Biogen, Cambridge, MA, USA.
Analysis Group, Inc, Montréal, Canada.
Curr Med Res Opin. 2021 May;37(5):781-788. doi: 10.1080/03007995.2021.1900090. Epub 2021 Mar 23.
Large hemispheric infarction (LHI) is associated with a high likelihood of the evolution of life-threatening edema. Few studies have assessed real-world clinical outcomes and management strategies among patients with LHI. The objective of this study was to describe the management, in-hospital outcomes, and direct healthcare resource burden of patients with LHI, as well as those of patients with subsequent cerebral edema.
This observational, retrospective cohort study analyzed de-identified data from US adult patients using the IBM MarketScan Hospital Drug Database (Q4-2015 to Q4-2017). Patients were included in the "Possible LHI" or the "Other Ischemic Strokes" cohorts using ICD-10 diagnosis codes. Patients with possible LHI were further categorized into "LHI with Edema" and "LHI without Edema" subgroups using diagnosis and procedure codes. Select clinical and economic outcomes were compared between cohorts and subgroups using multivariable regressions.
Of 79,201 eligible encounters with ischemic strokes, 11,772 unique patients were assigned to the Possible LHI cohort while 67,429 were assigned to the Other Ischemic Strokes cohort. Among patients with possible LHI, 869 (7%) were assigned to the LHI with Edema subgroup and 10,903 (93%) were assigned to the LHI without Edema subgroup. Patients in the Possible LHI cohort had longer hospital stays (mean difference [MD] [95%CI] = 2.6 [2.4;2.8] days), higher total facility charges (MD [95%CI] = $28,656 [26,794;30,524]), and higher odds of death (odds ratio [95%CI] = 2.2 [2.0;2.4]) than the Other Ischemic Strokes cohort. Among patients with possible LHI, the incremental clinical and resource burden was further exacerbated in the subgroup of patients with edema (hospital days: MD [95%CI] = 5.0 [3.9;6.2] days; total facility charges: MD [95%CI] = $59,585 [50,816;67,583]; mortality: odds ratio [95%CI] = 10.3 [8.5;12.4]).
Among patients with ischemic strokes, LHI was associated with increased clinical management and direct healthcare resource burden in real-world hospital settings. The burden was substantially increased among patients who developed cerebral edema.
大面积半球梗死（LHI）与发生危及生命的水肿的可能性较高相关。很少有研究评估 LHI 患者的真实临床结局和管理策略。本研究的目的是描述 LHI 患者的管理、住院结局以及直接医疗保健资源负担，以及随后发生脑水肿的患者的管理、住院结局以及直接医疗保健资源负担。
这项观察性、回顾性队列研究使用 IBM MarketScan 医院药物数据库（2015 年第 4 季度至 2017 年第 4 季度）分析了美国成年患者的去识别数据。使用 ICD-10 诊断代码将患者归入“可能的 LHI”或“其他缺血性中风”队列。使用诊断和程序代码，将可能患有 LHI 的患者进一步分为“伴有水肿的 LHI”和“不伴有水肿的 LHI”亚组。使用多变量回归比较队列和亚组之间的选择临床和经济结局。
在 79201 例符合条件的缺血性中风患者中，有 11772 例为独特患者被分配到可能的 LHI 队列，67429 例被分配到其他缺血性中风队列。在可能患有 LHI 的患者中，有 869 例（7%）被分配到伴有水肿的 LHI 亚组，10903 例（93%）被分配到不伴有水肿的 LHI 亚组。可能患有 LHI 的患者的住院时间更长（平均差异[MD] [95%CI] = 2.6 [2.4;2.8] 天），总设施费用更高（MD [95%CI] = $28656 [26794;30524]），死亡率更高（比值比[95%CI] = 2.2 [2.0;2.4]）比其他缺血性中风队列。在可能患有 LHI 的患者中，水肿亚组的临床和资源负担的增量进一步加重（住院天数：MD [95%CI] = 5.0 [3.9;6.2] 天；总设施费用：MD [95%CI] = $59585 [50816;67583]；死亡率：比值比[95%CI] = 10.3 [8.5;12.4]）。
在缺血性中风患者中，LHI 与现实医院环境中的临床管理和直接医疗保健资源负担增加相关。在发生脑水肿的患者中，负担显著增加。
