From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Neurology. 2020 Sep 22;95(12):e1724-e1732. doi: 10.1212/WNL.0000000000010356. Epub 2020 Jul 17.
To determine patient-reported health-related quality of life (HRQOL) after stroke thrombectomy in clinical practice and to identify predictors of better HRQOL by analyzing data of 504 consecutive patients treated in a large university stroke center.
All patients with stroke treated by thrombectomy (June 2015-October 2018) were prospectively enrolled in this observational study. At 90 days, functional outcome was assessed by the modified Rankin Scale (mRS) and patient-reported HRQOL was assessed by the EuroQol Group 5-Dimension (EQ-5D) self-report questionnaire, consisting of 5 health domains. The EQ-5D utility index (EQ-5D-I) score (-0.594 to 1.00, with higher values indicating better HRQOL) was calculated. Linear regression analysis was applied to identify predictors of better HRQOL (higher EQ-5D-I score).
Of 504 patients (median age 76 years, 51.8% female), the mean EQ-5D-I score was 0.39 (SD 0.44). The proportion of stroke survivors who reported complaints in the different domains decreased from 66% in Usual Activities to 57% in Mobility, 50.4% in Self-Care, 41.7% in Pain/Discomfort, and 40.8% Anxiety/Depression. Lower age, lower prestroke mRS score, lower baseline NIH Stroke Scale score, higher Alberta Stroke Program Early CT Score, concomitant thrombolysis therapy, and a successful recanalization were independent predictors of better HRQOL.
Patient-reported HRQOL provides a more comprehensive assessment of stroke outcome than the mRS score. Health domains involving motor function most frequently showed complaints in HRQOL after stroke thrombectomy, while a large proportion of patients did not report any complaints across the different health domains. Predictors of better HRQOL closely match the predictors of better functional outcome measured by the mRS in other thrombectomy studies.
通过分析在大型大学卒中中心治疗的 504 例连续患者的数据，确定临床实践中卒中取栓术后患者报告的健康相关生活质量（HRQOL），并确定更好的 HRQOL 的预测因素。
本观察性研究前瞻性纳入 2015 年 6 月至 2018 年 10 月期间接受取栓治疗的卒中患者。90 天时，采用改良 Rankin 量表（mRS）评估功能结局，采用欧洲五维健康量表（EQ-5D）自我报告问卷评估患者报告的 HRQOL，该问卷由 5 个健康领域组成。计算 EQ-5D 效用指数（EQ-5D-I）评分（-0.594 至 1.00，得分越高表示 HRQOL 越好）。应用线性回归分析确定更好的 HRQOL（更高的 EQ-5D-I 评分）的预测因素。
在 504 例患者中（中位年龄 76 岁，51.8%为女性），EQ-5D-I 评分的平均值为 0.39（标准差 0.44）。在不同领域报告有抱怨的卒中幸存者比例从一般活动的 66%下降到移动能力的 57%、自我照顾的 50.4%、疼痛/不适的 41.7%和焦虑/抑郁的 40.8%。年龄较低、基线 mRS 评分较低、基线 NIH 卒中量表评分较低、 Alberta 卒中项目早期 CT 评分较高、联合溶栓治疗和成功再通是更好的 HRQOL 的独立预测因素。
与 mRS 评分相比，患者报告的 HRQOL 为卒中取栓术后的结局提供了更全面的评估。涉及运动功能的健康领域在卒中取栓术后 HRQOL 中最常出现抱怨，而在不同的健康领域中，很大一部分患者没有报告任何抱怨。更好的 HRQOL 的预测因素与其他取栓研究中用 mRS 测量的更好的功能结局的预测因素密切匹配。
