Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
Geriatr Gerontol Int. 2022 Aug;22(8):554-559. doi: 10.1111/ggi.14411. Epub 2022 Jun 15.
Higher post-stroke functional performance is associated with lower mortality in patients with stroke. This study aimed to investigate the relationship between ambulation ability in the acute phase of stroke, and pneumonia and mortality 1 year after stroke onset.
This retrospective cohort study included consecutive stroke patients between April 2008 and December 2018. Patients were divided into six groups according to their Functional Ambulation Category score at discharge (0 [unable to walk] to 5 [able to walk independently]). We observed pneumonia cases and all-cause mortality over 1 year, and investigated the association between Functional Ambulation Category score and pneumonia or mortality. Survival analysis was carried out using Kaplan-Meier curves, log-rank tests and Cox regression models.
We analyzed 1727 consecutive patients (median age 77 years; 54% men). During the observation period, 144 patients (8.3%) experienced pneumonia and 157 (9.1%) died. Increasing ambulatory impairment showed stepwise relationships with the risk of pneumonia and mortality. Compared with patients with a Functional Ambulation Category score of 5, those with scores of 4 and 3 showed no significant association with pneumonia risk; a score ≤2 was significantly different. There was a stepwise relationship between increased gait disturbance and risk of death compared with the Functional Ambulation Category 5 group.
Ambulation ability at discharge from an acute hospital is an important predictor of pneumonia incidence and survival in stroke patients at 1 year; these associations were observed even after controlling for clinical parameters, such as stroke severity and comorbidity. Geriatr Gerontol Int 2022; 22: 554-559.
卒中后较高的功能表现与卒中患者的死亡率降低相关。本研究旨在探讨卒中急性期的步行能力与卒中发病后 1 年肺炎和死亡率之间的关系。
这是一项回顾性队列研究，纳入了 2008 年 4 月至 2018 年 12 月期间连续的卒中患者。患者根据出院时的功能性步行分类（FAC）评分（0 [无法行走]至 5 [能够独立行走]）分为 6 组。我们观察了 1 年以上的肺炎病例和全因死亡率，并探讨了 FAC 评分与肺炎或死亡率之间的关系。使用 Kaplan-Meier 曲线、对数秩检验和 Cox 回归模型进行生存分析。
我们分析了 1727 例连续患者（中位年龄 77 岁；54%为男性）。在观察期间，144 例（8.3%）发生肺炎，157 例（9.1%）死亡。步行能力逐渐受损与肺炎和死亡风险呈逐步相关。与 FAC 评分为 5 的患者相比，评分 4 和 3 的患者与肺炎风险无显著关联；评分 ≤2 与肺炎风险显著相关。与 FAC 评分为 5 的患者相比，步行障碍程度增加与死亡风险呈逐步相关。
急性医院出院时的步行能力是卒中患者 1 年时肺炎发生率和生存的重要预测指标；即使在控制了临床参数（如卒中严重程度和合并症）后，这些关联仍然存在。
