Years of optimum health lost due to complications after acute ischemic stroke: disability-adjusted life-years analysis.
Years of optimum health lost due to complications after acute ischemic stroke: disability-adjusted life-years analysis.
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DOI：
10.1161/strokeaha.109.576066
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发表时间：
2010-08
期刊：
影响因子：
8.3
通讯作者：
Lee BC
中科院分区：
文献类型：
--
作者：
Hong KS;Saver JL;Kang DW;Bae HJ;Yu KH;Koo J;Han MK;Cho YJ;Park JM;Lee BC
中风后的并发症会增加残疾或死亡。世界卫生组织为衡量全球疾病负担而制定的残疾调整生命年（DALY）指标综合了死亡率和残疾率。广泛用于人群水平数据分析，尚未应用于结局登记研究中采集的个体患者水平数据。我们分析了2004年9月1日至2005年8月31日在韩国登记的1254例连续急性缺血性卒中患者的结局登记处的患者水平数据。对于每例受试者，我们计算了由于合格卒中导致的DALY损失，然后分析了由于卒中后并发症导致的额外DALY损失。对于1233例有3个月结局的患者，由于指数卒中导致的平均DALY损失为3.82（95% CI，3.68 - 3.96）。任何并发症、神经系统并发症和内科并发症的发生率分别为34.0%、20.8%和24.0%。与任何神经系统和医学并发症相关的额外DALOS丢失分别为2.11（95% CI，1.78 - 2.44）、2.15（95% CI，1.72 - 2.59）和1.99（95% CI，1.59 - 2.40）。有1例并发症的患者额外损失1.52（95% CI，1.15 - 1.89）DALY，有2例或2例以上并发症的患者额外损失2.69（95% CI，2.18 - 3.20）DALY。中风后早期并发症剥夺了患者约2年的最佳健康状态。并发症的数量越多，健康生命年的损失越大。DALY分析量化了卒中后并发症的负担，其统一的指标可能对卫生系统规划者有用。
Complications after stroke increase disability or death. The disability-adjusted life year (DALY) metric, developed by the WHO to measure the global burden of disease, integrates both mortality and disability. Widely employed in population-level data analyses, it has not been applied to individual patient-level data captured in outcome registries. We analyzed patient-level data from the outcome registry of 1254 consecutive acute ischemic stroke patients enrolled between September 1, 2004 and August 31, 2005 in South Korea. For each subject, we calculated DALY lost due to the qualifying stroke, and then analyzed additional DALY lost due to complications after stroke. For 1233 patients with available 3-month outcomes, the average DALY lost due to the index stroke was 3.82 (95% CI, 3.68 to 3.96). Any complications, neurological complications, and medical complications occurred in 34.0%, 20.8%, and 24.0%, respectively. The additional DALYs lost associated with any, neurological, and medical complications were 2.11 (95% CI, 1.78 to 2.44), 2.15 (95% CI, 1.72 to 2.59), and 1.99 (95% CI, 1.59 to 2.40), respectively. Patients with one complication had 1.52 (95% CI, 1.15 to 1.89) additional DALY lost, and those with 2 or more complications had 2.69 (95% CI, 2.18 to 3.20) additional DALY lost. Early poststroke complications deprive patients of about 2 years of optimum health. Greater numbers of complications is associated with greater loss of healthy life years. DALY analysis quantifies the burden of poststroke complications with a uniform metric potentially useful for health system planners.