Predictors of functional outcome among stroke patients in Lima, Peru.
Predictors of functional outcome among stroke patients in Lima, Peru.
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DOI：
10.1016/j.jstrokecerebrovasdis.2012.11.021
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发表时间：
2013-10-01
期刊：
影响因子：
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通讯作者：
Zunt, Joseph
中科院分区：
文献类型：
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作者：
Abanto, Carlos;Ton, Thanh G N;Zunt, Joseph
背景技术背景：由于低收入和中等收入国家的人口老龄化，预计脑血管疾病仍将是导致死亡的主要原因。关于秘鲁中风的报道很少。我们对秘鲁利马转诊中心医院的住院脑卒中患者进行了回顾性队列研究，以探讨与脑卒中患者功能结局相关的因素。方法：我们确定了2008年和2009年在秘鲁利马国家神经科学研究所住院的579例缺血性卒中或脑出血性卒中患者。出院时改良兰金量表评分≤ 2分为良好结局。结果：平均年龄63.3岁，75.6%有缺血性卒中，平均住院时间17.3天。出院时，231例（39.9%）患者结局良好。总死亡率为5.2%。在多变量模型中，取得良好结果的可能性随着年龄的增加（P = 0.02）和美国国立卫生研究院中风量表（NIHSS）评分的增加（P = 0.02）而线性下降。有利结局还与男性（相对风险[RR] 1.2; 95%置信区间[CI] 1.0-1.5）和离婚状态（RR 1.3; 95% CI 1.1-1.7）相关。患者的健康积分健康（SIS;公共援助型保险; RR 0.7; 95%CI 0.5-1.0）也不太可能有一个有利的outcome.CONCLUSIONS：中风后的有利结果是独立相关的年轻，较低的NIHSS评分，男性，离婚，而不是SIS保险。这些结果表明，需要对SIS保险患者的功能结局进行额外研究，并确认在结局研究中对年龄、卒中严重程度（根据NIHSS量表）和其他社会经济因素进行风险调整的重要性。未来的研究应优先评估30天和6个月的结局，以提供更可靠的比较，并允许对秘鲁的临终决策和护理进行额外的研究。
BACKGROUND: Because of the aging population in low- and middle-income countries, cerebrovascular disease is expected to remain a leading cause of death. Little has been published about stroke in Peru. We conducted a retrospective cohort study of hospitalized stroke patients at a referral center hospital in Lima, Peru to explore factors associated with functional outcome among stroke patients.METHODS: We identified 579 patients hospitalized for ischemic stroke or intracerebral hemorrhage stroke at the National Institute of Neurologic Sciences in Lima, Peru in 2008 and 2009. A favorable outcome was defined as a modified Rankin scale score of ≤ 2 at discharge.RESULTS: The mean age was 63.3 years; 75.6% had ischemic stroke; the average duration of stay was 17.3 days. At hospital discharge, 231 (39.9%) had a favorable outcome. The overall mortality rate was 5.2%. In multivariate models, the likelihood of having a favorable outcome decreased linearly with increasing age (P = .02) and increasing National Institutes of Health Stroke Scale (NIHSS) score (P = .02). Favorable outcome was also associated with male gender (relative risk [RR] 1.2; 95% confidence interval [CI] 1.0-1.5) and divorced status (RR 1.3; 95% CI 1.1-1.7). Patients on Salud Integral de Salud (SIS; public assistance-type insurance; RR 0.7; 95% CI 0.5-1.0) were also less likely to have a favorable outcome.CONCLUSIONS: Favorable outcome after stroke was independently associated with younger age, a lower NIHSS score, male gender, being divorced, and not being on SIS insurance. These findings suggest that additional study of worse functional outcomes in patients with SIS insurance be conducted and confirm the importance of risk adjustment for age, stroke severity (according to the NIHSS scale), and other socioeconomic factors in outcomes studies. Future studies should preferentially assess outcome at 30 days and 6 months to provide more reliable comparisons and allow additional study of Peruvian end-of-life decision-making and care.