在阿姆哈拉州三级保健医院住院的伴有心房颤动的急性缺血性脑卒中患者的临床特征和治疗结局：回顾性队列研究。

Clinical Characteristics and Treatment Outcomes of Acute Ischemic Stroke with Atrial Fibrillation Among Patients Admitted to Tertiary Care Hospitals in Amhara Regional State: Retrospective-Cohort Study.

机构信息

Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.

Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

出版信息

Vasc Health Risk Manag. 2023 Dec 19;19:837-853. doi: 10.2147/VHRM.S447936. eCollection 2023.

DOI:10.2147/VHRM.S447936

PMID:38145253

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10748565/

Abstract

BACKGROUND

Atrial fibrillation (AF) is the leading cause of a surge in hospital expenses for the treatment of strokes. However, evidence regarding clinical features and survival of patients admitted with acute ischemic stroke (AIS) plus AF in Ethiopia is lacking.

OBJECTIVE

We assess clinical characteristics, survival, and predictors of mortality of patients with acute ischemic stroke and atrial fibrillation among patients admitted to Tertiary Care Hospitals in Amhara regional state.

METHODS

A retrospective cohort study was done on patients diagnosed with AIS who received care at Tibebe Ghion and Felege Hiwot hospitals from November 2018 to November 2021. Data were analyzed using SPSS version 25. Cox regression analysis was used to identify predictors of in-hospital mortality. Kaplan-Meier analysis was used to identify survival rates and mean survival time. The hazard ratio was used as a measure of the strength of the association and statistical significance was declared at p-value <0.05.

RESULTS

Of 378 patients with AIS, 58.7% were male. AF was diagnosed in 102 (26.9%) patients. Compared with patients without AF, patients with AF were more likely to have Glasgow Coma Scale <8 (83.3 vs 4%), valvular heart disease (56.9 vs 4.7%), and coronary heart disease (11.8 vs 4%). Patients with AF had a significant incidence of in-hospital mortality (38 per 1000 vs 17 per 1000) person-days. Glasgow Coma Scale <8: (AHR=12.69, 95% CI: [2.603-61.873]), aspirational pneumonia (AHR=2.602, 95% CI: 1.085-6.242), acute renal failure (AHR=6.114, 95% CI: [1.817-20.576]), hypokalemia (AHR=1.179, 95% CI: [1.112,-3.373]), atrial fibrillation (AHR=1.104, 95% CI: [1.015-5.404]), HIV/AIDS (AHR=8.302, 95% CI: [1.585-43.502]) and chronic liver disease (AHR=4.969, 95% CI: [1.192-20.704]) were indicators of in-hospital mortality.

CONCLUSION

In the current study, hospital mortality was greater in AIS associated with atrial fibrillation. Stroke-related complications were significant predictors of mortality. Hence, effective strategies should be in place to curb the impacts of these factors.

摘要

背景

心房颤动（AF）是导致中风治疗住院费用激增的主要原因。然而，关于在埃塞俄比亚急性缺血性中风（AIS）合并 AF 患者的临床特征和生存情况的证据尚缺乏。

目的

我们评估了在阿姆哈拉地区三级保健医院接受治疗的急性缺血性中风患者中，合并 AF 的患者的临床特征、生存情况以及死亡率的预测因素。

方法

这是一项回顾性队列研究，纳入了 2018 年 11 月至 2021 年 11 月在提比贝戈恩和费莱格希沃特医院接受治疗的确诊为 AIS 的患者。数据使用 SPSS 版本 25 进行分析。使用 Cox 回归分析确定院内死亡率的预测因素。采用 Kaplan-Meier 分析确定生存率和平均生存时间。风险比被用作关联强度的度量指标，以 p 值<0.05 表示具有统计学意义。

结果

在 378 例 AIS 患者中，58.7%为男性。102 例（26.9%）患者诊断为 AF。与无 AF 的患者相比，AF 患者更有可能格拉斯哥昏迷量表评分<8（83.3% vs 4%）、心脏瓣膜病（56.9% vs 4.7%）和冠心病（11.8% vs 4%）。AF 患者的院内死亡率显著较高（每 1000 人中有 38 人死亡 vs 每 1000 人中有 17 人死亡）。格拉斯哥昏迷量表评分<8（AHR=12.69，95%CI：[2.603-61.873]）、吸入性肺炎（AHR=2.602，95%CI：1.085-6.242）、急性肾衰竭（AHR=6.114，95%CI：[1.817-20.576]）、低钾血症（AHR=1.179，95%CI：[1.112-3.373]）、AF（AHR=1.104，95%CI：[1.015-5.404]）、HIV/AIDS（AHR=8.302，95%CI：[1.585-43.502]）和慢性肝脏疾病（AHR=4.969，95%CI：[1.192-20.704]）是院内死亡的指标。