Hemorrhagic and Ischemic Strokes Compared Stroke Severity, Mortality, and Risk Factors
Hemorrhagic and Ischemic Strokes Compared Stroke Severity, Mortality, and Risk Factors
复制标题
DOI：
10.1161/strokeaha.108.540112
复制
发表时间：
2009-06-01
期刊：
影响因子：
8.3
通讯作者：
Kammersgaard, Lars Peter
中科院分区：
文献类型：
--
作者：
Andersen, Klaus Kaae;Olsen, Tom Skyhoj;Kammersgaard, Lars Peter
背景和目的：比较出血性（HS）和缺血性脑卒中患者的脑卒中严重程度、死亡率和心血管危险因素。方法：2001年开始注册，目的是登记丹麦所有住院中风患者，目前拥有39484名患者的信息。患者接受了包括中风严重程度（斯堪的纳维亚中风量表）、CT和心血管危险因素的评估。他们被跟踪调查，直到2007年死亡或审查。通过基于25 123个具有完整数据集的个体的生存模型确定独立的死亡预测因子。结果：HS患者3993例（10.1%）。中风严重程度与HS发生的概率几乎呈线性相关（最轻中风患者为2%，最严重中风患者为30%）。缺血性卒中vs HS的有利因素是糖尿病、房颤、既往心肌梗死、既往卒中和间歇性动脉跛行。吸烟和饮酒有利于高血压，而年龄、性别和高血压不预示中风类型。与缺血性中风相比，HS与总体较高的死亡风险相关（HR, 1.564; 95% CI, 1.441-1.696）。然而，增加的风险与时间有关；最初，风险是4倍，1周后是2.5倍，3周后是1.5倍。3个月后，中风类型与死亡率无关。结论：HS患者的脑卒中一般更为严重。在中风后的前3个月内，HS与死亡率的显著增加相关，这与病变的出血性有关。（中风。2009;40:2068-2072。）
Background and Purpose-Stroke patients with hemorrhagic (HS) and ischemic strokes were compared with regard to stroke severity, mortality, and cardiovascular risk factors.Methods-A registry started in 2001, with the aim of registering all hospitalized stroke patients in Denmark, now holds information for 39 484 patients. The patients underwent an evaluation including stroke severity (Scandinavian Stroke Scale), CT, and cardiovascular risk factors. They were followed-up from admission until death or censoring in 2007. Independent predictors of death were identified by means of a survival model based on 25 123 individuals with a complete data set.Results-Of the patients 3993 (10.1%) had HS. Stroke severity was almost linearly related to the probability of having HS (2% in patients with the mildest stroke and 30% in those with the most severe strokes). Factors favoring ischemic strokes vs HS were diabetes, atrial fibrillation, previous myocardial infarction, previous stroke, and intermittent arterial claudication. Smoking and alcohol consumption favored HS, whereas age, sex, and hypertension did not herald stroke type. Compared with ischemic strokes, HS was associated with an overall higher mortality risk (HR, 1.564; 95% CI, 1.441-1.696). The increased risk was, however, time-dependent; initially, risk was 4-fold, after 1 week it was 2.5-fold, and after 3 weeks it was 1.5-fold. After 3 months stroke type did not correlate to mortality.Conclusion-Strokes are generally more severe in patients with HS. Within the first 3 months after stroke, HS is associated with a considerable increase of mortality, which is specifically associated with the hemorrhagic nature of the lesion. (Stroke. 2009; 40: 2068-2072.)