Trout Amanda L, McLouth Christopher J, Kitzman Patrick, Dobbs Michael R, Bellamy Lisa, Elkins Kelley, Fraser Justin F
Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, KY, USA.
Department of Neurology, University of Kentucky, Lexington, KY, USA.
Ann Transl Med. 2021 Sep;9(17):1371. doi: 10.21037/atm-21-1451.
Vascular risk factors, such as diabetes mellitus (DM), are associated with poorer outcomes following many neurodegenerative diseases, including hemorrhagic stroke and Alzheimer's disease (AD). Combined AD and DM co-morbidities are associated with an increased risk of hemorrhagic stroke and increased Medicare costs. Therefore, we hypothesized that patients with DM in combination with AD, termed DM/AD, would have increased hemorrhagic stroke severity.
Kentucky Appalachian Stroke Registry (KApSR) is a database of demographic and clinical data from patients that live in Appalachia, a distinct region with increased health disparities and stroke severity. Inpatients with a primary indication of hemorrhagic stroke were selected from KApSR for retrospective analysis and were separated into four groups: DM only, AD only, neither, or both.
Hemorrhagic stroke patients (2,071 total) presented with either intracerebral hemorrhage (ICH), n=1,448, or subarachnoid hemorrhage (SAH), n=623. When examining all four groups, subjects with AD were significantly older (AD+, 80.9±6.6 yrs) (DM+/AD+, 77.4±10.0 yrs) than non AD subjects (DM-/AD-, 61.3±16.5 yrs) and (DM+, 66.0±12.5 yrs). A higher percentage of females were among the AD+ group and a higher percentage of males among the DM+/AD+ group. Interestingly, after adjusting for multiple comparison, DM+/AD+ subjects were ten times as likely to suffer a moderate to severe stroke based on a National Institute of Health Stroke (NIHSS) upon admission [odds ratio (95% CI)] compared to DM-/AD- [0.1 (0.02-0.55)], DM+ [0.11 (0.02-0.59)], and AD+ [0.09(0.01-0.63)]. The odds of DM+/AD+ subjects having an unfavorable discharge destination (death, hospice, long-term care) was significant (P<0.05) from DM-/AD- [0.26 (0.07-0.96)] when adjusting for sex, age, and comorbidities.
In our retrospective analysis utilizing KApSR, regardless of adjusting for age, sex, and comorbidities, DM+/AD+ patients were significantly more likely to have had a moderate or severe stroke leading to an unfavorable outcome following hemorrhagic stroke.
血管危险因素，如糖尿病（DM），与包括出血性中风和阿尔茨海默病（AD）在内的许多神经退行性疾病预后较差相关。AD和DM合并症与出血性中风风险增加及医疗保险费用增加有关。因此，我们假设患有DM合并AD（称为DM/AD）的患者出血性中风严重程度会增加。
肯塔基阿巴拉契亚中风登记处（KApSR）是一个来自居住在阿巴拉契亚地区患者的人口统计学和临床数据数据库，该地区健康差距和中风严重程度增加。从KApSR中选择以出血性中风为主要指征的住院患者进行回顾性分析，并分为四组：仅患有DM、仅患有AD、两者均无、两者皆有。
出血性中风患者（共2071例）表现为脑出血（ICH），n = 1448例，或蛛网膜下腔出血（SAH），n = 623例。在检查所有四组时，患有AD的受试者（AD +，80.9±6.6岁）（DM + /AD +，77.4±10.0岁）比未患AD的受试者（DM - /AD -，61.3±16.5岁）和（DM +，66.0±12.5岁）年龄显著更大。AD +组中女性比例更高，DM + /AD +组中男性比例更高。有趣的是，在进行多重比较校正后，与DM - /AD - [0.1（0.02 - 0.55）]、DM + [0.11（0.02 - 0.59）]和AD + [0.09（0.01 - 0.63）]相比，DM + /AD +受试者入院时基于美国国立卫生研究院中风量表（NIHSS）发生中度至重度中风的可能性高出十倍。在对性别、年龄和合并症进行校正后，DM + /AD +受试者出院目的地不佳（死亡、临终关怀、长期护理）的几率与DM - /AD - [0.26（0.07 - 0.96）]相比具有显著性（P < 0.05）。
在我们利用KApSR进行的回顾性分析中，无论对年龄、性别和合并症进行校正与否，DM + /AD +患者出血性中风后发生中度或重度中风并导致不良结局的可能性显著更高。
