Muñoz-Rivas Nuria, Méndez-Bailón Manuel, Hernández-Barrera Valentín, de Miguel-Yanes José M, Jimenez-Garcia Rodrigo, Esteban-Hernández Jesus, Lopez-de-Andrés Ana
Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
Medicine Department, Hospital Clínico San Carlos, Madrid, Spain.
J Stroke Cerebrovasc Dis. 2016 Jun;25(6):1431-43. doi: 10.1016/j.jstrokecerebrovasdis.2016.02.031. Epub 2016 Mar 23.
The objective of this study is to compare trends in outcomes for intracerebral hemorrhagic stroke in people with or without type 2 diabetes in Spain between 2003 and 2012.
We selected all patients hospitalized for hemorrhagic stroke using national hospital discharge data. We evaluated annual incident rates stratified by diabetes status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, in-hospital mortality (IHM), length of hospital stay, and readmission rate in 1 month.
We identified a total of 173,979 discharges of patients admitted with hemorrhagic stroke (19.1% with diabetes). Incidences were higher among those with than those without diabetes in all the years studied. Diabetes was positively associated with stroke (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI] 1.35-1.40 for men; IRR = 1.31, 95% CI 1.29-1.34 for women). Length of stay decreased significantly and readmission rate remained stable for both groups (around 5%). We observed a significant increase in the use of decompressive craniectomy from 2002 to 2013. Mortality was positively associated with older age, with higher comorbidity and atrial fibrillation as risk factors. We found a negative association with the use of decompressive craniectomy. Mortality did not change over time among diabetic men and women. In those without diabetes, mortality decreased significantly over time. Suffering diabetes was not associated with higher mortality.
Type 2 diabetes is associated with higher incidence of hemorrhagic stroke but not with IHM. Incidence among diabetic people remained stable over time. In both groups, the use of decompressive craniectomy has increased and is associated with a decreased mortality.
本研究的目的是比较2003年至2012年间西班牙患有或未患有2型糖尿病的脑出血性卒中患者的预后趋势。
我们使用国家医院出院数据选择了所有因出血性卒中住院的患者。我们评估了按糖尿病状态分层的年度发病率。我们分析了诊断和治疗程序的使用趋势、患者合并症、住院死亡率（IHM）、住院时间和1个月内的再入院率。
我们共确定了173979例因出血性卒中入院患者的出院病例（19.1%患有糖尿病）。在所有研究年份中，糖尿病患者的发病率高于非糖尿病患者。糖尿病与卒中呈正相关（男性发病率比[IRR]=1.38，95%置信区间[CI]1.35-1.40；女性IRR=1.31，95%CI 1.29-1.34）。两组的住院时间均显著缩短，再入院率保持稳定（约5%）。我们观察到2002年至2013年间减压颅骨切除术的使用显著增加。死亡率与年龄较大、合并症较多和心房颤动呈正相关，是危险因素。我们发现与减压颅骨切除术的使用呈负相关。糖尿病男性和女性的死亡率随时间没有变化。在非糖尿病患者中，死亡率随时间显著下降。患糖尿病与较高的死亡率无关。
2型糖尿病与出血性卒中的较高发病率相关，但与住院死亡率无关。糖尿病患者的发病率随时间保持稳定。在两组中，减压颅骨切除术的使用都有所增加，且与死亡率降低相关。
