中风患者神经功能恶化与预后之间的关联。
Association between neurological deterioration and outcomes in patients with stroke.
作者信息
Liu Peipei, Liu Shoufeng, Feng Ning, Wang Yajing, Gao Yuan, Wu Jialing
机构信息
Department of Neurorehabilitation and Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin 300350, China.
The Graduate School, Tianjin Medical University, Tianjin 300070, China.
出版信息
Ann Transl Med. 2020 Jan;8(1):4. doi: 10.21037/atm.2019.12.36.
BACKGROUND
Neurological deterioration (ND) shortly after stroke is common in Chinese patients. We aimed to determine the effects of ND during hospitalization on stroke prognosis.
METHODS
We retrospectively reviewed files from the stroke registry of the Department of Neurology of Tianjin Huanhu Hospital between October 1, 2008, and December 31, 2015. The inclusion criteria were: age ≥18 years, diagnosis of acute ischemic stroke, and first-ever ischemic stroke occurring within 7 days prior to admission. ND was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score by ≥4 points during hospitalization. Early neurological deterioration (END) was defined as an increase in the NIHSS score by ≥4 points between the baseline and 48-hour evaluations. Late neurological deterioration (LND) was defined as an increase in the NIHSS score by ≥4 points between the 48-hour and discharge evaluations. Multivariate regression was used to evaluate the relationship between early and late ND and short- and long-term outcomes. Primary and secondary outcomes based on the modified Rankin scale (mRS) were evaluated at 3 months and 1 year. Favorable and poor outcomes were defined as mRS scores of 0-2 and ≥3, respectively.
RESULTS
A total of 9,650 patients were included. ND occurred in 293 patients (3.0%) during hospitalization. Among them, 192 (65.5%) were in the END group, and 101 (34.5%) were in the LND group. After adjusting for age, gender, and NIHSS scores, END was a significant independent predictor of poor outcome at both 3 months (primary outcome OR 8.069, secondary outcome OR 8.194) and 1 year (primary outcome OR 7.895, secondary outcome OR 5.679). The same pattern was seen in the LND group (3 months primary outcome OR 7.608, secondary outcome OR 6.349, 1-year primary outcome OR 10.793, secondary outcome OR 5.245).
CONCLUSIONS
ND during hospitalization, regardless of whether it occurs in the early or late period after stroke, is an independent predictor of poor prognosis.
背景
在中国患者中，卒中后不久出现神经功能恶化（ND）很常见。我们旨在确定住院期间ND对卒中预后的影响。
方法
我们回顾性分析了2008年10月1日至2015年12月31日天津环湖医院神经内科卒中登记处的病历。纳入标准为：年龄≥18岁，急性缺血性卒中诊断明确，且入院前7天内首次发生缺血性卒中。ND定义为住院期间美国国立卫生研究院卒中量表（NIHSS）评分增加≥4分。早期神经功能恶化（END）定义为基线评估和48小时评估之间NIHSS评分增加≥4分。晚期神经功能恶化（LND）定义为48小时评估和出院评估之间NIHSS评分增加≥4分。采用多因素回归评估早期和晚期ND与短期和长期结局之间的关系。基于改良Rankin量表（mRS）的主要和次要结局在3个月和1年时进行评估。良好和不良结局分别定义为mRS评分为0 - 2分和≥3分。
结果
共纳入9650例患者。293例患者（3.0%）在住院期间发生ND。其中，192例（65.5%）在END组，101例（34.5%）在LND组。在调整年龄、性别和NIHSS评分后，END是3个月（主要结局OR 为8.069，次要结局OR 为8.194）和1年（主要结局OR 为7.895，次要结局OR 为5.679）不良结局的显著独立预测因素。LND组也观察到相同模式（3个月主要结局OR 为7.608，次要结局OR 为6.349；1年主要结局OR 为10.793，次要结局OR 为5.245）。
结论
住院期间的ND，无论发生在卒中后的早期还是晚期，都是不良预后的独立预测因素。
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