入院前使用口服双膦酸盐对卒中后30天死亡率的影响：一项基于人群的队列研究，涉及100,043例患者。
The impact of preadmission oral bisphosphonate use on 30-day mortality following stroke: a population-based cohort study of 100,043 patients.
作者信息
Christensen Diana Hedevang, Horváth-Puhó Erzsébet, Schmidt Morten, Christiansen Christian Fynbo, Pedersen Lars, Langdahl Bente Lomholt, Thomsen Reimar Wernich
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark ; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
出版信息
Clin Epidemiol. 2015 Aug 24;7:381-9. doi: 10.2147/CLEP.S85427. eCollection 2015.
PURPOSE
Bisphosphonate use has been associated with increased risk of fatal stroke. We examined the association between preadmission use of oral bisphosphonates and 30-day mortality following hospitalization for stroke.
PATIENTS AND METHODS
We conducted a nationwide population-based cohort study using medical databases and identified all patients in Denmark with a first-time hospitalization for stroke between 1 July 2004 and 31 December 2012 (N=100,043). Cox regression was used to compute adjusted hazard ratios as a measure of 30-day mortality rate ratios (MRRs) associated with bisphosphonate current use (prescription filled within 90 days prior to the stroke) or recent use (prescription filled in the 90-180 days prior to the stroke). Current use was further classified as new or long-term use.
RESULTS
We found 51,982 patients with acute ischemic stroke (AIS), 11,779 with intracerebral hemorrhage (ICH), 4,528 with subarachnoid hemorrhage (SAH), and 31,754 with unspecified stroke. Absolute 30-day mortality risks were increased among current vs nonusers of bisphosphonates for AIS (11.9% vs 8.5%), ICH (43.2% vs 34.5%), SAH (40.3% vs 23.2%), and unspecified strokes (18.8% vs 14.0%). However, in adjusted analyses, current bisphosphonate use did not increase 30-day mortality from AIS (MRR, 0.87; 95% confidence interval [CI]: 0.75, 1.01); ICH (MRR, 1.05; 95% CI: 0.90, 1.23); SAH (MRR, 1.15; 95% CI: 0.83, 1.61); or unspecified stroke (MRR, 0.94; 95% CI: 0.81, 1.09). Likewise, no association with mortality was found for recent use. Adjusted analyses by type of bisphosphonate showed increased mortality following stroke among new users of etidronate (MRR, 1.40; 95% CI: 1.01, 1.93) and reduced mortality after AIS among current users of alendronate (MRR, 0.87; 95% CI: 0.74, 1.02).
CONCLUSION
We found no overall evidence that preadmission bisphosphonate use increases 30-day mortality following stroke.
目的
双膦酸盐类药物的使用与致命性中风风险增加有关。我们研究了入院前口服双膦酸盐类药物的使用与中风住院后30天死亡率之间的关联。
患者与方法
我们利用医疗数据库开展了一项全国性的基于人群的队列研究，确定了2004年7月1日至2012年12月31日期间丹麦所有首次因中风住院的患者（N = 100,043）。采用Cox回归计算调整后的风险比，作为与双膦酸盐类药物当前使用（中风前90天内开具的处方）或近期使用（中风前90 - 180天内开具的处方）相关的30天死亡率比值（MRR）的衡量指标。当前使用进一步分为新使用或长期使用。
结果
我们发现51,982例急性缺血性中风（AIS）患者、11,779例脑出血（ICH）患者、4,528例蛛网膜下腔出血（SAH）患者以及31,754例未明确类型的中风患者。双膦酸盐类药物当前使用者与非使用者相比，AIS（11.9%对8.5%）、ICH（43.2%对34.5%）、SAH（40.3%对23.2%）和未明确类型中风（18.8%对14.0%）的30天绝对死亡风险增加。然而，在调整分析中，双膦酸盐类药物当前使用并未增加AIS（MRR，0.87；95%置信区间[CI]：0.75，1.01）、ICH（MRR，1.05；95% CI：0.90，1.23）、SAH（MRR，1.15；95% CI：0.83，1.61）或未明确类型中风（MRR，0.94；95% CI：0.81，1.09）的30天死亡率。同样，近期使用与死亡率也无关联。按双膦酸盐类药物类型进行的调整分析显示，依替膦酸新使用者中风后的死亡率增加（MRR，1.40；95% CI：1.01，1.
Zotero 插件