Serrano-Villar Sergio, Fresco Gema, Ruiz-Artacho Pedro, Bravo Ana, Valencia Cristina, Fuentes-Ferrer Manuel, Estrada Vicente, Porta-Etessam Jesús
Servicio de Medicina Interna III, Hospital Clínico San Carlos, Madrid, España.
Med Clin (Barc). 2013 Jan 19;140(2):53-8. doi: 10.1016/j.medcli.2012.05.036. Epub 2012 Sep 15.
The incidence of stroke in the very old is increasing. However, there are very few data regarding the differences in the management and outcomes in Spain.
We analyzed the clinical characteristics, diagnostic and therapeutic procedures, medical complications and intrahospitalary mortality in 463 subjects admitted because of ischemic stroke between 2009 and 2010. Very-old patients (≥ 85 year-old) were compared with younger patients.
Very old patients showed on admission higher frequency of atrial fibrillation (34 vs 19%, P>.001) and lower use of antiplatelet agents and oral anticoagulants (P<.001). Disability and stroke severity were higher among the very old (P<.001) and the use of diagnostic and therapeutic procedures was significantly lower (P<.001). The length of stay was longer in the very old (12 [6-24] days vs 8 [5-15], P<.001), as wells as the intrahospitalary mortality (27 vs 6%, P<.001). After a multivariate analysis, independent predictive factors of mortality were previous disability, measured by the modified Rankin scale (95% confidence interval [95%CI] 1.6-10.7), impaired level of consciousness (IC95% 2.1-13.9) and stroke severity measured by the National Institutes of Health Stroke Scale (95%CI 1.8-38.1).
Very old patients admitted with ischemic stroke undergo less diagnostic and therapeutic procedures. However, in our study, very old age was not an independent predictor of mortality, which was essentially determined by previous functional status and stroke severity.
高龄人群中风的发病率正在上升。然而，关于西班牙在中风管理和预后方面的差异，相关数据非常少。
我们分析了2009年至2010年间因缺血性中风入院的463名患者的临床特征、诊断和治疗程序、医疗并发症及院内死亡率。将高龄患者（≥85岁）与年轻患者进行比较。
高龄患者入院时房颤发生率更高（34%对19%，P>0.001），抗血小板药物和口服抗凝剂的使用较少（P<0.001）。高龄患者的残疾程度和中风严重程度更高（P<0.001），诊断和治疗程序的使用显著更低（P<0.001）。高龄患者的住院时间更长（12[6 - 24]天对8[5 - 15]天，P<0.001），院内死亡率也更高（27%对6%，P<0.001）。多因素分析后，死亡率的独立预测因素为改良Rankin量表测量的既往残疾（95%置信区间[95%CI]1.6 - 10.7）、意识水平受损（IC95% 2.1 - 13.9）以及美国国立卫生研究院卒中量表测量的中风严重程度（95%CI 1.8 - 38.1）。
因缺血性中风入院的高龄患者接受的诊断和治疗程序较少。然而，在我们的研究中，高龄并非死亡率的独立预测因素，死亡率主要由既往功能状态和中风严重程度决定。
