From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
Neurology. 2018 Nov 13;91(20):e1909-e1917. doi: 10.1212/WNL.0000000000006510. Epub 2018 Oct 12.
We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW.
Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were included. Data on periods of payment came from the Finnish Centre for Pensions, and death data from Statistics Finland. Multivariate logistic regression analyses assessed factors associated with NRTW 1 year after IS, and lasagna plots visualized the proportion of patients returning to work over time.
We included a total of 769 patients, of whom 289 (37.6%) were not working at 1 year, 323 (42.0%) at 2 years, and 361 (46.9%) at 5 years from IS. When adjusted for age, sex, socioeconomic status, and NIH Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.
NRTW is a frequent adverse outcome after IS in young adults with mild to moderate IS. Clinical variables available during acute hospitalization may allow prediction of NRTW.
我们旨在调查缺血性卒中（IS）后 1 年及随访期间未重返工作岗位（NRTW）的年轻患者比例，以及与 NRTW 相关的临床因素。
纳入来自赫尔辛基青年卒中登记处的患者，这些患者在 1994 年至 2007 年期间发生 IS，在 IS 发生前 1 年内有薪酬工作，且在出院时 NIH 卒中量表评分≤15 分。薪酬数据来自芬兰养老金中心，死亡数据来自芬兰统计局。多变量逻辑回归分析评估了与 IS 后 1 年 NRTW 相关的因素，拉扎尼图可视化了患者随时间重返工作岗位的比例。
我们共纳入了 769 例患者，其中 289 例（37.6%）在 IS 后 1 年时未工作，323 例（42.0%）在 2 年时，361 例（46.9%）在 5 年时未工作。在校正年龄、性别、社会经济地位和入院时 NIH 卒中量表评分后，与 IS 后 1 年 NRTW 相关的因素包括大前循环卒中、大动脉粥样硬化引起的卒中、高风险心源性栓塞源和罕见病因（而非不明病因）、中重度失语症与无失语症、轻度和中重度至重度肢体瘫痪与无瘫痪、中重度至重度视野缺损与无缺损。
在轻度至中度 IS 的年轻成年人中，NRTW 是 IS 的常见不良后果。急性住院期间可用的临床变量可能允许预测 NRTW。
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