Mussa Raafiah, Ambler Gareth, Ozkan Hatice, Thiankhaw Kitti, Aboughdir Maryam, Smedley Imogen, Mitchell John, Banerjee Gargi, Jäger Hans Rolf, Leff Alex, Perry Richard, Simister Robert J, Chandratheva Arvind, Werring David J
Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.
Department of Statistical Science, UCL, London, UK.
Eur Stroke J. 2025 Jan 23:23969873251314360. doi: 10.1177/23969873251314360.
Stroke incidence in younger adults is increasing worldwide yet few comprehensive studies exist from a UK population. We investigated the risk factors, mechanisms, functional outcome and stroke recurrence rate in a cohort of young adults with stroke.
We included consecutive patients (<55 years) with ischaemic stroke or intracerebral haemorrhage (ICH) admitted to the University College London Hospitals Hyperacute Stroke Unit between 2017 and 2020. Ischaemic stroke was classified using Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria and ICH using modified CLAS-ICH criteria. Multivariable logistic regression was performed to identify predictors of unfavourable functional outcome (modified Rankin Scale [mRS] > 1) at 6 months.
Five hundred fifty-two patients were included (median age 47, IQR 41-51; 33% female; 76% ischaemic stroke). Common risk factors included dyslipidaemia (57%), hypertension (40%), and cigarette smoking (34%). Ischaemic stroke was mostly due to cardioembolism (22%). Probable cerebral small vessel disease was the most frequent ICH aetiology (53%). Unfavourable functional outcome was prevalent in 50% at 6 months and was associated with ICH (OR 2.02, 95%CI 1.14-3.58, = 0.017), female sex (OR 1.62, 95%CI 1.03-2.55, = 0.037), admission stroke severity (per point increase, OR 1.11, 95%CI 1.07-1.16, < 0.001) and pre-morbid mRS 2-5 (OR 3.16; 95%CI 1.11-9.03, = 0.032). 4.4% had a recurrent stroke within 6 months.
Traditional cardiovascular risk factors are common in young adults with stroke. Unfavourable functional outcome is associated with female sex, ICH, severe stroke and pre-morbid disability. These findings can inform national stroke prevention and rehabilitation strategies.
全球范围内，年轻成年人中风的发病率正在上升，但来自英国人群的全面研究却很少。我们调查了一组年轻中风患者的危险因素、发病机制、功能转归及中风复发率。
我们纳入了2017年至2020年间入住伦敦大学学院医院超急性中风单元的连续发病的缺血性中风或脑出血（ICH）患者（年龄<55岁）。缺血性中风采用急性中风治疗中Org 10172试验（TOAST）标准进行分类，ICH采用改良的CLAS-ICH标准进行分类。进行多变量逻辑回归分析以确定6个月时功能转归不良（改良Rankin量表[mRS]>1）的预测因素。
共纳入552例患者（中位年龄47岁，四分位间距41 - 51岁；33%为女性；76%为缺血性中风）。常见危险因素包括血脂异常（57%）、高血压（40%）和吸烟（34%）。缺血性中风主要由心源性栓塞引起（22%）。可能的脑小血管病是最常见的ICH病因（53%）。6个月时功能转归不良者占50%，且与ICH（比值比2.02，95%置信区间1.14 - 3.58，P = 0.017）、女性（比值比1.62，95%置信区间1.03 - 2.55，P = 0.037）、入院时中风严重程度（每增加1分，比值比1.11，95%置信区间1.07 - 1.16，P<0.001）及病前mRS 2 - 5（比值比3.16；95%置信区间1.11 - 9.03，P = 0.032）相关。4.4%的患者在6个月内发生中风复发。
传统心血管危险因素在年轻中风患者中很常见。功能转归不良与女性、ICH、严重中风及病前残疾有关。这些发现可为国家中风预防和康复策略提供参考。
