Years of Disability-Adjusted Life Gained as a Result of Thrombolytic Therapy for Acute Ischemic Stroke
Years of Disability-Adjusted Life Gained as a Result of Thrombolytic Therapy for Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.109.571083
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发表时间：
2010-03-01
期刊：
影响因子：
8.3
通讯作者：
Saver, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Hong, Keun-Sik;Saver, Jeffrey L.
背景和目的--残疾调整寿命年(DALY)指标反映了因残疾而失去健康寿命的年数和因过早死亡而丧失的寿命年数。DALY广泛应用于流行病学分析，但尚未应用于急性卒中试验。方法：从以前的研究中，我们得出了每个修正的Rankin量表水平的残疾权重、与残疾相关的死亡风险比和特定于年龄的预期寿命。然后，我们分析了两个公开可用的国家神经疾病和中风研究所(NINDS)重组组织型纤溶酶原激活剂试验的患者水平数据。对于每个受试者，我们提取了年龄、治疗任务和3个月的改良Rankin量表结果，并计算了合格中风导致的DALYs损失。结果-改良Rankin量表评分0到5的残疾相关风险比分别为1.53、1.52、2.17、3.18、4.55和6.55。在NINDS重组组织纤溶酶原激活剂试验中，由于符合条件的中风而损失的DALY(Mean+/-SE)显著低于安慰剂组(4.64+/-0.17vs5.91+/-0.21；P<；0.0001)，这一发现在调整了基线预后因素后仍然强劲。当将获得的DALY分配给29%的从溶栓治疗中受益的患者时，每个患者平均获得4.4个DALY。DALY分析显示，在区分整体和70岁患者的治疗效果方面，DALY分析比二分改良Rankin量表分析具有更大的能力。结论-对于从治疗中受益的患者，3小时溶栓治疗增加了相当于4.4年的健康生命，没有残疾。DALY指标提供了一个连续的量表，增加了统计能力，直观地理解了这一指标，并适用于广泛的条件和治疗。(笔划。2010；41：471-477。)
Background and Purpose-Disability-adjusted life year (DALY) metric reflects years of healthy life lost because of living with disability and years of life lost because of premature mortality. Widely used in epidemiological analyses, DALY has not been applied to acute stroke trials.Methods-From previous studies, we derived, for each modified Rankin Scale level, disability weights, disability-linked mortality hazard ratios, and age-specific life expectancies. We then analyzed patient level data from the 2 publicly available National Institute of Neurological Disorders and Stroke (NINDS) recombinant tissue plasminogen activator trials. For each subject, we abstracted age, treatment assignment, and 3-month modified Rankin Scale outcome and calculated the DALYs lost resulting from the qualifying stroke.Results-The disability-linked hazard ratios for premature annual mortality for a modified Rankin Scale score of 0 to 5 were 1.53, 1.52, 2.17, 3.18, 4.55, and 6.55, respectively. In the NINDS recombinant tissue plasminogen activator trials, DALYs (mean +/- SE) lost as a result of the qualifying stroke were substantially less with recombinant tissue plasminogen activator than with placebo (4.64 +/- 0.17 versus 5.91 +/- 0.21; P < 0.0001), a finding that remained robust after adjustment for baseline prognostic factors. When DALYs gained were apportioned to the 29% of patients experiencing any benefit from lytic therapy, each patient gained an average of 4.4 DALYs. DALY analysis showed greater power than dichotomized modified Rankin Scale analysis in discriminating treatment effects overall and in patients >= 70 years of age.Conclusion-For patients who benefit from treatment, < 3-hour thrombolytic therapy adds the equivalent of 4.4 years of healthy life, free of disability. The DALY metric provides a continuous scale that increases statistical power, is intuitively understandable, and is applicable to a wide range of conditions and treatments. (Stroke. 2010;41:471-477.)