Irie Fumi, Matsuo Ryu, Nakamura Kuniyuki, Wakisaka Yoshinobu, Ago Tetsuro, Kamouchi Masahiro, Kitazono Takanari
Department of Medicine and Clinical Science (FI, RM, KN, YW, TA, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Food Safety Commission Secretariat (FI), Cabinet Office, Government of Japan, Tokyo, Japan; Department of Health Care Administration and Management (RM, MK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Center for Cohort Studies (MK, TK), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Neurol Clin Pract. 2021 Dec;11(6):e809-e816. doi: 10.1212/CPJ.0000000000001087.
To examine sex differences in early stroke deaths according to cause of death.
We investigated 30-day deaths in patients with acute ischemic stroke enrolled in a multicenter stroke registry between 2007 and 2019 in Fukuoka, Japan. We estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of cause-specific deaths for women vs men using Cox proportional hazards models and competing risk models. The risk of acute infections during hospitalization and the associated case fatality rates were also compared between the sexes.
Among 17,956 patients with acute ischemic stroke (women: 41.3%), the crude 30-day death rate after stroke was higher in women than men. However, adjusting for age and stroke severity resulted in a lower risk of death among women (HR [95% CI]: 0.76 [0.62-0.92]). Analyses using competing risk models revealed that women were less likely to die of acute infections (subdistribution HR [95% CI]: 0.33 [0.20-0.54]). Further analyses showed that women were associated with a lower risk of acute infections during hospitalization (OR [95% CI]: 0.62 [0.52-0.74]) and a lower risk of death due to these infections (subdistribution HR [95% CI]: 052 [0.33-0.83]).
When adjusting for confounders, the female sex was associated with a lower risk of 30-day death after stroke, which could be explained by a female survival advantage in poststroke infections. Sex-specific strategies are needed to reduce early stroke deaths.
This is a Class I prognostic study because it is a prospective population-based cohort with objective outcomes. Female sex appears to be protective against early stroke deaths and post stroke infections.
根据死因研究早期卒中死亡的性别差异。
我们调查了2007年至2019年在日本福冈一个多中心卒中登记处登记的急性缺血性卒中患者的30天死亡情况。我们使用Cox比例风险模型和竞争风险模型估计了女性与男性特定原因死亡的多变量调整风险比（HRs）和95%置信区间（CIs）。还比较了两性住院期间急性感染的风险及相关病死率。
在17956例急性缺血性卒中患者中（女性：41.3%），卒中后粗30天死亡率女性高于男性。然而，调整年龄和卒中严重程度后，女性死亡风险较低（HR [95% CI]：0.76 [0.62 - 0.92]）。使用竞争风险模型的分析显示，女性死于急性感染的可能性较小（亚分布HR [95% CI]：0.33 [0.20 - 0.54]）。进一步分析表明，女性住院期间急性感染风险较低（OR [95% CI]：0.62 [0.52 - 0.74]），因这些感染导致的死亡风险也较低（亚分布HR [95% CI]：0.52 [0.33 - 0.83]）。
校正混杂因素后，女性性别与卒中后30天死亡风险较低相关，这可能是由于女性在卒中后感染方面的生存优势。需要采取针对性别的策略来降低早期卒中死亡。
这是一项I类预后研究，因为它是一项基于人群的前瞻性队列研究，有客观结局。女性性别似乎对早期卒中死亡和卒中后感染具有保护作用。
