Prestroke Disability Predicts Adverse Poststroke Outcome
Prestroke Disability Predicts Adverse Poststroke Outcome
复制标题
中风前残疾预示着中风后的不良后果
作者：
T. Han;C. Fry;G. Gulli;Brendan Affley;J. Robin;Melanie Irvin;D. Fluck;P. Kakar;Sapna D Sharma;Pankaj Sharma
背景和目的--关于卒中前残疾对卒中预后有何影响的信息缺乏.我们评估了卒中前残疾与卒中后住院结果的关系。方法-分析从哨兵中风国家审计计划前瞻性收集的数据。2014年至2016年期间，共有1656名男性（平均年龄±SD =73.1±13.2岁）和1653名女性（79.3±13.0岁）因急性卒中在4个主要UK的超急性卒中单元住院。采用改良兰金量表（mRS）评估卒中前残疾，对照卒中后不良结局，校正年龄、性别和并存疾病。结果：与卒中前mRS评分=0的患者相比，卒中前mRS评分=3、4或5的患者在到达时发生中重度或重度卒中的校正风险更高（4.4% vs 16.7%;比值比[OR]，3.2 [95% CI，2.3-4.6] P<0.001）;入院7天内尿路感染或肺炎（9.6% vs 35.9%; OR，3.7 [95% CI，2.8-4.8] P<0.001）;死亡率（7.2% vs 37.1%; OR，4.9 [95% CI，3.7-6.5] P<0.001）;出院时需要日常生活活动帮助（12.3%对26.7%; OR，3.1 [95% CI，2.3-4.1] P<0.001）;转移到新的护理之家（2.4%对9.4%; OR，2.1 [95% CI，1.3-3.3] P=0.002）。mRS评分=1或2的患者的不良结局风险为中等。总体而言，mRS评分=1或2的患者在超急性卒中单元的住院时间延长了5.3天（95% CI，2.8-7.7; P<0.001），mRS评分=3、4或5的患者延长了7.2天（95% CI，4.0-10.5; P<0.001）。结论：经mRS评估，有卒中前残疾证据的个体卒中后不良结局的风险显著增加，在超急性卒中单元的住院时间更长，出院时护理水平更高。
Background and Purpose— Information on what effect disability before stroke can have on stroke outcome is lacking. We assessed prestroke disability in relation to poststroke hospital outcome. Methods— Analysis of prospectively collected data from the Sentinel Stroke National Audit Programme. A total of 1656 men (mean age ±SD =73.1±13.2 years) and 1653 women (79.3±13.0 years) were admitted to hyperacute stroke units with acute stroke in 4 major UK between 2014 and 2016. Prestroke disability, assessed by modified Rankin Scale (mRS), was tested against poststroke adverse outcomes, adjusted for age, sex, and coexisting morbidities. Results— Compared with patients with prestroke mRS score =0, individuals with prestroke mRS scores =3, 4, or 5 had greater adjusted risks of moderately severe or severe stroke on arrival (4.4% versus 16.7%; odds ratio [OR], 3.2 [95% CI, 2.3–4.6] P<0.001); urinary tract infection or pneumonia within 7 days of admission (9.6% versus 35.9%; OR, 3.7 [95% CI, 2.8–4.8] P<0.001); mortality (7.2% versus 37.1%; OR, 4.9 [95% CI, 3.7–6.5] P<0.001); requiring help with activities of daily living on discharge (12.3% versus 26.7%; OR, 3.1 [95% CI, 2.3–4.1] P<0.001); and transferred to new care home (2.4% versus 9.4%; OR, 2.1 [95% CI, 1.3–3.3] P=0.002). Patients with mRS scores =1 or 2 had intermediate risk of adverse outcomes. Overall, those with a mRS score =1 or 2 had length of stay on hyperacute stroke units extended by 5.3 days (95% CI, 2.8–7.7; P<0.001) and mRS score =3, 4 or 5 by 7.2 days (95% CI, 4.0–10.5; P<0.001). Conclusions— Individuals with evidence of prestroke disability, assessed by mRS, had significantly increased risk of poststroke adverse outcomes and longer length of stay on hyperacute stroke units and higher level of care on discharge.