Department of Neurology, Kaohsiung Medical University Hospital, Taiwan (K.-Y.L.).
Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan (K.-Y.L.).
Stroke. 2021 Mar;52(3):913-921. doi: 10.1161/STROKEAHA.120.029998. Epub 2021 Jan 26.
Preceding infection as an important risk factor for ischemic stroke has been reported but neglected for hemorrhagic stroke, especially in young and middle-aged patients. This study investigates whether newly diagnosed leptospirosis is associated with an increased risk of stroke.
We identified 3699 in-patients who were aged ≥18 years and newly diagnosed with leptospirosis. We also randomly selected a comparison cohort 14 796 in-patients from the general population by using a propensity score matching method (at a 1:4 ratio). We analyzed the risks of stroke by using Cox proportional hazard regression models.
The adjusted hazard ratio (HR; 95% CI) of stroke for the leptospirosis group was 1.14 (0.93-1.38; =0.200) as opposed to the comparison group after adjusting sex, age, and comorbidities. However, adjusted HR (95% CI) of ischemic stroke and hemorrhagic stroke was 1.01 (0.80-1.29) and 1.58 (1.12-2.23), respectively. The strength of association between leptospirosis and hemorrhagic stroke remained statistically significant after variation of leptospirosis and stroke definitions. The post hoc subgroup analysis indicated that a patient with leptospirosis had a significantly greater risk of hemorrhagic stroke in male (adjusted HR, 1.62 [95% CI, 1.08-2.44]) and individuals between age 18 and 39 (adjusted HR, 3.67 [95% CI, 1.33-10.14]). The risk of hemorrhagic stroke among people with leptospirosis was highest in the first 2 years after diagnosis (adjusted HR, 1.97 [95% CI, 1.15-3.38]).
A 2.49-fold risk of stroke was found among the leptospirosis cohort of aged younger than 39 years. Age acted as an effect modifier between the leptospirosis and risk of new-onset stroke.
前驱感染是缺血性卒中的一个重要危险因素，已被报道，但在出血性卒中，尤其是中青年患者中，这一因素被忽视。本研究旨在探讨新诊断的钩端螺旋体病是否与卒中风险增加相关。
我们纳入了 3699 例年龄≥18 岁且新诊断为钩端螺旋体病的住院患者，并通过倾向性评分匹配方法（1:4 比例）随机选择了 14796 例普通人群中的住院患者作为对照组。我们使用 Cox 比例风险回归模型分析卒中风险。
调整性别、年龄和合并症后，钩端螺旋体病组卒中的调整后危险比（HR；95%CI）为 1.14（0.93-1.38；=0.200），与对照组相比。然而，调整后缺血性卒中和出血性卒中的 HR（95%CI）分别为 1.01（0.80-1.29）和 1.58（1.12-2.23）。改变钩端螺旋体病和卒中的定义后，钩端螺旋体病与出血性卒中之间的关联仍具有统计学意义。事后亚组分析表明，男性（调整 HR，1.62[95%CI，1.08-2.44]）和 18-39 岁的患者（调整 HR，3.67[95%CI，1.33-10.14]）中，钩端螺旋体病患者发生出血性卒中的风险显著增加。钩端螺旋体病患者在诊断后 2 年内发生出血性卒中的风险最高（调整 HR，1.97[95%CI，1.15-3.38]）。
年龄小于 39 岁的钩端螺旋体病队列中，卒中风险增加了 2.49 倍。年龄是钩端螺旋体病与新发卒中风险之间的效应修饰因素。
