Hahn Marianne, Brockstedt Lavinia, Gröschel Sonja, Geschke Katharina, Grauhan Nils F, Brockmann Marc A, Othman Ahmed E, Gröschel Klaus, Uphaus Timo
Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Front Aging Neurosci. 2025 Feb 14;17:1486726. doi: 10.3389/fnagi.2025.1486726. eCollection 2025.
Post-stroke-delirium has been linked to worse outcome in patients with acute cerebrovascular disease; identification of individuals at risk may prevent delirium and thereby improve outcome. We investigate prognosis and factors associated with post-stroke-delirium in patients with large vessel occlusion (LVO) ischemic stroke treated by mechanical thrombectomy (MT).
747 patients (53.4% female) prospectively enrolled in the Gutenberg-Stroke-Study from May 2018-November 2022 were analyzed with regard to diagnosis of delirium. Group comparison of patient-, stroke- and treatment characteristics as well as computed tomography(CT)-imaging based parameters of cerebral atrophy (global cortical atrophy [GCA], posterior atrophy [Koedam], medial temporal lobe atrophy [MTA] scores) and white matter lesions (Fazekas score) was conducted. Independent predictors of delirium and the association of delirium with functional outcome at 90-day follow-up was investigated by multiple logistic regression analyses.
We report 8.2% of patients (61/747) developing delirium following MT of LVO. Independent predictors were older age (aOR[95%CI] per year: 1.034[1.005-1.065], = 0.023), male sex (aOR[95%CI]: 2.173[1.182-3.994], = 0.012), general anesthesia during MT (aOR[95%CI]: 2.455[1.385-4.352], = 0.002), infectious complications (aOR[95%CI]: 1.845[1.031-3.305], = 0.039), "other determined" etiology of stroke (aOR[95%CI]: 2.424[1.100-5.345], = 0.028), and a MTA score exceeding age-specific cut-offs (aOR[95%CI]: 2.126[1.065-4.244], = 0.033). Delirium was independently associated with worse functional outcome (aOR[95%CI]: 2.902[1.005-8.383], = 0.049) at 90-day follow-up.
Delirium is independently associated with worse functional outcome after MT of LVO, stressing the importance of screening and preventive measures. Besides conventional risk factors, pathological MTA scores and use of general anesthesia during MT may be easy-to-apply criteria to identify individuals at risk of delirium and implement prevention strategies.
卒中后谵妄与急性脑血管病患者的不良预后相关；识别有风险的个体可能预防谵妄，从而改善预后。我们研究了接受机械取栓术（MT）治疗的大动脉闭塞（LVO）缺血性卒中患者卒中后谵妄的预后及相关因素。
对2018年5月至2022年11月前瞻性纳入古登堡卒中研究的747例患者（53.4%为女性）进行谵妄诊断分析。对患者、卒中和治疗特征以及基于计算机断层扫描（CT）成像的脑萎缩参数（全脑皮质萎缩[GCA]、后部萎缩[Koedam]、内侧颞叶萎缩[MTA]评分）和白质病变（Fazekas评分）进行组间比较。通过多因素逻辑回归分析研究谵妄的独立预测因素以及谵妄与90天随访时功能预后的关联。
我们报告LVO患者MT后有8.2%（61/747）发生谵妄。独立预测因素为年龄较大（每年调整后比值比[aOR][95%置信区间]：1.034[1.005 - 1.065]，P = 0.023）、男性（aOR[95%置信区间]：2.173[1.182 - 3.994]，P = 0.012）、MT期间全身麻醉（aOR[95%置信区间]：2.455[1.385 - 4.352]）、感染并发症（aOR[95%置信区间]：1.845[1.031 - 3.305]，P = 0.039）、卒中“其他确定”病因（aOR[95%置信区间]：2.424[1.100 - 5.345]，P = 0.028）以及MTA评分超过年龄特异性临界值（aOR[95%置信区间]：2.126[1.065 - 4.244]，P = 0.033）。谵妄与90天随访时较差的功能预后独立相关（aOR[95%置信区间]：2.902[1.005 - 8.383]，P = 0.049）。
谵妄与LVO患者MT后的较差功能预后独立相关，强调了筛查和预防措施的重要性。除传统危险因素外，病理性MTA评分和MT期间全身麻醉的使用可能是易于应用的标准，用于识别谵妄风险个体并实施预防策略。
