Ministry of Health, Colombo, Sri Lanka.
General Hospital Trincomalee, Trincomalee, Sri Lanka.
Ethn Dis. 2021 Oct 21;31(4):509-518. doi: 10.18865/ed.31.4.509. eCollection 2021 Fall.
Stroke is a heterogeneous, catastrophic disease. A comprehensive clinical analysis of ischemic stroke (IS) risk factors and outcomes is crucial for optimum management in resource-poor settings.
A prospective cross-sectional study of acute cerebrovascular disease (ACVD) involving 592 patients was conducted in a tertiary care center in Sri Lanka from November 2018 to May 2019. We aimed to describe the ACVD subtypes and the relationship of IS subtypes and subtype-categories (as defined by the Oxfordshire Community Stroke Project clinical classification) with risk factors, severity, and outcome.
The majority (63.3%) had IS. Partial anterior circulation syndromes (PACS), total anterior circulation syndrome (TACS), posterior circulation syndromes (POCS), and lacunar syndromes (LACS) accounted for 102 (29.7%), 58 (16.9%), 88 (25.7%) and 95 (27.7%) of the cases, respectively. The most common PACS sub-category was higher-cerebral-dysfunction-with-homonymous-hemianopia (HCD+HH,39 cases;38.2%). Cerebellar-signs-without-long-tract-signs (CS-LTS) sub-category constituted the highest among POCS (47 cases; 53.4%). The leading sub-category within LACS was pure-motor (PM) strokes (43 cases; 45.3%).Patients aged ≥50 years (adjusted-OR [AOR]2.439; 95%CI,1.163-5.116;P=.018), IHD(AOR 2.520; 95%CI,1.347-4.713; P=.004) and BMI>23kg/m(AOR 2.607; 95% CI,1.420-4.784; P=.002) were 2.5 times more likely to associate with TACS. Patients with a history of TIA (AOR 1.910; 95%CI,1.036-3.524; P=.038) and arrhythmias (AOR 5.933; 95%CI,3.294-10.684; P<.001) were 1.9 and 5.9 times more likely to be associated with POCS respectively. Those with hypertension were 2.3 times more likely to associate with LACS (AOR 2.233; 95%CI,1.270-3.926; P=.005).NIHSS(P<.001), mRS on admission (P=.001) and in 3 months (P<.001), deaths during hospital stay (P=.003) and within 28 days (P<.001) had a stronger relationship with individual stroke subtypes.
The comparative risk of different IS subtypes depends on different risk factors. The findings of this study demonstrate that sub-categories within each stroke subtype may behave independently with regard to risk factors and outcomes, thus warranting the need for individual assessment.
中风是一种异质性、灾难性的疾病。对缺血性中风（IS）风险因素和结果进行全面的临床分析，对于资源匮乏环境下的最佳管理至关重要。
我们在斯里兰卡的一家三级护理中心进行了一项涉及 592 名急性脑血管病（ACVD）患者的前瞻性横断面研究。我们旨在描述 ACVD 亚型以及 IS 亚型和亚型类别（根据牛津社区中风项目临床分类定义）与风险因素、严重程度和结果之间的关系。
大多数患者（63.3%）患有 IS。部分前循环综合征（PACS）、完全前循环综合征（TACS）、后循环综合征（POCS）和腔隙综合征（LACS）分别占 102 例（29.7%）、58 例（16.9%）、88 例（25.7%）和 95 例（27.7%）。最常见的 PACS 亚类是高脑功能伴同视性偏盲（HCD+HH，39 例；38.2%）。小脑征伴无长束征（CS-LTS）亚类在 POCS 中占比最高（47 例；53.4%）。LACS 中最高的亚类是单纯运动（PM）中风（43 例；45.3%）。年龄≥50 岁的患者（调整后的优势比 [AOR] 2.439；95%CI，1.163-5.116；P=.018）、缺血性心脏病（AOR 2.520；95%CI，1.347-4.713；P=.004）和 BMI＞23kg/m（AOR 2.607；95%CI，1.420-4.784；P=.002）发生 TACS 的可能性是 2.5 倍。有 TIA 病史的患者（AOR 1.910；95%CI，1.036-3.524；P=.038）和心律失常（AOR 5.933；95%CI，3.294-10.684；P<.001）发生 POCS 的可能性分别为 1.9 和 5.9 倍。高血压患者发生 LACS 的可能性增加 2.3 倍（AOR 2.233；95%CI，1.270-3.926；P=.005）。NIHSS（P<.001）、入院时（P=.001）和 3 个月时（P<.001）mRS、住院期间（P=.003）和 28 天内（P<.001）的死亡率与个体中风亚型有更强的关系。
不同 IS 亚型的相对风险取决于不同的风险因素。本研究的结果表明，每个中风亚型内的亚类可能在风险因素和结果方面表现出独立性，因此需要进行单独评估。
