Alcázar Lázaro Victoria, del Ser Quijano Teodoro, Barba Martín Raquel
Endocrinology Department, Hospital Severo Ochoa, Leganés, Madrid, Spain.
Nutr Hosp. 2013 Mar-Apr;28(2):456-63. doi: 10.3305/nh.2013.28.2.6301.
The aim of this study was to investigate whether hypoalbuminemia and other risk factors for mortality after stroke have the same or different short (1 month), medium (3 months), long (1 year) or very long term (5 years) prognostic value.
SUBJECTS/METHODS: clinical and analytical data from 254 patients admitted to our Hospital with an ischemic stroke and followed up prospectively for 2 years were collected with a prospective standard protocol. Additional data up to 5 years were obtained from Clinical and Laboratory Registries of the Hospital, a mailed questionnaire, a phone call and the Council Registry of Mortality. Risk factors for mortality at different time points were calculated with logistic regression and Cox proportional hazard analyses.
The following factors were significantly associated with mortality at one month: cardioembolic mechanism, hypoalbuminemia, glycemia, age, low diastolic arterial pressure and Canadian Scale, at three months: previous stroke and Barthel index at discharge, at one year: previous dementia and Barthel index at three months and at five years: age, Canadian Scale score at discharge and low cholesterol at admission. Cox regression analysis considering survival time showed hypoalbuminemia at admission (hazard ratio (HR) 2; p = 0.03), age (HR 1.06; p < 0.00), previous dementia (HR 2; p < 0.00), cardioembolic mechanism (HR 2; p < 0.00) and severity on the Canadian Neurological Stroke Scale (HR 1.2; p < 0.00) to be independently associated with mortality.
Mortality after ischemic stroke seems to depend on different factors along time. Hypoalbuminemia at admission is an independent factor for short term (acute) and global mortality. Other risk factors for global mortality were previous dementia, cardioembolic mechanism and severity on the Canadian Neurological Stroke Scale at admittance.
本研究旨在调查低白蛋白血症及其他卒中后死亡风险因素在短期（1个月）、中期（3个月）、长期（1年）或极长期（5年）是否具有相同或不同的预后价值。
受试者/方法：采用前瞻性标准方案收集了254例因缺血性卒中入住我院并进行了2年前瞻性随访的患者的临床和分析数据。另外从医院临床和实验室登记处、邮寄问卷、电话及死亡登记处获取了长达5年的额外数据。采用逻辑回归和Cox比例风险分析计算不同时间点的死亡风险因素。
以下因素与1个月时的死亡率显著相关：心源性栓塞机制、低白蛋白血症、血糖、年龄、低舒张压及加拿大神经功能缺损量表评分；与3个月时的死亡率显著相关：既往卒中及出院时的巴氏指数；与1年时的死亡率显著相关：既往痴呆及3个月时的巴氏指数；与5年时的死亡率显著相关：年龄、出院时加拿大神经功能缺损量表评分及入院时低胆固醇水平。考虑生存时间的Cox回归分析显示，入院时低白蛋白血症（风险比[HR] 2；p = 0.03）、年龄（HR 1.06；p < 0.00）、既往痴呆（HR 2；p < 0.00）、心源性栓塞机制（HR 2；p < 0.00）及加拿大神经卒中量表严重程度（HR 1.2；p < 0.00）与死亡率独立相关。
缺血性卒中后的死亡率似乎随时间取决于不同因素。入院时低白蛋白血症是短期（急性期）及总体死亡率的独立因素。总体死亡率的其他风险因素为既往痴呆、心源性栓塞机制及入院时加拿大神经卒中量表的严重程度。
