Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Eur J Neurol. 2021 Jun;28(6):1958-1966. doi: 10.1111/ene.14792. Epub 2021 Mar 21.
Poststroke delirium (PSD) comprises a common and severe complication after stroke. However, treatment options for PSD remain insufficient. We investigated whether prophylactic melatonin supplementation may be associated with reduced risk for PSD.
Consecutive patients admitted to the Tübingen University Stroke Unit, Tübingen, Germany, with acute ischemic stroke (AIS), who underwent standard care between August 2017 and December 2017, and patients who additionally received prophylactic melatonin (2 mg per day at night) within 24 h of symptom onset between August 2018 and December 2018 were included. Primary outcomes were (i) PSD prevalence in AIS patients and (ii) PSD risk and PSD-free survival in patients with cerebral infarction who underwent melatonin supplementation compared to propensity score-matched (PSM) controls. Secondary outcomes included time of PSD onset and PSD duration.
Out of 465 (81.2%) patients with cerebral infarction and 108 (18.8%) transient ischemic attack (TIA) patients, 152 (26.5%) developed PSD (median time to onset [IQR]: 16 [8-32] h; duration 24 [8-40] h). Higher age, cerebral infarction rather than TIA, and higher National Institutes of Health Stroke Scale score and aphasia on admission were significant predictors of PSD. After PSM (164 melatonin-treated patients with cerebral infarction versus 164 matched controls), 42 (25.6%) melatonin-treated patients developed PSD versus 60 (36.6%) controls (odds ratio, 0.597; 95% confidence interval, 0.372-0.958; p = 0.032). PSD-free survival differed significantly between groups (p = 0.027), favoring melatonin-treated patients. In patients with PSD, no between-group differences in the time of PSD onset and PSD duration were noted.
Patients prophylactically treated with melatonin within 24 h of AIS onset had lower risk for PSD than patients undergoing standard care. Prospective randomized trials are warranted to corroborate these findings.
中风后谵妄（PSD）是中风后的一种常见且严重的并发症。然而，针对 PSD 的治疗选择仍然不足。我们研究了预防性褪黑素补充是否可能与降低 PSD 风险相关。
连续纳入 2017 年 8 月至 12 月期间在德国图宾根大学卒中单元因急性缺血性卒中（AIS）入院、接受标准治疗的患者，以及 2018 年 8 月至 12 月期间在症状发作后 24 小时内接受预防性褪黑素（每晚 2 毫克）治疗的患者。主要结局是（i）AIS 患者中 PSD 的患病率，以及（ii）接受褪黑素补充的脑梗死患者与倾向性评分匹配（PSM）对照组相比的 PSD 风险和 PSD 无进展生存率。次要结局包括 PSD 发病时间和 PSD 持续时间。
在 465 例脑梗死（81.2%）和 108 例短暂性脑缺血发作（TIA）（18.8%）患者中，152 例（26.5%）发生 PSD（发病中位时间 [IQR]：16 [8-32] 小时；持续时间 24 [8-40] 小时）。较高的年龄、脑梗死而非 TIA，以及较高的国立卫生研究院卒中量表评分和入院时的失语，是 PSD 的显著预测因素。经过 PSM（164 例接受褪黑素治疗的脑梗死患者与 164 例匹配的对照组），42 例（25.6%）接受褪黑素治疗的患者发生 PSD，而 60 例（36.6%）对照组发生 PSD（比值比，0.597；95%置信区间，0.372-0.958；p=0.032）。两组之间的 PSD 无进展生存率有显著差异（p=0.027），接受褪黑素治疗的患者更有利。在 PSD 患者中，两组在 PSD 发病时间和 PSD 持续时间方面无差异。
在 AIS 发病后 24 小时内接受预防性褪黑素治疗的患者，其 PSD 风险低于接受标准治疗的患者。需要进行前瞻性随机试验来证实这些发现。
