Department of Neurology, Panzhihua Municipal Central Hospital, Panzhihua, China.
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Eur Neurol. 2020;83(2):138-146. doi: 10.1159/000506198. Epub 2020 Jun 3.
Wake-up stroke (WUS) accounts for up to 25% of all new ischemic strokes, but debate exists regarding whether WUS differs from non-WUS in previous studies. Our study aimed to investigate the proportion of WUS cases and to examine differences in clinical characteristics and outcomes in these two groups.
Data from acute ischemic stroke patients who presented to the First Affiliated Hospital of Chongqing Medical University between April 2017 and September 2017 were prospectively collected. Admission demographic information, clinical and radiological characteristics, and 3-month functional outcomes were assessed and compared between patients with WUS and those with non-WUS. Poor functional outcome was defined as modified Rankin Scale ≥ 3 at the 90-day follow-up. Risks of poor outcomes for WUS were estimated with logistic regression analysis.
A total of 473 eligible patients were included, of which 132 had been diagnosed with WUS (27.9%). Forty WUS patients had poor functional outcomes and 92 WUS patients had good functional outcomes. WUS and non-WUS patients were similar in regard to stroke risk factors, severity, etiology, and prognosis at 90 days (p > 0.05), but WUS patients were more likely to have had previous stroke (p < 0.001) and a tendency of higher albumin levels (p = 0.051). WUS patients show significant differences in terms of age, gender, prior stroke, atrial fibrillation, impaired consciousness at admission, levels of albumin and triglycerides, stroke severity, and stroke etiology between the good outcome group and the poor outcome group (p < 0.05). Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.079, 95% confidence interval [CI] 1.021-1.141; p < 0.05), previous stroke (OR 4.017, 95% CI 1.197-13.484; p < 0.05), and admission National Institutes of Health Stroke Scale (NIHSS) score ≥5 (OR 5.453, 95% CI 1.510-19.696; p < 0.05) were independently associated with an unfavorable outcome of WUS.
WUS accounts for 27.9% of 473 ischemic strokes in the Chinese population. WUS and non-WUS patients were similar in terms of stroke risk factors, severity, etiology, and early outcomes. Age, previous stroke, and a high admission NIHSS score were independent risk factors for unfavorable outcomes in patients with WUS.
唤醒性卒中（WUS）占所有新发缺血性卒中的 25%，但之前的研究对于 WUS 是否与非 WUS 不同存在争议。我们的研究旨在调查 WUS 病例的比例，并研究这两组患者的临床特征和结局差异。
前瞻性收集 2017 年 4 月至 2017 年 9 月期间在重庆医科大学第一附属医院就诊的急性缺血性卒中患者的数据。评估并比较 WUS 患者和非 WUS 患者入院时的人口统计学信息、临床和影像学特征以及 3 个月的功能结局。不良功能结局定义为 90 天随访时改良 Rankin 量表评分≥3。使用 logistic 回归分析估计 WUS 不良结局的风险。
共纳入 473 例符合条件的患者，其中 132 例被诊断为 WUS（27.9%）。40 例 WUS 患者功能结局不良，92 例 WUS 患者功能结局良好。WUS 和非 WUS 患者在卒中危险因素、严重程度、病因和 90 天预后方面相似（p＞0.05），但 WUS 患者既往卒中发生率更高（p＜0.001），白蛋白水平有升高趋势（p=0.051）。WUS 患者在年龄、性别、既往卒中史、入院时的房颤、意识障碍、白蛋白和甘油三酯水平、卒中严重程度和病因方面，在预后良好组和预后不良组之间存在显著差异（p＜0.05）。多变量 logistic 回归分析显示，年龄（比值比[OR]1.079，95%置信区间[CI]1.021-1.141；p＜0.05）、既往卒中史（OR 4.017，95%CI 1.197-13.484；p＜0.05）和入院时国立卫生研究院卒中量表（NIHSS）评分≥5（OR 5.453，95%CI 1.510-19.696；p＜0.05）与 WUS 的不良结局独立相关。
WUS 占中国人群 473 例缺血性卒中的 27.9%。WUS 和非 WUS 患者在卒中危险因素、严重程度、病因和早期结局方面相似。年龄、既往卒中史和入院时较高的 NIHSS 评分是 WUS 患者不良结局的独立危险因素。
