国际标准化比值和凝血酶原时间在中国急性缺血性脑卒中患者中的预后意义

Prognostic significance of international normalised ratio and prothrombin time in Chinese acute ischaemic stroke patients.

作者信息

You Shoujiang, Han Qiao, Dong Xiaofeng, Zhong Chongke, Du Huaping, Sun Yaming, Cao Yongjun, Liu Chunfeng

机构信息

Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, China.

出版信息

Postgrad Med J. 2022 Jan 12. doi: 10.1136/postmj/postgradmedj-2021-141204.

DOI:10.1136/postmj/postgradmedj-2021-141204

PMID:37076768

Abstract

BACKGROUND

We investigated the association between international normalised ratio (INR) and prothrombin time (PT) levels on hospital admission and in-hospital outcomes in acute ischaemic stroke (AIS) patients.

METHODS

A total of 3175 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included. We divided patients into four groups according to their level of admission INR: (<0.92), Q2 (0.92-0.98), Q3 (0.98-1.04) and Q4 (≥1.04) and PT. Logistic regression models were used to estimate the effect of INR and PT on death or major disability (modified Rankin Scale score (mRS)>3), death and major disability (mRS scores 4-5) separately on discharge in AIS patients.

RESULTS

Having an INR level in the highest quartile (Q4) was associated with an increased risk of death or major disability (OR 1.69; 95% CI 1.23 to 2.31; P-trend = 0.001), death (OR, 2.64; 95% CI 1.12 to 6.19; P-trend = 0.002) and major disability on discharge (OR, 1.56; 95% CI 1.13 to 2.15; P-trend = 0.008) in comparison to Q1 after adjusting for potential covariates. Moreover, in multivariable logistic regression models, having a PT level in the highest quartile also significantly increased the risk of death (OR, 2.38; 95% CI 1.06 to 5.32; P-trend = 0.006) but not death or major disability (P-trend = 0.240), major disability (P-trend = 0.606) on discharge.

CONCLUSIONS

High INR at admission was independently associated with death or major disability, death and major disability at hospital discharge in AIS patients and increased PT was also associated with death at hospital discharge.

摘要

背景

我们研究了急性缺血性卒中（AIS）患者入院时国际标准化比值（INR）和凝血酶原时间（PT）水平与院内结局之间的关联。

方法

纳入2013年12月至2014年5月期间在苏州市22家医院登记的3175例AIS患者。我们根据患者入院时的INR水平将其分为四组：Q1（<0.92）、Q2（0.92 - 0.98）、Q3（0.98 - 1.04）和Q4（≥1.04）以及PT。使用逻辑回归模型分别估计INR和PT对AIS患者出院时死亡或重度残疾（改良Rankin量表评分（mRS）>3）、死亡和重度残疾（mRS评分4 - 5）的影响。

结果

在校正潜在协变量后，与Q1组相比，INR水平处于最高四分位数（Q4）与死亡或重度残疾风险增加相关（比值比[OR] 1.69；95%置信区间[CI] 1.23至2.31；P趋势 = 0.001）、死亡（OR，2.64；95% CI 1.12至6.19；P趋势 = 0.002）以及出院时重度残疾（OR，1.56；95% CI 1.13至2.15；P趋势 = 0.008）。此外，在多变量逻辑回归模型中，PT水平处于最高四分位数也显著增加了死亡风险（OR，2.38；95% CI 1.06至5.32；P趋势 = 0.006），但与出院时死亡或重度残疾（P趋势 = 0.240）、重度残疾（P趋势 = 0.606）无关。