Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy
Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy
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DOI：
10.1001/jama.292.15.1831
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发表时间：
2004-10-20
影响因子：
120.7
通讯作者：
Berger, K
中科院分区：
文献类型：
--
作者：
Heuschmann, PU;Kolominsky-Rabas, PL;Berger, K
背景数据是有限的风险和利益的溶栓治疗急性缺血性stroke以外的临床试验目的探讨预测院内死亡率的缺血性卒中患者静脉注射组织纤溶酶原激活剂（tPA）在一个大型德国中风登记的汇总分析设计和设置前瞻性，在德国卒中登记研究组的合作下，在德国的225家社区和学术医院进行了一项观察性队列研究。结果166例（10%）接受tPA治疗的患者在住院期间死亡，其中67.5%发生在7天内。预测tPA使用后院内死亡的因素是年龄较大（年龄每增加10岁，校正比值比[OR]为1.6; 95%置信区间[0]为1.3-1.9）和意识水平改变（校正OR为3.4 - 95%CI为2.4-4.7）。症状性颅内出血的总体发生率为7.1%，并随年龄增长而增加。在tPA治疗后，27.2%的患者和83.9%的死亡患者中观察到一种或多种严重并发症。观察到在各自医院接受tPA治疗的患者数量与院内死亡风险之间呈负相关（调整OR，0.97; 95%CI，0.96-0.99，每增加一名患者每年接受tPA治疗）。结论在接受tPA治疗的缺血性卒中患者中，意识障碍和年龄增加与院内死亡率增加相关。
Context Data are limited regarding the risks and benefits of thrombolytic therapy for acute ischemic stroke outside of clinical trials.Objective To investigate predictors of in-hospital mortality in patients with ischemic stroke treated with intravenous tissue plasminogen activator (tPA) within a pooled analysis of large German stroke registers.Design and Setting Prospective, observational cohort study conducted at 225 community and academic hospitals throughout Germany cooperating within the German Stroke Registers Study Group.Patients A total of 1658 patients with acute ischemic stroke who were admitted to study hospitals between 2000 and 2002 and were treated with tPA.Main Outcome Measure In-hospital mortality.Results One hundred sixty-six patients (10%) who received tPA died during hospitalization, with 67.5% of these deaths occurring within 7 days. Factors predicting inhospital death after tPA use were older age (for each 10-year increment in age, adjusted odds ratio [OR], 1.6; 95% confidence interval [0], 1.3-1.9) and altered level of consciousness (adjusted OR, 3.4 95% Cl, 2.4-4.7). The overall rate of symptomatic intracranial hemorrhage was 7.1 % and increased with age. One or more serious complications was observed in 27.2% of all patients and in 83.9% of patients who died after tPA treatment. An inverse relation between the number of patients treated with tPA in the respective hospital and the risk of in-hospital death was observed (adjusted OR, 0.97; 95% Cl, 0.96-0.99 for each additional patient treated with tPA per year).Conclusion In patients with ischemic stroke who are treated with tPA, disturbances of consciousness and increasing age are associated with increased in-hospital mortality.