van Valburg Mariëlle K, Vernooij Lisette M, Kalkman Cornelis J, van der Worp H Bart
Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Anesthesiology and Intensive Care, Amphia Hospital, Breda, The Netherlands.
Eur Stroke J. 2025 Mar;10(1):248-257. doi: 10.1177/23969873241263195. Epub 2024 Jul 30.
Patients with acute stroke are at risk of respiratory or circulatory compromise resulting in vital instability, which can be captured through the widely used aggregated National Early Warning Score (NEWS). We aimed to assess the relation between vital instability (defined as NEWS of five or higher) and death or dependency at 90 days after stroke.
In this observational cohort study we studied 763 patients with ischaemic stroke ( = 400), intracerebral haemorrhage (ICH) ( = 146) or subarachnoid haemorrhage (SAH) ( = 217), hospitalized to a Dutch tertiary referral hospital from 1 January 2017 to 31 December 2018. We calculated NEWS for each 8 h time span during the first 72 h after hospitalization. We also decomposed NEWS into its three components respiration, circulation and consciousness. The primary outcome was death or dependency (modified Rankin Scale score ⩾3) at 90 days after stroke. The association of vital instability with functional dependency was examined using Poisson regression.
Two hundred and twenty-seven (58%) patients with ischaemic stroke, 101 (69%) with ICH and 142 (65%) with SAH had at least one episode of vital instability. In patients with ischaemic stroke or SAH, vital instability was associated after adjustment for confounders with death or dependency (adjusted relative risk 1.55 ((95% CI) 1.25-1.93 and 2.13 (1.35-3.36), respectively)). This was mainly driven by impaired consciousness, which was associated with death or dependency in all types of stroke. Respiratory insufficiency and circulatory instability were associated with death or dependency only in SAH.
Vital instability in the first 72 h of hospitalization for ischaemic stroke or SAH is associated with death or dependency at 90 days. Impaired consciousness was the main driver of this relationship. NEWS may not be appropriate for patients with acute stroke, mainly due to the dichotomous manner in which the level of consciousness is classified, and modification of NEWS should be considered for these patients.
急性中风患者存在呼吸或循环功能受损导致生命体征不稳定的风险，这可通过广泛使用的综合国家早期预警评分（NEWS）来捕捉。我们旨在评估生命体征不稳定（定义为NEWS为5分或更高）与中风后90天死亡或依赖之间的关系。
在这项观察性队列研究中，我们研究了763例缺血性中风（n = 400）、脑出血（ICH）（n = 146）或蛛网膜下腔出血（SAH）（n = 217）患者，这些患者于2017年1月1日至2018年12月31日入住荷兰一家三级转诊医院。我们计算了住院后前72小时内每8小时时间段的NEWS。我们还将NEWS分解为其三个组成部分：呼吸、循环和意识。主要结局是中风后90天死亡或依赖（改良Rankin量表评分⩾3）。使用泊松回归检验生命体征不稳定与功能依赖之间的关联。
227例（58%）缺血性中风患者、101例（69%）ICH患者和142例（65%）SAH患者至少有一次生命体征不稳定发作。在缺血性中风或SAH患者中，在调整混杂因素后，生命体征不稳定与死亡或依赖相关（调整后的相对风险分别为1.55（（95%CI）1.25 - 1.93）和2.13（1.35 - 3.36））。这主要是由意识障碍驱动的，意识障碍在所有类型的中风中均与死亡或依赖相关。呼吸功能不全和循环不稳定仅在SAH中与死亡或依赖相关。
缺血性中风或SAH住院后前72小时内的生命体征不稳定与90天死亡或依赖相关。意识障碍是这种关系的主要驱动因素。NEWS可能不适用于急性中风患者，主要是由于意识水平分类的二分法方式，对于这些患者应考虑对NEWS进行修改。
