Desai Rupak, Patel Upenkumar, Rupareliya Chintan, Singh Sandeep, Shah Manan, Patel Rikinkumar S, Patel Smit, Mahuwala Zabeen
Research Coordinator, Atlanta Veterans Affairs Medical Center.
Public Health, National University.
Cureus. 2017 Aug 2;9(8):e1536. doi: 10.7759/cureus.1536.
Cocaine is the third most common substance of abuse after cannabis and alcohol. The use of cocaine as an illicit substance is implicated as a causative factor for multisystem derangements ranging from an acute crisis to chronic complications. Vasospasm is the proposed mechanism behind adverse events resulting from cocaine abuse, acute ischemic strokes (AIS) being one of the few. Our study looked into in-hospital outcomes owing to cocaine use in the large population based study of AIS patients. Using the national inpatient sample (NIS) database from 2014 of United States of America, we identified AIS patients with cocaine use using International Classification of Disease, Ninth Revision (ICD-9) codes. We compared demographics, mortality, in-hospital outcomes and comorbidities between AIS with cocaine use cohort versus AIS without cocaine use cohort. Acute ischemic strokes (AIS) with cocaine group consisted of higher number of older patients (> 85 years) (25.6% versus 18.7%, p <0.001) and females (52.4% versus 51.0%, p <0.001). Cocaine cohort had higher incidence of valvular disorders (13.2% versus 9.7%, p <0.001), venous thromboembolism (3.5% versus 2.6%, p<0.03), vasculitis (0.9% versus 0.4%, p <0.003), sudden cardiac death (0.4% versus 0.2%, p<0.02), epilepsy (10.1% versus 7.4%, p <0.001) and major depression (13.2% versus 10.7%, p<0.007). The multivariate logistic regression analysis found cocaine use to be the major risk factor for hospitalization in AIS cohort. In-hospital mortality (odds ratio (OR)= 1.4, 95% confidence interval= 1.1-1.9, p <0.003) and the disposition to short-term hospitals (odds ratio (OR)= 2.6, 95% confidence interval = 2.1-3.3, p <0.001) were also higher in cocaine cohort. Venous thromboembolism was observed to be linked with cocaine use (OR= 1.5, 95% confidence interval= 1.0-2.1, p < 0.01) but less severely than vasculitis (OR= 3.0, 95% confidence interval= 1.6-5.8, p <0.001). Further prospective research is warranted in this direction to improve the outcomes for AIS and lessen the financial burden on the healthcare system of the United States.
可卡因是仅次于大麻和酒精的第三大最常见滥用物质。将可卡因用作非法物质被认为是导致多系统紊乱的一个致病因素，这些紊乱涵盖从急性危机到慢性并发症的范围。血管痉挛被认为是可卡因滥用导致不良事件背后的机制，急性缺血性中风（AIS）是其中少数情况之一。我们的研究在基于大样本人群的AIS患者研究中调查了因使用可卡因导致的住院结局。利用美国2014年的国家住院样本（NIS）数据库，我们使用国际疾病分类第九版（ICD - 9）编码识别出使用可卡因的AIS患者。我们比较了使用可卡因的AIS队列与未使用可卡因的AIS队列之间的人口统计学特征、死亡率、住院结局和合并症。使用可卡因的急性缺血性中风（AIS）组中年龄较大患者（>85岁）数量更多（25.6%对18.7%，p<0.001），女性数量也更多（52.4%对51.0%，p<0.001）。使用可卡因的队列中瓣膜疾病发生率更高（13.2%对9.7%，p<0.001）、静脉血栓栓塞发生率更高（3.5%对2.6%，p<0.03）、血管炎发生率更高（0.9%对0.4%，p<0.003）、心源性猝死发生率更高（0.4%对0.2%，p<0.02）、癫痫发生率更高（10.1%对7.4%，p<0.001）以及重度抑郁症发生率更高（13.2%对10.7%，p<0.007）。多因素逻辑回归分析发现使用可卡因是AIS队列中住院的主要危险因素。使用可卡因的队列中住院死亡率（比值比（OR）=1.4，95%置信区间=1.1 - 1.9，p<0.003）以及转至短期医院的比例（比值比（OR）=2.6，95%置信区间 = 2.1 - 3.3，p<0.001）也更高。观察到静脉血栓栓塞与使用可卡因有关（OR=1.5，95%置信区间=1.0 - 2.1，p<0.01），但严重程度低于血管炎（OR=3.0，95%置信区间=1.6 - 5.8，p<0.001）。有必要在这个方向上进行进一步的前瞻性研究，以改善AIS的结局并减轻美国医疗保健系统的经济负担。
