合并症负担和多种药物治疗对急性缺血性脑卒中不良功能结局的影响。
Effect of Comorbidity Burden and Polypharmacy on Poor Functional Outcome in Acute Ischemic Stroke.
机构信息
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Institut für Medizinische Biometrie und Epidemiologie, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Clin Neuroradiol. 2023 Mar;33(1):147-154. doi: 10.1007/s00062-022-01193-8. Epub 2022 Jul 13.
PURPOSE
Comorbidities and polypharmacy are risk factors for worse outcome in stroke. However, comorbidities and polypharmacy are mostly studied separately with various approaches to assess them. We aimed to analyze the impact of comorbidity burden and polypharmacy on functional outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).
METHODS
Acute ischemic stroke patients with large vessel occlusion (LVO) treated with MT from a prospective observational study were analyzed. Relevant comorbidity burden was defined as a Charlson Comorbidity Index (CCI) score ≥ 2, polypharmacy as the intake of ≥ 5 medications at time of stroke onset. Favorable outcome was a score of 0-2 on the modified Rankin scale at 90 days after stroke. The effect of comorbidity burden and polypharmacy on favorable outcome was studied via multivariable regression analysis.
RESULTS
Of 903 patients enrolled, 703 AIS patients (mean age 73.4 years, 54.9% female) with anterior circulation LVO were included. A CCI ≥ 2 was present in 226 (32.1%) patients, polypharmacy in 315 (44.8%) patients. Favorable outcome was less frequently achieved in patients with a CCI ≥ 2 (47, 20.8% vs. 172, 36.1%, p < 0.001), and in patients with polypharmacy (69, 21.9% vs. 150, 38.7%, p < 0.001). In multivariable regression analysis including clinical covariates, a CCI ≥ 2 was associated with lower odds of favorable outcome (odds ratio, OR 0.52, 95% confidence interval, 95% CI 0.33-0.82, p = 0.005), while polypharmacy was not (OR 0.81, 95% CI 0.52-1.27, p = 0.362).
CONCLUSION
Relevant comorbidity burden and polypharmacy are common in AIS patients with LVO, with comorbidity burden being a risk factor for poor outcome.
目的
合并症和多种药物治疗是影响卒中预后的危险因素。然而，合并症和多种药物治疗通常是分开研究的，并且有不同的方法来评估它们。我们旨在分析急性缺血性卒中（AIS）患者接受机械取栓（MT）治疗时，合并症负担和多种药物治疗对功能结局的影响。
方法
对一项前瞻性观察性研究中接受 MT 治疗的大血管闭塞（LVO）急性缺血性卒中患者进行了分析。相关的合并症负担定义为 Charlson 合并症指数（CCI）评分≥2，多种药物治疗定义为卒中发作时服用≥5 种药物。90 天后改良 Rankin 量表评分 0-2 分为良好结局。通过多变量回归分析研究合并症负担和多种药物治疗对良好结局的影响。
结果
在纳入的 903 例患者中，纳入了 703 例 AIS 患者（平均年龄 73.4 岁，54.9%为女性），其中前循环 LVO 患者 315 例。226 例（32.1%）患者存在 CCI≥2，315 例（44.8%）患者存在多种药物治疗。CCI≥2 的患者中，良好结局的发生率较低（47 例，20.8% vs. 172 例，36.1%，p<0.001），而多种药物治疗的患者中，良好结局的发生率也较低（69 例，21.9% vs. 150 例，38.7%，p<0.001）。在包括临床协变量的多变量回归分析中，CCI≥2 与良好结局的可能性较低相关（比值比，OR 0.52，95%置信区间，95%CI 0.33-0.82，p=0.005），而多种药物治疗则没有（OR 0.81，95%CI 0.52-1.27，p=0.362）。
结论
在 LVO 的 AIS 患者中，合并症负担和多种药物治疗都很常见，而合并症负担是预后不良的危险因素。
Zotero 插件