Causes of Death and Predictors of 5-Year Mortality in Young Adults After First-Ever Ischemic Stroke The Helsinki Young Stroke Registry
Causes of Death and Predictors of 5-Year Mortality in Young Adults After First-Ever Ischemic Stroke The Helsinki Young Stroke Registry
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DOI：
10.1161/strokeaha.109.554998
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发表时间：
2009-08-01
期刊：
影响因子：
8.3
通讯作者：
Tatlisumak, Turgut
中科院分区：
文献类型：
--
作者：
Putaala, Jukka;Curtze, Sami;Tatlisumak, Turgut
背景和目的——关于年轻人急性缺血性中风后死亡率及其预后因素的数据很少，并且基于相对较小的异质性患者系列。方法——我们分析了1994年1月至2003年9月在赫尔辛基大学中央医院神经内科治疗的所有15至49岁首次缺血性中风患者的连续5年死亡率数据。我们使用芬兰统计局死亡率登记处的数据对患者进行了随访。我们使用生命表分析来计算死亡风险。 Kaplan-Meier 方法允许比较临床亚组之间的生存率。我们使用 Cox 比例风险模型来确定死亡率的预测因素。使用美国国立卫生研究院中风量表和格拉斯哥昏迷量表来测量中风严重程度。结果-在 731 名患者（平均年龄，41.5 +/- 7.4 岁；62.8% 男性）中，78 人死亡。 1 个月时的累积死亡风险为 2.7%（95% CI，1.5% 至 3.9%），1 年时为 4.7%（3.1% 至 6.3%），5 年时为 10.7%（9.9% 至 11.5%），无性别差异。 45 岁以上的人生存概率较低。在 30 天幸存者 (n = 711) 中，中风导致死亡人数占 21%，心主动脉和其他血管原因占 36%，恶性肿瘤占 12%，感染占死亡人数的 9%。恶性肿瘤、心力衰竭、酗酒、既往感染、1型糖尿病、年龄增长和导致中风的大动脉粥样硬化可独立预测5年死亡率，并根据年龄、性别、相关危险因素、中风严重程度和病因亚型进行调整。结论——尽管年轻人缺血性中风后死亡率总体较低，但从长远来看，几个可识别的亚组死亡风险大幅增加。 （中风。2009；40：2698-2703。）
Background and Purpose-Data on mortality and its prognostic factors after an acute ischemic stroke in young adults are scarce and based on relatively small heterogeneous patient series.Methods-We analyzed 5-year mortality data of all consecutive patients aged 15 to 49 with first-ever ischemic stroke treated at the Department of Neurology, Helsinki University Central Hospital, from January 1994 to September 2003. We followed up the patients using data from the mortality registry of Statistics Finland. We used life table analyses for calculating mortality risks. Kaplan-Meier method allowed comparisons of survival between clinical subgroups. We used the Cox proportional hazard model for identifying predictors of mortality. Stroke severity was measured using the National Institutes of Health Stroke Scale and the Glasgow Coma Scale.Results-Among the 731 patients (mean age, 41.5 +/- 7.4 years; 62.8% males) followed, 78 died. Cumulative mortality risks were 2.7% (95% CI, 1.5% to 3.9%) at 1 month, 4.7% (3.1% to 6.3%) at 1 year, and 10.7% (9.9% to 11.5%) at 5 years with no gender difference. Those >= 45 years of age had lower probabilities of survival. Among the 30-day survivors (n = 711), stroke caused 21%, cardioaortic and other vascular causes 36%, malignancies 12%, and infections 9% of the deaths. Malignancy, heart failure, heavy drinking, preceding infection, type 1 diabetes, increasing age, and large artery atherosclerosis causing the index stroke independently predicted 5-year mortality adjusted for age, gender, relevant risk factors, stroke severity, and etiologic subtype.Conclusions-Despite the overall low mortality after an ischemic stroke in young adults, several recognizable subgroups had substantially increased risk of death in the long term. (Stroke. 2009; 40: 2698-2703.)