and treatment. Examination included clinical evaluation, laboratory tests, and brain CT and/or MRI. Follow-up data at 30 days were available for 467 patients (93%) who were included in the present analysis.
The median National Institute of Health Stroke Study (NIHSS) score on admission was 6. A total of 62 patients (13%) died within 30 days. The cause of death was the initial event in 43 (69%), pneumonia in 12 (19%), intracerebral haemorrhage in 9 (15%), recurrent stroke in 6 (10%), myocardial infarction in 2 (3%), and cancer in 1 (2%) of the patients. In univariate comparisons, advanced age (p<0.001), hypertension (p=0.013), coronary disease (p=0.001), NIHSS score (p<0.001), undetermined stroke etiology (p=0.031), relevant co-morbidities (p=0.008), hyperglycemia (p<0.001), atrial fibrillation (p<0.001), early CT signs of ischemia (p<0.001), dense artery sign (p<0.001), proximal vessel occlusion (p<0.001), and thrombolysis (p=0.008) were associated with early mortality. In multivariate analysis, advanced age (HR=1.12; 95% CI 1.05-1.19; p<0.001) and high NIHSS score on admission (HR=1.15, 95% CI 1.05-1.25; p=0.002) were independent predictors of early mortality.
We report 13% mortality at 30 days after AIS. More than two thirds of the deaths are related to the initial stroke. Advanced age and high NIHSS score are the only independent predictors of early mortality in this series.
本研究旨在确定急性缺血性脑卒中（AIS）后早期死亡的临床、实验室和影像学预测因素，并分析导致死亡的医疗和神经并发症。
共纳入 479 例连续 AIS 患者（平均年龄 63+/-14 岁），进行卒中检查和治疗。检查包括临床评估、实验室检查以及脑 CT 和/或 MRI。467 例（93%）患者在 30 天时有随访数据，纳入本分析。
入院时的美国国立卫生研究院卒中量表（NIHSS）中位数为 6 分。共有 62 例（13%）患者在 30 天内死亡。死亡原因是初始事件的 43 例（69%），肺炎的 12 例（19%），颅内出血的 9 例（15%），复发性卒中的 6 例（10%），心肌梗死的 2 例（3%），以及癌症的 1 例（2%）。单因素比较显示，高龄（p<0.001）、高血压（p=0.013）、冠心病（p=0.001）、NIHSS 评分（p<0.001）、未明确病因的卒中（p=0.031）、相关合并症（p=0.008）、高血糖（p<0.001）、心房颤动（p<0.001）、早期 CT 缺血征象（p<0.001）、致密动脉征（p<0.001）、近端血管闭塞（p<0.001）和溶栓治疗（p=0.008）与早期死亡率相关。多因素分析显示，高龄（HR=1.12；95%CI 1.05-1.19；p<0.001）和入院时高 NIHSS 评分（HR=1.15，95%CI 1.05-1.25；p=0.002）是早期死亡率的独立预测因素。
我们报告 AIS 后 30 天死亡率为 13%。三分之二以上的死亡与初始卒中有关。在本系列中，高龄和高 NIHSS 评分是早期死亡的唯一独立预测因素。
