血管风险与严重或非严重卒中的关联：INTERSTROKE 研究分析。
Association of Vascular Risk With Severe vs Non-Severe Stroke: An Analysis of the INTERSTROKE Study.
机构信息
From the HRB Clinical Research Facility Galway (C.R., M.C., C.J., M.J.O.), School of Medicine, University of Galway; Wellcome Trust-HRB (C.R.), Irish Clinical Academic Training, Dublin, Ireland; Institute of Health Informatics (C.R.), University College London, United Kingdom; Perron Institute Chair in Stroke Research (G.J.H.), Medical School, The University of Western Australia; Perron Institute for Neurological and Translational Science (G.J.H.), Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom; Beijing Hypertension League Institute (X.W.), China; Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; St Johns Medical College and Research Institute (D.X.), Bangalore, India; and Population Health Research Institute (S.Y., M.J.O.), Hamilton Health Sciences and McMaster University, Ontario, Canada.
出版信息
Neurology. 2024 Dec 10;103(11):e210087. doi: 10.1212/WNL.0000000000210087. Epub 2024 Nov 13.
BACKGROUND AND OBJECTIVES
Acute stroke is associated with a spectrum of functional deficits. The objective of this analysis was to explore whether the importance of individual risk factors differ by stroke severity, which may be of relevance to public health strategies to reduce disability.
METHODS
INTERSTROKE is an international case-control study of risk factors of first acute stroke (recruitment 2007-August 2015) in 32 countries. Stroke severity was measured using the modified Rankin Scale (mRS) score within 72 hours of admission to hospital. Severe stroke is defined as mRS scores of 4-6 (and non-severe stroke, score of 0-3). We used multinomial logistic regression to estimate comparative odds ratios (ORs; 95% CIs) for severe and non-severe stroke and tested for heterogeneity (). We also conducted a matched case-case analysis (matched for age, sex, country, and primary stroke subtype) to determine whether the prevalence of risk factors differed significantly between severe and non-severe stroke. A significant difference in the association of a risk factor of severe stroke compared with non-severe stroke was defined as < 0.05 for both and .
RESULTS
Of patients with acute stroke (n = 13,460), 64.0% (n = 8,612) were reported to have mRS scores of 0-3 and 36.0% (n = 4,848) scores of 4-6. The mean age was 61.7 years for patients with non-severe stroke and 62.9 years for patients with severe stroke ( = 0.72). 38.1% (n = 3,278) of patients with non-severe stroke and 44.6% (n = 2,162) of patients with severe stroke were female. Hypertension (OR 3.21; 95% CI 2.97-3.47 for severe stroke, OR 2.87; 95% CI 2.69-3.05 for non-severe stroke; = 0.03; < 0.001), atrial fibrillation (OR 4.70; 95% CI 4.05-5.45 for severe stroke, OR 3.61; 95% CI 3.16-4.13 for non-severe stroke; = 0.009; < 0.001), and smoking (OR 1.87; 95% CI 1.72-2.03 for severe stroke, OR 1.65; 95% CI 1.54-1.77 for non-severe stroke; = 0.02; < 0.001) had a stronger association with severe stroke, compared with non-severe stroke. The waist-to-hip ratio had a stronger association with non-severe stroke compared with severe stroke ( < 0.001; < 0.001).
DISCUSSION
Hypertension, atrial fibrillation, and smoking had a stronger magnitude of association with severe stroke (compared with non-severe stroke) while the increased waist-to-hip ratio had a stronger magnitude of association with non-severe stroke.
背景与目的
急性中风与一系列功能障碍有关。本分析的目的是探讨个体风险因素的重要性是否因中风严重程度而异，这可能与减少残疾的公共卫生策略有关。
方法
INTERSTROKE 是一项在 32 个国家进行的首次急性中风（招募时间为 2007 年 8 月至 2015 年）的国际病例对照研究。中风严重程度采用入院后 72 小时内的改良 Rankin 量表（mRS）评分来衡量。严重中风定义为 mRS 评分为 4-6（非严重中风，评分为 0-3）。我们使用多变量逻辑回归来估计严重和非严重中风的比值比（OR；95%CI），并检验异质性（）。我们还进行了匹配病例对照分析（按年龄、性别、国家和主要中风亚型匹配），以确定严重和非严重中风之间的风险因素是否存在显著差异。严重中风风险因素与非严重中风相比的关联差异显著定义为 ＜0.05 。
结果
在急性中风患者中（n=13460），64.0%（n=8612）报告 mRS 评分为 0-3，36.0%（n=4848）评分为 4-6。非严重中风患者的平均年龄为 61.7 岁，严重中风患者为 62.9 岁（=0.72）。38.1%（n=3278）的非严重中风患者和 44.6%（n=2162）的严重中风患者为女性。高血压（OR 3.21；95%CI 2.97-3.47 为严重中风，OR 2.87；95%CI 2.69-3.05 为非严重中风；=0.03；＜0.001）、心房颤动（OR 4.70；95%CI 4.05-5.45 为严重中风，OR 3.61；95%CI 3.16-4.13 为非严重中风；=0.009；＜0.001）和吸烟（OR 1.87；95%CI 1.72-2.03 为严重中风，OR 1.65；95%CI 1.54-1.77 为非严重中风；=0.02；＜0.001）与严重中风的关联更强，而非非严重中风。腰臀比与非严重中风的关联强于严重中风（＜0.001；＜0.001）。
讨论
高血压、心房颤动和吸烟与严重中风（而非非严重中风）的关联程度更强，而增加的腰臀比与非严重中风的关联程度更强。
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