Kortazar-Zubizarreta Izaro, Pinedo-Brochado Ana, Azkune-Calle Itxaso, Aguirre-Larracoechea Urko, Gomez-Beldarrain Marian, Garcia-Monco Juan Carlos
Department of Neurology Hospital de Galdakao Galdakao Bizkaia Spain.
REDISSEC, Health Services Research on Chronic Patients Network Research Unit, Hospital de Galdakao Galdakao Bizkaia Spain.
Health Sci Rep. 2019 Feb 17;2(4):e110. doi: 10.1002/hsr2.110. eCollection 2019 Apr.
Stroke is the second leading cause of death around the globe. Studies examining the predictors of in-hospital mortality and the impact of complications on early outcome of acute ischemic stroke are scant. The aim of this study was to identify predictors of in-hospital mortality in patients with acute ischemic stroke.
This was a prospective, single-center study of patients with acute ischemic stroke consecutively admitted to the Neurology Department of a general hospital during a 2-year period (from January 1, 2010 to December 31, 2011). Prospective data from this single-center study included variables related to sociodemographics, comorbidities, and medical complications, together with in-hospital mortality. Since stroke mortality may impact differently by sex and is also influenced by hospital length of stay, we proceeded to stratify by these variables.
Six-hundred and seventy-three patients were included. Overall, in-hospital mortality rate was 7.13%. Stratifying by length of stay in-hospital (< 7 days and ≥ 7 days), we observed that within the first week, overall mortality was related to a history of previous stroke, higher stroke severity, and to cardiovascular and respiratory complications. After 7 days, the main factor independently associated with overall in-hospital mortality was stroke severity (National Institutes of Health Stroke Scale (NIHSS) ≥ 14, odds ratio (OR): 17.15; 95% CI, 3.06-96.07).Stratifying by sex, we observed that females had a worse outcome if there was a history of prior stroke (OR: 3.29; 95% CI, 1.19-9.10), higher stroke severity (NIHSS ≥ 14, OR: 16.63; 95% CI, 4.66-59.31), and cardiovascular complications (OR: 29.70; 95% CI, 5.70-154.8). Among men, stroke severity (NIHSS ≥ 14, OR: 23.19; 95% CI, 5.69-94.56), respiratory infections (OR: 3.84; 95% CI, 1.32-11.20), and older age had significant negative impact.
Stroke severity and potentially modifiable complications (respiratory infections and cardiovascular complications) confer an increased risk of in-hospital death in both women and men, particularly during the first week of admission.
中风是全球第二大致死原因。关于急性缺血性中风患者院内死亡率预测因素以及并发症对其早期预后影响的研究较少。本研究旨在确定急性缺血性中风患者院内死亡的预测因素。
这是一项前瞻性单中心研究，研究对象为在两年期间（2010年1月1日至2011年12月31日）连续入住一家综合医院神经内科的急性缺血性中风患者。该单中心研究的前瞻性数据包括与社会人口统计学、合并症、医疗并发症相关的变量以及院内死亡率。由于中风死亡率可能因性别而异，且受住院时间影响，我们按这些变量进行分层分析。
共纳入673例患者。总体而言，院内死亡率为7.13%。按住院时间分层（<7天和≥7天），我们观察到在第一周内，总体死亡率与既往中风史、中风严重程度更高以及心血管和呼吸系统并发症有关。7天后，与总体院内死亡率独立相关的主要因素是中风严重程度（美国国立卫生研究院卒中量表（NIHSS）≥14，比值比（OR）：17.15；95%置信区间，3.06 - 96.07）。按性别分层，我们观察到如果女性有既往中风史（OR：3.29；95%置信区间，1.19 - 9.10）、中风严重程度更高（NIHSS≥14，OR：16.63；95%置信区间，4.66 - 59.31）以及有心血管并发症（OR：29.70；95%置信区间，5.70 - 154.8），其预后更差。在男性中，中风严重程度（NIHSS≥14，OR：23.19；95%置信区间，5.69 - 94.56）、呼吸道感染（OR：3.84；95%置信区间，1.32 - 11.20）和年龄较大有显著负面影响。
中风严重程度以及潜在可改变的并发症（呼吸道感染和心血管并发症）会增加男性和女性院内死亡风险，尤其是在入院的第一周。
