Foster Emma J, Barlas Raphae S, Wood Adrian D, Bettencourt-Silva Joao H, Clark Allan B, Metcalf Anthony K, Bowles Kristian M, Potter John F, Myint Phyo K
Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
Norfolk and Norwich University Hospital, Norwich, UK.
J Clin Neurol. 2017 Oct;13(4):411-421. doi: 10.3988/jcn.2017.13.4.411.
The risks of falls and fractures increase after stroke. Little is known about the prognostic significance of previous falls and fractures after stroke. This study examined whether having a history of either event is associated with poststroke mortality.
We analyzed stroke register data collected prospectively between 2003 and 2015. Eight sex-specific models were analyzed, to which the following variables were incrementally added to examine their potential confounding effects: age, type of stroke, Oxfordshire Community Stroke Project classification, previous comorbidities, frailty as indicated by the prestroke modified Rankin Scale score, and acute illness parameters. Logistic regression was applied to investigate in-hospital and 30-day mortality, and Cox proportional-hazards models were applied to investigate longer-term outcomes of mortality.
In total, 10,477 patients with stroke (86.1% ischemic) were included in the analysis. They were aged 77.7±11.9 years (mean±SD), and 52.2% were women. A history of falls was present in 8.6% of the men (n=430) and 20.2% of the women (n=1,105), while 3.8% (n=189) of the men and 12.9% of the women (n=706) had a history of both falls and fractures. Of the outcomes examined, a history of falls alone was associated with increased in-hospital mortality [odds ratio (OR)=1.33, 95% confidence interval (CI)=1.03-1.71] and 30-day mortality (OR=1.34, 95% CI=1.03-1.73) in women in the fully adjusted models. The Cox proportional-hazards models for longer-term outcomes and the history of falls and fractures combined showed no significant results.
The history of falls is an important factor for acute stroke mortality in women. A previous history of falls may therefore be an important factor to consider in the short-term stroke prognosis, particularly in women.
中风后跌倒和骨折的风险会增加。对于中风前跌倒和骨折的预后意义知之甚少。本研究探讨了既往有这两种情况之一是否与中风后死亡率相关。
我们分析了2003年至2015年期间前瞻性收集的中风登记数据。分析了八个性别特异性模型，并逐步添加以下变量以检查其潜在的混杂效应：年龄、中风类型、牛津郡社区中风项目分类、既往合并症、中风前改良Rankin量表评分所表明的虚弱程度以及急性疾病参数。应用逻辑回归分析住院死亡率和30天死亡率，应用Cox比例风险模型分析死亡率的长期结局。
总共10477例中风患者（86.1%为缺血性中风）纳入分析。他们的年龄为77.7±11.9岁（均值±标准差），52.2%为女性。8.6%的男性（n = 430）和20.2%的女性（n = 1105）有跌倒史，而3.8%的男性（n = 189）和12.9%的女性（n = 706）有跌倒和骨折史。在所检查的结局中，在完全调整模型中，仅跌倒史与女性住院死亡率增加相关[比值比（OR）= 1.33，95%置信区间（CI）= 1.03 - 1.71]和30天死亡率（OR = 1.34，95% CI = 1.03 - 1.73）。关于长期结局以及跌倒和骨折史合并情况的Cox比例风险模型未显示出显著结果。
跌倒史是女性急性中风死亡率的一个重要因素。因此，既往跌倒史可能是短期中风预后中需要考虑的一个重要因素，尤其是在女性中。
