Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, TH.
Glob Heart. 2020 Feb 6;15(1):2. doi: 10.5334/gh.364.
Patients with diabetes mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited.
We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients.
We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type.
Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p < 0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HR (99% CI) at t = 4108 days: 1.54 (1.27, 1.86) and HR (99% CI) = 1.27(1.23,1.32), respectively. In HS, HR (t = 4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HR (t = 455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge.
Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and stroke recurrence.
患有糖尿病（DM）的患者中风风险增加。然而，关于 DM 对中风结果影响的研究有限。
我们旨在研究 DM 对缺血性（IS）和出血性中风（HS）患者结局的影响。
我们纳入了来自泰国国家保险登记处的 608890 例连续中风患者。使用逻辑回归评估住院死亡率、脓毒症、肺炎、急性肾损伤（AKI）、尿路感染（UTI）和心血管事件。使用 Royston-Parmar 模型对确定病理的首次中风患者（n=398663）进行长期分析。IS 和 HS 的中位随访时间分别为 4.21 年和 4.78 年。所有分析均按中风亚型分层。
平均年龄（SD）为 64.3（13.7）岁，44.9%为女性，61%为 IS，28%为 HS，11%为未确定的中风。DM 与两种类型的中风住院死亡、肺炎、脓毒症、AKI 和心血管事件相关（比值比范围为 1.13-1.78，p<0.01）。在 IS 中，DM 与整个随访期间的长期死亡率和复发相关：t=4108 天时的 HR（99%CI）为 1.54（1.27，1.86）和 HR（99%CI）=1.27（1.23，1.32）。在 HS 中，长期死亡率的 HR（t=4108 天）为 2.10（1.87，2.37），在出院后第 14 天以后具有统计学意义。HS 长期复发的 HR（t=455 天）为 1.29（1.09，1.53），在出院后第 116 天以后具有统计学意义。
无论中风类型如何，DM 与住院死亡和并发症、长期死亡率和中风复发相关。
