Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Stroke. 2011 Oct;42(10):2806-12. doi: 10.1161/STROKEAHA.111.619049. Epub 2011 Aug 4.
Predictors of early case-fatality (3-day, 7-day, and 30-day) in first-ever ischemic stroke were identified and compared with predictors of late case-fatality (90-day and 1-year).
A registry designed to register hospitalized patients with stroke in Denmark 2000 to 2007 holds 26,818 patients with first-ever ischemic stroke with information on stroke severity (Scandinavian Stroke Scale), CT scan, cardiovascular risk factors, marital status, and fatality within 1 year. Multiple logistic regression was used in identifying predictors.
Mean age was 71.2 years; 48.5% were women; mean Scandinavian Stroke Scale score was 43.9. Early case-fatality showed stroke severity and age were significant predictors of 3-day, 7-day, and 30-day case-fatality (nonlinear effect). In addition, atrial fibrillation (OR, 1.56) predicted 30-day case-fatality. For late case-fatality, significant predictors of 90-day and 1-year case-fatality were age, stroke severity (nonlinear effect), atrial fibrillation (OR, 1.37 and 1.57), and diabetes (OR, 1.35 and 1.33), respectively. Male gender (OR, 1.28), previous myocardial infarction (OR, 1.40), and smoking (OR, 1.21) were also associated with 1-year case-fatality. Alcohol consumption, hypertension, intermittent arterial claudication, and marital state had no influence. All case-fatality rates accelerated with increasing age, but 3-day and 7-day case-fatality rates tended to level off or decline at the highest ages.
Age and stroke severity were the only significant predictors of fatality within the first poststroke week; they were associated with late case-fatality as well. Cardiovascular risk factors were associated with late case-fatality; with the exception of atrial fibrillation, they were not significantly associated with early case-fatality rates.
本研究旨在识别并比较首发缺血性脑卒中患者的早期病死率（3 天、7 天和 30 天）和晚期病死率（90 天和 1 年）的预测因素。
一项旨在登记 2000 年至 2007 年丹麦住院卒中患者的登记研究共纳入 26818 例首发缺血性脑卒中患者，记录了患者的卒中严重程度（斯堪的纳维亚卒中量表）、CT 扫描、心血管危险因素、婚姻状况和 1 年内的病死率。采用多因素逻辑回归分析识别预测因素。
患者平均年龄为 71.2 岁，48.5%为女性，平均斯堪的纳维亚卒中量表评分为 43.9。早期病死率显示，卒中严重程度和年龄是 3 天、7 天和 30 天病死率的显著预测因素（非线性效应）。此外，心房颤动（OR=1.56）预测 30 天病死率。对于晚期病死率，年龄、卒中严重程度（非线性效应）、心房颤动（OR=1.37 和 1.57）、糖尿病（OR=1.35 和 1.33）是 90 天和 1 年病死率的显著预测因素。男性（OR=1.28）、既往心肌梗死（OR=1.40）和吸烟（OR=1.21）也与 1 年病死率相关。饮酒、高血压、间歇性动脉跛行和婚姻状况对病死率无影响。所有病死率均随年龄增长而增加，但 3 天和 7 天病死率在高龄时趋于稳定或下降。
年龄和卒中严重程度是卒中后第一周内死亡的唯一显著预测因素，与晚期病死率也相关。心血管危险因素与晚期病死率相关，但除心房颤动外，与早期病死率无显著相关性。
