Department of Information Management, Chang Gung University, Taoyuan 33302, Taiwan.
Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
Int J Environ Res Public Health. 2020 Jan 18;17(2):618. doi: 10.3390/ijerph17020618.
Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke.
缺血性脑卒中是最常见的脑卒中类型，早期介入治疗与良好的预后相关。指南推荐对符合条件的急性缺血性脑卒中患者使用重组组织型纤溶酶原激活剂（rt-PA）进行溶栓治疗。然而，出血并发症的风险限制了 rt-PA 的使用，需要确定治疗效果不佳的风险因素。为了确定接受 rt-PA 治疗的患者住院期间预后不良的相关风险因素，我们分析了 2006 年至 2016 年期间在长庚纪念医院被诊断为急性缺血性脑卒中并接受 rt-PA 治疗的患者的电子病历。住院期间死亡、入住重症监护病房（ICU）或延长住院时间被定义为治疗效果不佳。将病史变量和实验室检查结果作为感兴趣的变量来确定风险因素。在 643 名符合条件的患者中，537 名（83.5%）和 106 名（16.5%）患者的治疗效果良好和不佳。多变量分析显示，预后不良的风险因素为女性、较高的卒中严重度指数（SSI）、较高的血糖水平、较低的平均红细胞血红蛋白浓度（MCHC）、较低的血小板计数和贫血。本研究发现的风险因素有助于我们研究缺血性脑卒中的治疗策略。
