Viderman Dmitriy, Issanov Alpamys, Temirov Talgat, Goligher Ewan, la Fleur Philip
Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan.
National Research Oncology Center, Nur-Sultan, Kazakhstan.
Front Neurol. 2020 Dec 15;11:579733. doi: 10.3389/fneur.2020.579733. eCollection 2020.
Risk factors for medium to long-term mortality after stroke are well-established but predictors of in-hospital stroke mortality are less clearly characterized. Kazakhstan has the highest age-standardized mortality rate from ischemic stroke in the world. We performed a retrospective analysis of patients with stroke who were admitted over a 3.5-years period to the neurocritical care unit of a tertiary care hospital in Nur-Sultan, Kazakhstan. In total, 148 critically ill patients were included in the analysis (84 ischemic stroke, 64 hemorrhagic stroke). The mean age was 63 years, 45% were male and the mean Glasgow Coma Score (±) at baseline was 10.3 (±3.4). The in-hospital mortality rate was similar in patients with ischemic (36%) and hemorrhagic (39%) stroke (HR 0.88, 95%CI 0.48-1.60). Median survival was 38 days (range: 1-89 days) in patients with ischemic stroke and 39 days (range: 1-63 days) in patients with hemorrhagic stroke. Univariable analysis found that patients who had a lower Glasgow Coma Scale, were in coma and who had cerebral edema were more likely to die in-hospital ( = 0.04, 0.02, <0.01, respectively). Our analysis showed that mortality risk in critically ill patients with hemorrhagic stroke was closer to mortality risk in patients with ischemic stroke than has been reported in other analyses. Hypertension, chronic heart failure, ischemic heart disease and atrial fibrillation were the most frequent comorbidities in patients who developed severe (life-threatening) stroke. Coma and cerebral edema on admission appear to be associated with poor outcome. This is the first publication of in-hospital stroke mortality from a Central Asian population and could form the basis for future research including development of risk scores and identifying modifiable risk factors.
中风后中长期死亡率的风险因素已得到充分证实，但院内中风死亡率的预测因素尚不明确。哈萨克斯坦的缺血性中风年龄标准化死亡率位居世界之首。我们对哈萨克斯坦努尔苏丹市一家三级医院神经重症监护病房在3.5年期间收治的中风患者进行了回顾性分析。总计148例重症患者纳入分析（84例缺血性中风，64例出血性中风）。平均年龄为63岁，45%为男性，基线时平均格拉斯哥昏迷评分（±）为10.3（±3.4）。缺血性中风患者（36%）和出血性中风患者（39%）的院内死亡率相似（风险比0.88，95%置信区间0.48 - 1.60）。缺血性中风患者的中位生存期为38天（范围：1 - 89天），出血性中风患者为39天（范围：1 - 63天）。单因素分析发现，格拉斯哥昏迷量表评分较低、处于昏迷状态以及有脑水肿的患者更有可能在院内死亡（分别为P = 0.04、0.02、P <0.01）。我们的分析表明，重症出血性中风患者的死亡风险比其他分析报告的更接近缺血性中风患者的死亡风险。高血压、慢性心力衰竭、缺血性心脏病和心房颤动是发生严重（危及生命）中风患者中最常见的合并症。入院时昏迷和脑水肿似乎与不良预后相关。这是关于中亚人群院内中风死亡率的首次发表，可为未来研究奠定基础，包括开发风险评分和识别可改变的风险因素。
