Predictors of In-hospital Mortality and the Risk of Symptomatic Intracerebral Hemorrhage after Thrombolytic Therapy with Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke
Predictors of In-hospital Mortality and the Risk of Symptomatic Intracerebral Hemorrhage after Thrombolytic Therapy with Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2012.04.004
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发表时间：
2014-01-01
影响因子：
2.5
通讯作者：
Eggers, Juergen
中科院分区：
文献类型：
--
作者：
Al-Khaled, Mohamed;Matthis, Christine;Eggers, Juergen
重组组织纤溶酶原激活剂（rt-PA）疗法可改善急性缺血性中风（AIS）患者的功能结果，但与严重并发症相关，包括症状性脑出血（sICH）。本研究旨在确定 rt-PA 治疗后院内死亡率 (IHM) 和 sICH 风险的独立预测因素。自 2007 年 11 月开始的为期 42 个月的研究中，共有 1007 名接受 rt-PA 治疗的 AIS 患者（平均年龄 72 +/- 12 岁；52% 为女性；平均美国国立卫生研究院卒中量表 [NIHSS] 评分为 11.6 +/- 5.6）入组。进行单变量和多变量回归分析以估计 IHM 的预测因素。 1007 名患者中有 83 名 (8.2%) 在住院期间死亡（平均住院时间为 10 +/- 1.8 天）。 Logistic 回归估计了 IHM 的以下独立预测因素：年龄 >= 80 岁（优势比 [OR]，1.8；95% 置信区间 [CI]，1.1-3.0；P = .031）、失语症（OR，2.0；95% CI，1.1-3.4；P = 0.017）、意识改变（OR，3.6；95% CI， 2.0-6.2；P < .001）、高血压（OR，4；95% CI，1.4-11.6；P - 0.012）、sICH（OR，5.9；95% CI，2.9-11.9；P < 0.001）和住院期间肺炎（OR，3.0；95% CI，1.8-5.0；P < .001）。 rt-PA 治疗后，58 名患者 (5.8%) 持续出现 sICH，其中 16 名 (28%) 死亡。年龄增加 (P = .008)、较高的 NIHSS 评分 (P = .011) 和心房颤动 (P = .025) 与 sICH 相关。这项研究的结果可能有助于临床医生评估接受 rt-PA 治疗的 AIS 患者的预后和 sICH 风险。
Recombinant tissue-plasminogen activator (rt-PA) therapy improves functional outcome in patients with acute ischemic stroke (AIS) but is associated with serious complications, including symptomatic intracerebral hemorrhage (sICH). This study aimed to determine the independent predictors of in-hospital mortality (IHM) and the risk of sICH after rt-PA therapy. A total of 1007 patients (mean age, 72 +/- 12 years; 52% women; mean National Institutes of Health Stroke Scale [NIHSS] score, 11.6 +/- 5.6) with AIS treated with rt-PA were enrolled in this study during a 42-month period beginning in November 2007. Univariate and multivariate regression analyses were performed to estimate the predictors of IHM. Eighty-three of the 1007 patients (8.2%) died during hospitalization (mean duration of hospitalization, 10 +/- 1.8 days). Logistic regression estimated the following independent predictors for IHM: age >= 80 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.0; P = .031), aphasia (OR, 2.0; 95% CI, 1.1-3.4; P = .017), altered consciousness (OR, 3.6; 95% CI, 2.0-6.2; P < .001), hypertension (OR, 4; 95% CI, 1.4-11.6; P - 0.012), sICH(OR, 5.9; 95% CI, 2.9-11.9; P < 0.001), and pneumonia during hospitalization (OR, 3.0; 95% CI, 1.8-5.0; P < .001). After rt-PA therapy, 58 patients (5.8%) sustained sICH, 16 (28%) of whom died. Increased age (P = .008), higher NIHSS score (P = .011), and atrial fibrillation (P = .025) were correlated with sICH. The findings from this study may help clinicians estimate the prognosis and risk of sICH in patients with AIS treated with rt-PA.