Ouyang Menglu, Billot Laurent, Song Lili, Wang Xia, Roffe Christine, Arima Hisatomi, Lavados Pablo M, Hackett Maree L, Olavarría Verónica V, Muñoz-Venturelli Paula, Middleton Sandy, Pontes-Neto Octavio M, Lee Tsong-Hai, Watkins Caroline L, Robinson Thompson G, Anderson Craig S
The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.
The George Institute China at Peking University Health Science Center, Beijing, China.
Int J Stroke. 2021 Feb;16(2):200-206. doi: 10.1177/1747493020908140. Epub 2020 Feb 19.
An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST).
Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as "poor outcome," scores 3-6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates.
Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13-1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59-2.18). The number exposed to IUC for poor outcome was 13.
IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.
留置导尿管（IUC）常用于处理膀胱功能障碍，但其对预后的影响尚不确定。我们旨在确定在国际多中心整群交叉急性卒中头位试验（HeadPoST）中，使用IUC与急性卒中后临床结局之间的关联。
对随机分配至平卧位或坐立位头位的HeadPoST参与者（n = 11,093）的数据进行分析。采用二项式、逻辑回归和分层混合模型，确定随机分组后7天内早期插入IUC与死亡或残疾结局（定义为“不良结局”，改良Rankin量表评分3 - 6分）以及90天时任何尿路感染之间的关联，并对基线和随机分组后管理协变量进行调整。
总体而言，1167例（12%）患者使用了IUC，但不同地区患者的使用频率和持续时间差异很大。老年患者、患有血管合并症的患者、初始神经功能缺损较重（根据美国国立卫生研究院卒中量表）以及以脑出血为潜在卒中类型的患者使用IUC更为频繁。使用IUC与不良结局独立相关（调整后的比值比（aOR）：1.40，95%置信区间（CI）：1.13 - 1.74），但在调整抗生素治疗和出院时的卒中严重程度后，与尿路感染无关（aOR：1.13，95% CI：0.59 - 2.18）。因不良结局而暴露于IUC的人数为13人。
急性卒中后使用IUC与不良结局相关。需要进一步研究以指导IUC的合理使用。
