Falsetti Lorenzo, Viticchi Giovanna, Tarquinio Nicola, Silvestrini Mauro, Capeci William, Catozzo Vania, Fioranelli Agnese, Buratti Laura, Pellegrini Francesco
Internal and Sub-intensive Medicine Department, A.O.U. "Ospedali Riuniti", Via Conca no. 10, Ancona, Italy.
Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
Neurol Sci. 2016 Sep;37(9):1443-8. doi: 10.1007/s10072-016-2602-1. Epub 2016 May 11.
Chronic diseases are increasing worldwide. Association of two or more chronic conditions is related with poor health status and reduced life expectancy, particularly among elderly patients. Comorbidities represent a risk factor for adverse events in several critical illnesses. We aimed to evaluate if elderly patients are affected by multiple chronic pathologies, assessed by Charlson comorbidity index (CCI), showed a reduced in-hospital survival after ischemic stroke. In a 3-year period, we evaluated all the subjects admitted to our internal medicine department for ischemic stroke. Age, sex, NIHSS score and all the comorbidities were recorded. Days of hospitalization, hospital-related infections and in-hospital mortality were also assessed. For each patient, we evaluated CCI, obtaining four classes: group 1 (CCI: 2-3), group 2 (CCI: 4-5), group 3 (CCI: 6-7) and group 4 (CCI: ≥8). Survival was evaluated with Kaplan-Meier and Cox regression analyses. The complete model considered in-hospital death as the main outcome, days of hospitalization as the time variable and CCI as the main predictor, adjusting for NIHSS, sex and nosocomial infections. Patients in CCI group 3 and 4 had an increased risk of in-hospital mortality, independently of NIHSS, sex and nosocomial infections. Elderly patients with multiple comorbidities have higher risk of in-hospital death when affected by ischemic stroke.
慢性病在全球范围内日益增多。两种或更多种慢性病并存与健康状况不佳和预期寿命缩短相关，在老年患者中尤为如此。合并症是几种危重病发生不良事件的危险因素。我们旨在评估通过查尔森合并症指数（CCI）评估的老年患者是否受多种慢性疾病影响，这些患者在缺血性中风后院内生存率是否降低。在3年期间，我们评估了所有因缺血性中风入住我们内科的患者。记录了年龄、性别、美国国立卫生研究院卒中量表（NIHSS）评分和所有合并症。还评估了住院天数、医院相关感染和院内死亡率。对于每位患者，我们评估了CCI，分为四类：第1组（CCI：2 - 3）、第2组（CCI：4 - 5）、第3组（CCI：6 - 7）和第4组（CCI：≥8）。采用Kaplan - Meier法和Cox回归分析评估生存率。完整模型将院内死亡作为主要结局，住院天数作为时间变量，CCI作为主要预测因素，并对NIHSS、性别和医院感染进行校正。CCI第3组和第4组的患者院内死亡风险增加，与NIHSS、性别和医院感染无关。患有多种合并症的老年患者在发生缺血性中风时院内死亡风险更高。
