Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race.
Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race.
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DOI：
10.1161/strokeaha.108.521906
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发表时间：
2009-02
期刊：
影响因子：
8.3
通讯作者：
Tsevat J
中科院分区：
文献类型：
--
作者：
Kissela B;Lindsell CJ;Kleindorfer D;Alwell K;Moomaw CJ;Woo D;Flaherty ML;Air E;Broderick J;Tsevat J
我们寻求建立模型，通过预测缺血性卒中后的短期和长期死亡率和功能结局来解决患者和家属感兴趣的问题，同时允许随着合并症事件的积累进行风险重新分层。1999年对451名缺血性卒中患者进行了住院期间、3个月和大约4年的随访。对急性住院患者的病历进行了摘要。对卒中后3个月的所有住院情况进行回顾，以确定医学和精神方面的合并症，并对其进行分类分析。建立了多变量模型来预测3个月和4年的死亡率和功能预后（改良Rankin量表）。合并症作为3个月模型的修正因素，也包括在4年预测中。卒中后医学和精神合并症显著增加卒中后短期死亡率和发病率。严重的心室周围白质疾病（PVWMD）与3个月时的不良功能预后显著相关，独立于其他因素，如糖尿病和年龄；纳入这一影像学变量排除了卒中结局模型中常见的其他传统危险因素。3个月的预后是长期死亡率和功能预后的重要预测因子。黑人种族是4年死亡率的预测因子。我们建议卒中预后的预测模型，以及临床试验的分析，应该包括对合并症的调整。PVWMD对短期功能结局的影响以及黑人对长期死亡率的影响有待证实。
We sought 0074o build models that address questions of interest to patients and families by predicting short- and long-term mortality and functional outcome after ischemic stroke, while allowing for risk re-stratification as comorbid events accumulate. A cohort of 451 ischemic stroke subjects in 1999 were interviewed during hospitalization, at 3 months, and at approximately 4 years. Medical records from the acute hospitalization were abstracted. All hospitalizations for 3 months post-stroke were reviewed to ascertain medical and psychiatric comorbidities, which were categorized for analysis. Multivariable models were derived to predict mortality and functional outcome (modified Rankin Scale) at 3 months and 4 years. Comorbidities were included as modifiers of the 3 month models, and included in 4-year predictions. Post-stroke medical and psychiatric comorbidities significantly increased short term post-stroke mortality and morbidity. Severe periventricular white matter disease (PVWMD) was significantly associated with poor functional outcome at 3 months, independent of other factors, such as diabetes and age; inclusion of this imaging variable eliminated other traditional risk factors often found in stroke outcomes models. Outcome at 3 months was a significant predictor of long-term mortality and functional outcome. Black race was a predictor of 4-year mortality. We propose that predictive models for stroke outcome, as well as analysis of clinical trials, should include adjustment for comorbid conditions. The effects of PVWMD on short-term functional outcomes and black race on long-term mortality are findings that require confirmation.