Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York (S.C.P., C.Z., S.B.M., A.E.M., B.B.N., C.I., H.K., N.S.P.).
Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O.).
Stroke. 2022 Nov;53(11):3313-3319. doi: 10.1161/STROKEAHA.122.038673. Epub 2022 Aug 9.
Posterior reversible encephalopathy syndrome (PRES) can cause short-term cerebrovascular complications, such as brain infarction and hemorrhage. We hypothesized that PRES is also associated with an increased long-term risk of stroke.
We performed a retrospective cohort study in the United States using statewide all-payer claims data from 2016 to 2018 on all admissions to nonfederal hospitals in 11 states. Adults with PRES were compared with adults with renal colic (negative control) and transient ischemic attack (TIA; positive control). Any stroke and the secondary outcomes of ischemic and hemorrhagic stroke were ascertained using . We excluded prevalent stroke. We used time-to-event statistics to calculate incidence rates and Cox proportional hazards analyses to evaluate the association between PRES and stroke, adjusting for demographics and stroke risk factors. In a sensitivity analysis, outcomes within 2 weeks of index admission were excluded.
We identified 1606 patients with PRES, 1192 with renal colic, and 38 216 with TIA. Patients with PRES had a mean age of 56±17 years; 72% were women. Over a median follow-up of 0.9 years, the stroke incidence per 100 person-years was 6.1 (95% CI, 5.0-7.4) after PRES, 1.0 (95% CI, 0.62-1.8) after renal colic, and 9.7 (95% CI, 9.4-10.0) after TIA. After statistical adjustment for patient characteristics and risk factors, patients with PRES had an elevated risk of stroke compared with renal colic (hazard ratio [HR], 2.3 [95% CI, 1.7-3.0]), but lower risk than patients with TIA (HR, 0.67 [95% CI, 0.54-0.82]). In secondary analyses, compared with TIA, PRES was associated with hemorrhagic stroke (HR, 2.0 [95% CI, 1.4-2.9]). PRES was associated with ischemic stroke when compared with renal colic (HR, 1.9 [95% CI, 1.4-2.7]) but not when compared with TIA (HR, 0.49 [95% CI, 0.38-0.63]). Results were similar with 2-week washout.
Patients with PRES had an elevated risk of incident stroke.
后部可逆性脑病综合征（PRES）可导致短暂性脑血管并发症，如脑梗死和脑出血。我们假设 PRES 也与中风的长期风险增加有关。
我们在美国进行了一项回顾性队列研究，使用了 2016 年至 2018 年来自 11 个州的 11 个非联邦医院所有入院患者的全州所有支付者索赔数据。将 PRES 患者与肾绞痛（阴性对照）和短暂性脑缺血发作（TIA；阳性对照）患者进行比较。使用. 确定任何中风和缺血性中风及出血性中风的次要结局。排除了先前存在的中风。我们使用时间事件统计来计算发病率，并使用 Cox 比例风险分析来评估 PRES 与中风之间的关联，调整了人口统计学和中风危险因素。在敏感性分析中，排除了指数入院后 2 周内的结局。
我们确定了 1606 例 PRES 患者、1192 例肾绞痛患者和 38216 例 TIA 患者。PRES 患者的平均年龄为 56±17 岁；72%为女性。在中位随访 0.9 年期间，PRES 后每 100 人年中风发生率为 6.1（95%CI，5.0-7.4），肾绞痛后为 1.0（95%CI，0.62-1.8），TIA 后为 9.7（95%CI，9.4-10.0）。在对患者特征和危险因素进行统计学调整后，与肾绞痛相比，PRES 患者中风风险升高（风险比[HR]，2.3[95%CI，1.7-3.0]），但低于 TIA 患者（HR，0.67[95%CI，0.54-0.82]）。在二级分析中，与 TIA 相比，PRES 与出血性中风相关（HR，2.0[95%CI，1.4-2.9]）。与肾绞痛相比，PRES 与缺血性中风相关（HR，1.9[95%CI，1.4-2.7]），但与 TIA 无关（HR，0.49[95%CI，0.38-0.63]）。在 2 周洗脱期，结果相似。
PRES 患者发生中风的风险增加。
