Emergency Medicine Department, Nemazee Hospital, Shiraz, Iran.
Emergency Medicine Department, Rajaee Hospital, Shiraz, Iran.
J Clin Neurosci. 2019 Nov;69:245-249. doi: 10.1016/j.jocn.2019.07.031. Epub 2019 Sep 18.
BACKGROUND/OBJECTIVE: Stroke is the second leading cause of death globally that predisposed to sepsis. Therefore, this study was aimed to assess the risk factors and epidemiologic features of sepsis in ischemic stroke patients admitted to ICUs.
Throughout this prospective study, we investigated all severe ischemic stroke patients admitted to ICUs of Namazi and Ali-Ashghar Hospitals in Shiraz. After ICU admission and diagnosing stroke by a neurologist according to NIHSS (National Institute of Health Stroke Scale) criteria, sepsis work-up was performed in all patients suspected to have sepsis. Then the incidence of sepsis and its risk factors in ICU admitted stroke patients were determined.
A total of 149 patients were screened in this study. The mean age of the participants was 65.37 ± 15.40 years old and 57.4% of them were male. Hypertension was the most common coexistent disease (74.6%) in stroke patients. Seventy-six patients (62.3%) were diagnosed with sepsis and pneumonia was the most common infection leading to sepsis in stroke patients. Our data showed significant differences between two groups in terms of APACHE-IV score (P < 0.001), NIHSS and APS (P < 0.001) before ICU admission (P < 0.001) and NIHSS at admission (P < 0.001); however, age (P = 0.07) and sex (P = 0.17) were not significantly different between the groups. Logistic regression analysis displayed that severe stroke (NIHSS = 21-42, OR = 49.09) and severe loss of consciousness (GCS < 8, OR = 27.95) at admission were the most essential predictive factors for sepsis after ischemic stroke.
This study showed that ICU patients with severe ischemic stroke were more susceptible to sepsis during the hospital course.
背景/目的：卒中是全球第二大致死病因，易并发脓毒症。因此，本研究旨在评估 ICU 收治的缺血性卒中患者发生脓毒症的危险因素和流行病学特征。
在这项前瞻性研究中，我们调查了所有入住设拉子纳马齐和阿里阿什加尔医院 ICU 的严重缺血性卒中患者。在 ICU 收治后，由神经科医生根据 NIHSS（美国国立卫生研究院卒中量表）标准诊断为卒中，对所有疑似脓毒症的患者进行脓毒症检查。然后确定 ICU 收治的卒中患者中脓毒症的发生率及其危险因素。
本研究共筛选了 149 例患者。参与者的平均年龄为 65.37±15.40 岁，其中 57.4%为男性。高血压是卒中患者最常见的并存疾病（74.6%）。76 例（62.3%）患者被诊断为脓毒症，卒中患者中导致脓毒症最常见的感染是肺炎。我们的数据显示，在 ICU 收治前，两组在 APACHE-IV 评分（P<0.001）、NIHSS 和 APS（P<0.001）方面存在显著差异（P<0.001），且 ICU 收治时 NIHSS 也存在显著差异（P<0.001）；然而，年龄（P=0.07）和性别（P=0.17）在两组间无显著差异。Logistic 回归分析显示，入院时卒中严重程度（NIHSS=21-42，OR=49.09）和严重意识丧失（GCS<8，OR=27.95）是缺血性卒中后发生脓毒症的最主要预测因素。
本研究表明，在住院期间，重症缺血性卒中的 ICU 患者更容易发生脓毒症。
