Hospital mortality from atrial fibrillation associated with ischemic stroke: a national data report
Hospital mortality from atrial fibrillation associated with ischemic stroke: a national data report
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DOI：
10.3109/00207454.2014.986266
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发表时间：
2015-01-01
影响因子：
2.2
通讯作者：
Sawanyawisuth, Kittisak
中科院分区：
文献类型：
--
作者：
Kongbunkiat, Kannikar;Kasemsap, Narongrit;Sawanyawisuth, Kittisak
目的：利用国家数据库研究急性缺血性卒中合并心房颤动(房颤)患者不良预后的相关因素。材料和方法：本研究是一项回顾性分析研究，检索了泰国国家全民保险(UC)医疗保险数据库系统的数据。检索2004-2012财政年度通过适当的ICD代码入院的所有18岁以上的急性缺血性中风的成年患者。符合条件的房颤患者在住院期间被分类为活着或死亡。研究病死率及影响住院病死率的因素。结果：522,699例急性卒中患者中，277,291例(53.1%)为急性缺血性卒中。在缺血性中风患者中，25,319名患者(9.1%)有房颤。急性缺血性卒中合并房颤的死亡率为14.1%，无房颤的死亡率为6.2%(p<；0.001)。多因素Logistic回归分析显示，女性(调整后的优势比；AOR 1.28)、糖尿病(AOR 1.28)、高血压(AOR 1.26)、rt-PA治疗(AOR 0.55)等并存疾病，以及中风并发症(如肺炎(AOR 2.60)、败血症(AOR 6.50)或胃肠道出血(AOR 2.16))与急性卒中合并房颤患者的死亡率显著相关。结论：在全国范围内，房颤导致急性缺血性卒中患者的死亡率高于非房颤患者。性别、合并症、rt-PA治疗和卒中并发症与急性缺血性卒中合并房颤的死亡率相关。
Purpose: To study factors associated with poor outcomes in acute ischemic stroke patients with atrial fibrillation (AF) by using a national database. Materials and Methods: This study was a retrospective analytical study by retrieving data from the Thailand national database system for universal coverage (UC) health insurance system. All adult patients aged over 18 years who were admitted with acute ischemic stroke during the fiscal years 2004-2012 by the appropriate ICD codes were searched. Eligible patients with AF were categorized as alive or dead during hospital stay. The mortality rate and factors associated with in-hospital mortality were studied. Results: There were 522,699 patients diagnosed as acute stroke; 277,291 patients (53.1%) had acute ischemic stroke. Of those with ischemic stroke, 25,319 patients (9.1%) had AF. The mortality rates of acute ischemic stroke with AF were 14.1% and without AF were 6.2%, (p < 0.001). Significant factors associated with mortality in acute stroke patients with AF by multivariate logistic regression were female gender (adjusted odds ratio; AOR 1.28), co-morbid diseases such as diabetes (AOR 1.28), hypertension (AOR 1.26), rt-PA treatment (AOR 0.55), and stroke complications, such as pneumonia (AOR 2.60), septicemia (AOR 6.50), or gastrointestinal bleeding (AOR 2.16). Conclusions: At the national level, AF caused a higher mortality rate in acute ischemic stroke than in non-AF patients. Gender, co-morbid diseases, rt-PA treatment, and stroke complications were associated with mortality in acute ischemic stroke with AF.