急性缺血性卒中后90天初始卒中严重程度对死亡率、整体功能结局及住院安置的影响：一项三级医院卒中登记研究
The influence of initial stroke severity on mortality, overall functional outcome and in-hospital placement at 90 days following acute ischemic stroke: A tertiary hospital stroke register study.
作者信息
Bhaskar Sonu, Stanwell Peter, Bivard Andrew, Spratt Neil, Walker Rhonda, Kitsos Gemma H, Parsons Mark W, Evans Malcolm, Jordan Louise, Nilsson Michael, Attia John, Levi Christopher
机构信息
Department of Neurology, John Hunter Hospital, University of Newcastle; Centre for Translational Neuroscience and Mental Health, and Hunter Medical Research Institute (HMRI), University of Newcastle, Australia.
Centre for Translational Neuroscience and Mental Health, and Hunter Medical Research Institute (HMRI), University of Newcastle, Australia.
出版信息
Neurol India. 2017 Nov-Dec;65(6):1252-1259. doi: 10.4103/0028-3886.217947.
BACKGROUND AND PURPOSE
Epidemiological studies on the extent of the interaction and/or influence of stroke severity on clinical outcomes are important. The aim of the present study was to investigate the putative (and degree of) impact of initial stroke severity in predicting the overall functional outcome, in-hospital placement, and mortality in acute ischemic stroke (AIS) in comparison with age, admission to the stroke unit and thrombolytic treatment.
MATERIALS AND METHODS
The John Hunter Hospital acute stroke register was used to collect a retrospective cohort of AIS patients being assessed for reperfusion therapy and admitted between January 2006 and December 2013. Univariate and multivariate logistic regression and receiver operating characteristics analyses were used to assess associations with functional outcome, in-hospital placement, and mortality at 90 days.
RESULTS
608 AIS patients with complete datasets were included in the study. On univariate analysis, initial stroke severity showed the strongest independent association to the risk of death within 90 days (Odds ratio (OR) =1.15; P < 0.001; 95% confidence interval (CI) = [1.11, 1.18]); age was a less significant independent influence (OR = 1.02; P = 0.049; 95% CI = [1.00, 1.03]). Multivariate logistic regression analysis demonstrated that initial stroke severity independently predicted the 90 day mortality (OR = 1.16; 95% CI = [1.12, 1.2]; P < 0.0001) and unfavorable outcome (OR = 1.16; 95% CI = [1.13, 1.2]; P < 0.0001). Higher National Institute of Health Stroke Scale at admission was significantly associated with longer in-hospital placement (P < 0.0001).
CONCLUSIONS
In this acute stroke cohort, initial stroke severity had a major impact on the likelihood of death following an AIS and appears to be the dominant influence on the overall stroke outcome and in-hospital placement.
背景与目的
关于中风严重程度对临床结局的相互作用和/或影响程度的流行病学研究具有重要意义。本研究的目的是调查急性缺血性中风（AIS）初始中风严重程度在预测总体功能结局、住院安置和死亡率方面的假定（及程度）影响，并与年龄、入住中风单元和溶栓治疗进行比较。
材料与方法
使用约翰·亨特医院急性中风登记册收集2006年1月至2013年12月期间接受再灌注治疗评估并入院的AIS患者的回顾性队列。采用单因素和多因素逻辑回归以及受试者工作特征分析来评估与90天时的功能结局、住院安置和死亡率的关联。
结果
608例具有完整数据集的AIS患者纳入研究。单因素分析显示，初始中风严重程度与90天内死亡风险的独立关联最强（比值比（OR）=1.15；P<0.001；95%置信区间（CI）=[1.11,1.18]）；年龄的独立影响较小（OR = 1.02；P = 0.049；95% CI = [1.00, 1.03]）。多因素逻辑回归分析表明，初始中风严重程度可独立预测90天死亡率（OR = 1.16；95% CI = [1.12, 1.2]；P < 0.0001）和不良结局（OR = 1.16；95% CI = [1.13, 1.2]；P < 0.0001）。入院时较高的美国国立卫生研究院卒中量表评分与更长的住院时间显著相关（P < 0.0001）。
结论
在这个急性中风队列中，初始中风严重程度对AIS后的死亡可能性有重大影响，似乎是对总体中风结局和住院安置的主要影响因素。
Zotero 插件