Wei Weimin, Li Suting, San Fulan, Zhang Shijun, Shen Qingyu, Guo Jianjun, Zhang Li
Department of Neurology Department of Emergency, The Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University), Guangzhou The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, China.
Medicine (Baltimore). 2018 Apr;97(15):e0412. doi: 10.1097/MD.0000000000010412.
To determine differences in 90-day mortality and identify risk factors among different etiological classifications of ischemic stroke using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification.Our retrospective analysis included 538 ischemic stroke patients. The cause of stroke was categorized according to the TOAST criteria, and 90-day mortality rates were obtained through the patient follow-up. Age, sex, previous medical history, and clinical features were used in the analysis of potential risk factors.There were 38 deaths during the 90-day follow-up period. Patients in the undetermined cause subgroups experienced significantly higher mortality rate than those in subgroups with small artery occlusion and large artery atherosclerosis. Factors independently associated with 90-day mortality for patients with the large artery atherosclerosis stroke subtype were age (95% confidence interval [CI], 1.010-1.192, P = .028), history of hypertension (95% CI, 3.030-99.136, P = .001), high blood glucose (95% CI, 1.273-2.354, P < .001), high cholesterol (95% CI, 0.017-0.462, P = .004), high uric acid (95% CI, 2.360-64.389, P = .003), and National Institute of Health Stroke Scale(95% CI, 1.076-1.312, P = .001). Age (95% CI, 1.012-1.358, P = .034) and high cholesterol (95% CI, 0.011-0.496, P = .007) were independently associated with 90-day mortality for patients with the small artery occlusion subtype of stroke.Our analysis identified that certain risk factors and 90-day mortality differ significantly among different stroke subtypes, as classified by the TOAST criteria. These risk factors must be considered carefully to provide the best clinical management of these patients and thus reduce mortality.
利用急性卒中治疗中ORG 10172试验（TOAST）分类法，确定缺血性卒中不同病因分类中的90天死亡率差异并识别风险因素。我们的回顾性分析纳入了538例缺血性卒中患者。根据TOAST标准对卒中病因进行分类，并通过患者随访获得90天死亡率。在分析潜在风险因素时使用了年龄、性别、既往病史和临床特征。在90天随访期内有38例死亡。病因未明亚组患者的死亡率显著高于小动脉闭塞亚组和大动脉粥样硬化亚组患者。大动脉粥样硬化性卒中亚型患者90天死亡率的独立相关因素为年龄（95%置信区间[CI]，1.010 - 1.192，P = 0.028）、高血压病史（95% CI，3.030 - 99.136，P = 0.001）、高血糖（95% CI，1.273 - 2.354，P < 0.001）、高胆固醇（95% CI，0.017 - 0.462，P = 0.004）、高尿酸（95% CI，2.360 - 64.389，P = 0.003）以及美国国立卫生研究院卒中量表评分（95% CI，1.076 - 1.312，P = 0.001）。年龄（95% CI，1.012 - 1.358，P = 0.034）和高胆固醇（95% CI，0.011 - 0.496，P = 0.007）是小动脉闭塞型卒中患者90天死亡率的独立相关因素。我们的分析表明，根据TOAST标准分类，不同卒中亚型之间某些风险因素和90天死亡率存在显著差异。必须仔细考虑这些风险因素，以便为这些患者提供最佳临床管理从而降低死亡率。
