Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Korea.
Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan, Korea.
Sci Rep. 2021 Mar 16;11(1):5963. doi: 10.1038/s41598-021-85390-4.
The eligibility of reperfusion therapy has been expanded to increase the number of patients. However, it remains unclear the reperfusion therapy will be beneficial in stroke patients with various comorbidities. We developed a reperfusion comorbidity index for predicting 6-month mortality in patients with acute stroke receiving reperfusion therapy. The 19 comorbidities included in the Charlson comorbidity index were adopted and modified. We developed a statistical model and it was validated using data from a prospective cohort. Among 1026 patients in the retrospective nationwide reperfusion therapy registry, 845 (82.3%) had at least one comorbidity. As the number of comorbidities increased, the likelihood of mortality within 6 months also increased (p < 0.001). Six out of the 19 comorbidities were included for developing the reperfusion comorbidity index on the basis of the odds ratios in the multivariate logistic regression analysis. This index showed good prediction of 6-month mortality in the retrospective cohort (area under the curve [AUC], 0.747; 95% CI, 0.704-0.790) and in 333 patients in the prospective cohort (AUC, 0.784; 95% CI, 0.709-0.859). Consideration of comorbidities might be helpful for the prediction of the 6-month mortality in patients with acute ischemic stroke who receive reperfusion therapy.
再灌注治疗的适应证已经扩大，以增加患者数量。然而，对于伴有各种合并症的脑卒中患者，再灌注治疗是否有益仍不清楚。我们开发了一种再灌注合并症指数，用于预测接受再灌注治疗的急性脑卒中患者 6 个月的死亡率。采用并修改了 Charlson 合并症指数中包含的 19 种合并症。我们开发了一个统计模型，并使用前瞻性队列的数据进行了验证。在回顾性全国性再灌注治疗登记研究的 1026 例患者中，845 例（82.3%）至少有一种合并症。随着合并症数量的增加，6 个月内死亡的可能性也随之增加（p<0.001）。基于多变量逻辑回归分析中的比值比，有 6 种合并症被纳入再灌注合并症指数的开发。该指数在回顾性队列中（曲线下面积 [AUC]，0.747；95%CI，0.704-0.790）和前瞻性队列中的 333 例患者中（AUC，0.784；95%CI，0.709-0.859）均能很好地预测 6 个月死亡率。考虑合并症可能有助于预测接受再灌注治疗的急性缺血性脑卒中患者的 6 个月死亡率。
