Skafida Anastasia, Mitrakou Asimina, Georgiopoulos Georgios, Alevizaki Maria, Spengos Konstantinos, Takis Konstantinos, Ntaios George, Thomadakis Christos, Vemmos Konstantinos
Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Alexandra Hospital, Athens, Greece.
Department of Neurology, G. Gennimatas General Hospital, Athens, Greece.
Eur Stroke J. 2018 Jun;3(2):174-184. doi: 10.1177/2396987318765824. Epub 2018 Mar 16.
We aimed to assess alterations in glucose, blood pressure and temperature in acute ischaemic stroke and investigate their association with early all-cause mortality and functional outcome.
We studied all consecutive acute ischaemic stroke patients admitted in 2001-2010 to the Acute Stroke Unit, at Alexandra University Hospital, in Athens. Serial measurements were performed in the first seven days post-stroke and different parameters have been estimated: mean daily values, variability, subject-specific baseline levels and rate of change in serial measurements. Cox-proportional-hazards-model analysis and logistic-regression analysis were applied to investigate the association between these parameters and all-cause mortality and functional outcome after adjustment for known confounders of stroke outcome.
In 1271 patients (mean age 72.3 ± 11.2 years), after adjusting for confounders, baseline glucose levels (HR: 1.005, 95%CI: 1.001-1.01; 0.017), variability of systolic BP (SBP) as estimated by standard deviation (HR: 1.028, 95%CI: 1.01-1.048; 0.005), the baseline temperature (HR: 2.758, 95%CI: 2.067-3.68; 0.001) and the rate of temperature change (HR: 1.841, 95%CI: 1.616-2.908; 0.001) were independently associated with all-cause mortality within three months. Poor functional outcome was associated with subject-specific baseline values of temperature (OR: 1.743; 95%CI: 1.076-2.825; 0.024), the rate of SBP (OR: 1.159; 95% CI: 1.047-1.280; 0.004) and temperature change (OR: 1.402; 95% CI: 1.061-1.853; 0.018).
The main strength of our study is that we analysed simultaneously three parameters and we used four different variables for each parameter of interest.
Baseline glucose levels, variability of SBP and baseline temperature and its rate of change are independent predictors of all-cause mortality. Baseline values of temperature and the rate of changes in SBP and temperature are independent predictors of poor functional outcome.
我们旨在评估急性缺血性卒中患者的血糖、血压和体温变化，并研究它们与早期全因死亡率和功能结局的关联。
我们研究了2001年至2010年期间入住雅典亚历山德拉大学医院急性卒中单元的所有连续性急性缺血性卒中患者。在卒中后的头七天内进行了系列测量，并估算了不同参数：每日平均值、变异性、个体特异性基线水平以及系列测量中的变化率。应用Cox比例风险模型分析和逻辑回归分析，在对已知的卒中结局混杂因素进行调整后，研究这些参数与全因死亡率和功能结局之间的关联。
在1271例患者（平均年龄72.3±11.2岁）中，在对混杂因素进行调整后，基线血糖水平（风险比：1.005，95%置信区间：1.001 - 1.01；P = 0.017）、通过标准差估算的收缩压（SBP）变异性（风险比：1.028，95%置信区间：1.01 - 1.048；P = 0.005）、基线体温（风险比：2.758，95%置信区间：2.067 - 3.68；P = 0.001）以及体温变化率（风险比：1.841，95%置信区间：1.616 - 2.908；P = 0.001）与三个月内的全因死亡率独立相关。功能结局不良与个体特异性体温基线值（比值比：1.743；95%置信区间：1.076 - 2.825；P = 0.024）、SBP变化率（比值比：1.159；95%置信区间：1.047 - 1.280；P = 0.004）以及体温变化（比值比：1.402；95%置信区间：1.061 - 1.853；P = 0.018）相关。
我们研究的主要优势在于我们同时分析了三个参数，并且对每个感兴趣的参数使用了四个不同的变量。
基线血糖水平、SBP变异性、基线体温及其变化率是全因死亡率的独立预测因素。体温基线值以及SBP和体温的变化率是功能结局不良的独立预测因素。
