Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.
Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
J Neurol. 2019 Jun;266(6):1526-1532. doi: 10.1007/s00415-019-09293-1. Epub 2019 Mar 26.
To explore risk factors contributing to 30-day and long-term survival in children with a first episode of arterial ischemic stroke (AIS).
Single center prospective observational study including 119 children aged between 30 days and 18 years, with a first episode of AIS between 2003 and 2015. Diagnosis was confirmed with magnetic resonance images. Outcomes included 30-day mortality and survival up to 8 years of follow-up. Demographic (e.g., gender, age), clinical (e.g., stroke severity measured by the Pediatric National Institute of Health Stroke Scale (NIHSS), clinical presentation, underlying conditions), radiological (e.g., involved circulation, location), and stroke recurrence data, were used to predict outcomes. Data analyses included logistic and Cox regression multivariate models with Firth's bias correction.
30-day mortality was 11.7% (n = 14). A total of 23 (19.3%) children died during the follow-up. 30-day mortality was only predicted by stroke severity (OR = 1.11, 95% CI = 1.02-1.26) in children > 2 years. Survival was predicted by stroke severity (HR = 1.05, 95% CI = 1.01-1.09), congenital heart disease (HR = 3.62, 95% CI = 1.33-10.93), prothrombotic states (HR = 3.51, 95% CI = 1.25-9.32), and anterior plus posterior circulation stroke (HR = 2.43, 95% CI = 1.42-4.61, p 0.026). Stroke recurrence (n= 23; 19.3%) was not a significant predictor of follow-up mortality.
This study identified groups with greater acute and long-term mortality after a first episode of AIS in childhood. Specific interventions focused on these risk groups may decrease mortality rates. Further studies need to confirm our findings by adding children from other centers.
探讨导致儿童首次动脉缺血性脑卒中（AIS）30 天和长期生存的危险因素。
这是一项包括 2003 年至 2015 年期间首次发生 AIS 的 119 名年龄在 30 天至 18 岁之间的儿童的单中心前瞻性观察性研究。诊断通过磁共振成像确认。结果包括 30 天死亡率和 8 年随访的生存情况。人口统计学（如性别、年龄）、临床（如由儿科国立卫生研究院卒中量表（NIHSS）测量的卒中严重程度、临床表现、基础疾病）、影像学（如受累循环、位置）和卒中复发数据用于预测结果。数据分析包括逻辑和 Cox 回归多变量模型，并用 Firth 偏置校正。
30 天死亡率为 11.7%（n=14）。共有 23 名（19.3%）儿童在随访期间死亡。30 天死亡率仅在>2 岁的儿童中被卒中严重程度（OR=1.11，95%CI=1.02-1.26）预测。卒中严重程度（HR=1.05，95%CI=1.01-1.09）、先天性心脏病（HR=3.62，95%CI=1.33-10.93）、血栓前状态（HR=3.51，95%CI=1.25-9.32）和前循环加后循环卒中（HR=2.43，95%CI=1.42-4.61，p=0.026）预测生存。卒中复发（n=23；19.3%）不是随访死亡率的显著预测因素。
本研究确定了儿童首次 AIS 后急性和长期死亡率较高的人群。针对这些风险人群的特定干预措施可能会降低死亡率。需要进一步的研究通过纳入来自其他中心的儿童来证实我们的发现。
