Lu Yuxuan, Sun Weiping, Huang Yining, Wang Zhaoxia, Shen Zhiyuan, Sun Wei, Liu Ran, Li Fan, Shu Junlong, Peng Qing, Jia Jingjing, Sun Peng, Song Yijun, Jin Haiqiang
Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China.
Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China.
Neurol Ther. 2025 Jun;14(3):1023-1038. doi: 10.1007/s40120-025-00743-9. Epub 2025 Apr 29.
Research investigating the differences in determinants affecting the quality of life (QoL) in patients with acute ischemic stroke (AIS) of varying severities remains limited, and how these factors influence QoL remains unclear. The aim of this study was to address this critical issue, refining treatments to enhance long-term QoL and optimize resource use.
In this multicenter prospective study conducted in China, patients with AIS were assessed using the EuroQol-5 Dimension (EQ-5D) questionnaire at admission and 1 year later. Univariate and multivariate analyses were conducted to identify QoL determinants. Motor function-related outcomes (MFRO) and non-motor function-related outcomes (NMFRO) were defined based on the EQ-5D questionnaire to explore how factors influence outcomes through mediation analysis.
The study included 8598 patients with AIS (median age 64 years; 65.7% male), 3927 of whom had minor stroke severity (National Institutes of Health Stroke Scale [NIHSS] scores ≤ 3). The median QoL score improved from 0.597 at admission to 1.000 after 1 year. Compared to patients with minor stroke, more patients with non-minor stroke had non-motor function-related problems (NMFRP) at admission (78.2% vs. 56.6%). Age, stroke history, QoL at admission, infection, hospitalization costs, and discharge outcomes were found to be factors influencing QoL in both cohorts. In the non-minor stroke cohort, analysis revealed that additional factors include diabetes mellitus, geographical region, speech impairment, and thrombolysis, while in the minor stroke cohort, hypertension, coronary heart disease, cancer, prolonged length of stay, and hemorrhage were found to be relevant factors. The impact of most factors on QoL was mediated by MFRO, while the effects of age, speech impairment, and geographical region were also mediated by NMFRO. Hospitalization costs beyond 15,000 China Yuan (CNY) did not improve QoL for the patients with non-minor stroke, with a threshold of 10,000 CNY for the patients with minor stroke.
Over half of the patients in the study population had NMFRP, necessitating greater medical attention. Patients with different stroke severities had distinct QoL determinants. Age, speech impairment, and geographical region may exert an impact partly mediated through NMFRO. Higher hospitalization costs did not consistently improve QoL beyond a certain threshold.
ClinicalTrials.gov Identifier: NCT02470624.
关于不同严重程度的急性缺血性卒中（AIS）患者影响生活质量（QoL）的决定因素差异的研究仍然有限，且这些因素如何影响生活质量尚不清楚。本研究的目的是解决这一关键问题，优化治疗以提高长期生活质量并优化资源利用。
在中国进行的这项多中心前瞻性研究中，AIS患者在入院时和1年后使用欧洲五维健康量表（EQ-5D）问卷进行评估。进行单因素和多因素分析以确定生活质量的决定因素。基于EQ-5D问卷定义运动功能相关结局（MFRO）和非运动功能相关结局（NMFRO），以通过中介分析探索因素如何影响结局。
该研究纳入了8598例AIS患者（中位年龄64岁；65.7%为男性），其中3927例卒中严重程度较轻（美国国立卫生研究院卒中量表[NIHSS]评分≤3）。生活质量中位数评分从入院时的0.597提高到1年后的1.000。与轻度卒中患者相比，非轻度卒中患者入院时更多存在非运动功能相关问题（NMFRP）（78.2%对56.6%）。年龄、卒中病史、入院时的生活质量、感染、住院费用和出院结局被发现是两个队列中影响生活质量的因素。在非轻度卒中队列中，分析显示其他因素包括糖尿病、地理区域、言语障碍和溶栓治疗，而在轻度卒中队列中，高血压、冠心病、癌症、住院时间延长和出血被发现是相关因素。大多数因素对生活质量的影响是通过MFRO介导的，而年龄、言语障碍和地理区域的影响也通过NMFRO介导。对于非轻度卒中患者，住院费用超过15000元人民币（CNY）并未改善生活质量，而对于轻度卒中患者，这一阈值为10000元人民币。
研究人群中超过一半的患者存在NMFRP，需要更多医疗关注。不同卒中严重程度的患者有不同的生活质量决定因素。年龄、言语障碍和地理区域可能部分通过NMFRO产生影响。超过一定阈值后，更高的住院费用并不能持续改善生活质量。
ClinicalTrials.gov标识符：NCT02470624。
