Background The risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms. The impact of this clinical deterioration on long-term o...Background The risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms. The impact of this clinical deterioration on long-term outcomes is unknown. We characterized the clinical features of neurological deterioration （ND） in the acute phase of minor ischemic stroke （MIS） and investigated its impact on mid- and long-term outcomes. Methods This was a multi-centered, prospective clinical study involving patients with MIS （the National Institutes of Health Stroke Scale, NIHSS ~3） recruited from the China National Stroke Registry. Patients were included who had been hospitalized within 24 hours of stroke onset. Baseline characteristics, complication rates during hospitalization, etiology of stroke, as well as 3-, 6-, and 12-month post-stroke outcomes were compared between patients with and without ND during the acute phase. Results A number of 368 （15.2%） out of 2424 patients included in the study exhibited ND in the acute phase. Compared to patients without ND, patients with ND had longer hospital stay, increased rate of baseline diabetes, and multiple complications. Multivariate Logistic regression indicated that ND in acute phase was an independent factor predictive of increased dependence （adjusted odds ratio = 5.20, 95% CI, 3.51-7.70, P 〈0.001） at 12-month post-stroke. Conclusions The risk of ND in the acute phase is high in patients with MIS. ND in the acute phase is an independent predictor for poor outcomes at 12 months post-stroke onset.展开更多
目的比较Essen卒中风险分层量表(Essen Stroke Risk Score,ESRS)预测短暂性脑缺血发作(transient ischemic attack,TIA)、缺血性小卒中和缺血性大卒中患者的卒中复发和联合血管事件发生的效度。方法以前瞻性、多中心中国国家卒中登记研...目的比较Essen卒中风险分层量表(Essen Stroke Risk Score,ESRS)预测短暂性脑缺血发作(transient ischemic attack,TIA)、缺血性小卒中和缺血性大卒中患者的卒中复发和联合血管事件发生的效度。方法以前瞻性、多中心中国国家卒中登记研究(China National Stroke Registry,CNSR)中连续录入的11 384例完成1年随访的TIA、非心房颤动性缺血性卒中的住院患者为研究人群,小卒中定义为入院时缺血性卒中患者的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤3分,大卒中定义为NIHSS评分>3分。采用曲线下面积(area under the curve,AUC)评价ESRS对TIA、缺血性小卒中和大卒中患者进行卒中复发和联合血管事件复发风险的分层能力,预测卒中复发和联合血管事件发生的效度。结果本研究有1061例TIA,3254例小卒中,7069例大卒中患者。在TIA患者中,ESRS预测卒中复发AUC=0.57,预测联合血管事件AUC=0.56;小卒中患者中,ESRS预测卒中复发的AUC=0.58,预测联合血管事件AUC=0.59;大卒中患者中,ESRS预测卒中复发的AUC=0.60,预测联合血管事件AUC=0.60。结论 ESRS评分对大卒中的卒中复发/联合血管事件发生的预测效度最高,其次是对小卒中,在TIA中预测效度最低,但是三组人群中差异无显著性。展开更多
目的:评估轻度急性缺血性卒中患者起病后早期神经功能恶化(early neurological deterioration,END)的风险因素,构建起病后END的列线图预测模型。方法:回顾性收集南京医科大学附属南京医院(南京市第一医院)及南通市第三人民医院2015年4月...目的:评估轻度急性缺血性卒中患者起病后早期神经功能恶化(early neurological deterioration,END)的风险因素,构建起病后END的列线图预测模型。方法:回顾性收集南京医科大学附属南京医院(南京市第一医院)及南通市第三人民医院2015年4月—2018年6月收治的轻度急性缺血性卒中患者临床资料,比较END组与非END组患者的基线临床资料,采用多因素Logistic回归分析确定END的独立相关因素,基于独立相关因素构建轻度急性缺血性卒中END列线图预测模型。结果:共纳入507例患者,END组99例(19.5%),非END组408例(80.5%)。END组患者的年龄(P=0.001)、心房纤颤病史构成比(P=0.001)、缺血性心脏病病史构成比(P=0.010)、基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分(P=0.023)、快速血糖水平(P=0.001)、超敏C反应蛋白水平(P=0.006)显著高于非END组,饮酒史构成比(P=0.042)、白蛋白水平(P=0.001)显著低于非END组。多因素Logistic回归分析提示,年龄(OR=1.031,95%CI:1.008~1.054;P=0.007)、心房纤颤病史(OR=4.349,95%CI:1.932~9.792;P=0.001)、基线NIHSS评分(OR=1.219,95%CI:1.021~1.455;P=0.029)、快速血糖水平(OR=1.199,95%CI:1.083~1.328;P=0.001)、超敏C反应蛋白水平(OR=1.069,95%CI:1.027~1.113;P=0.001)、白蛋白水平(OR=0.826,95%CI:0.733~0.930;P=0.002)是轻型急性缺血性卒中END的独立相关因素。基于多因素Logistic回归发现的独立相关因素,构建列线图模型,一致性指数为0.736(95%CI:0.677~0.796,P <0.001)。结论:本列线图对轻型急性缺血性卒中后END的发生具有一定的预测价值。展开更多
基金This study was funded by grants from the Ministry of Science and Technology and the Ministry of Health of the People＇s Republic of China： National Science and Technology Major Project of China （No. 2008ZX09312-008）, the National Science Foundation （No. 81071115）, and the Beijing Science and Technology Committee （No. 7102050）.
文摘Background The risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms. The impact of this clinical deterioration on long-term outcomes is unknown. We characterized the clinical features of neurological deterioration （ND） in the acute phase of minor ischemic stroke （MIS） and investigated its impact on mid- and long-term outcomes. Methods This was a multi-centered, prospective clinical study involving patients with MIS （the National Institutes of Health Stroke Scale, NIHSS ~3） recruited from the China National Stroke Registry. Patients were included who had been hospitalized within 24 hours of stroke onset. Baseline characteristics, complication rates during hospitalization, etiology of stroke, as well as 3-, 6-, and 12-month post-stroke outcomes were compared between patients with and without ND during the acute phase. Results A number of 368 （15.2%） out of 2424 patients included in the study exhibited ND in the acute phase. Compared to patients without ND, patients with ND had longer hospital stay, increased rate of baseline diabetes, and multiple complications. Multivariate Logistic regression indicated that ND in acute phase was an independent factor predictive of increased dependence （adjusted odds ratio = 5.20, 95% CI, 3.51-7.70, P 〈0.001） at 12-month post-stroke. Conclusions The risk of ND in the acute phase is high in patients with MIS. ND in the acute phase is an independent predictor for poor outcomes at 12 months post-stroke onset.
文摘目的比较Essen卒中风险分层量表(Essen Stroke Risk Score,ESRS)预测短暂性脑缺血发作(transient ischemic attack,TIA)、缺血性小卒中和缺血性大卒中患者的卒中复发和联合血管事件发生的效度。方法以前瞻性、多中心中国国家卒中登记研究(China National Stroke Registry,CNSR)中连续录入的11 384例完成1年随访的TIA、非心房颤动性缺血性卒中的住院患者为研究人群,小卒中定义为入院时缺血性卒中患者的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤3分,大卒中定义为NIHSS评分>3分。采用曲线下面积(area under the curve,AUC)评价ESRS对TIA、缺血性小卒中和大卒中患者进行卒中复发和联合血管事件复发风险的分层能力,预测卒中复发和联合血管事件发生的效度。结果本研究有1061例TIA,3254例小卒中,7069例大卒中患者。在TIA患者中,ESRS预测卒中复发AUC=0.57,预测联合血管事件AUC=0.56;小卒中患者中,ESRS预测卒中复发的AUC=0.58,预测联合血管事件AUC=0.59;大卒中患者中,ESRS预测卒中复发的AUC=0.60,预测联合血管事件AUC=0.60。结论 ESRS评分对大卒中的卒中复发/联合血管事件发生的预测效度最高,其次是对小卒中,在TIA中预测效度最低,但是三组人群中差异无显著性。
文摘目的:评估轻度急性缺血性卒中患者起病后早期神经功能恶化(early neurological deterioration,END)的风险因素,构建起病后END的列线图预测模型。方法:回顾性收集南京医科大学附属南京医院(南京市第一医院)及南通市第三人民医院2015年4月—2018年6月收治的轻度急性缺血性卒中患者临床资料,比较END组与非END组患者的基线临床资料,采用多因素Logistic回归分析确定END的独立相关因素,基于独立相关因素构建轻度急性缺血性卒中END列线图预测模型。结果:共纳入507例患者,END组99例(19.5%),非END组408例(80.5%)。END组患者的年龄(P=0.001)、心房纤颤病史构成比(P=0.001)、缺血性心脏病病史构成比(P=0.010)、基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分(P=0.023)、快速血糖水平(P=0.001)、超敏C反应蛋白水平(P=0.006)显著高于非END组,饮酒史构成比(P=0.042)、白蛋白水平(P=0.001)显著低于非END组。多因素Logistic回归分析提示,年龄(OR=1.031,95%CI:1.008~1.054;P=0.007)、心房纤颤病史(OR=4.349,95%CI:1.932~9.792;P=0.001)、基线NIHSS评分(OR=1.219,95%CI:1.021~1.455;P=0.029)、快速血糖水平(OR=1.199,95%CI:1.083~1.328;P=0.001)、超敏C反应蛋白水平(OR=1.069,95%CI:1.027~1.113;P=0.001)、白蛋白水平(OR=0.826,95%CI:0.733~0.930;P=0.002)是轻型急性缺血性卒中END的独立相关因素。基于多因素Logistic回归发现的独立相关因素,构建列线图模型,一致性指数为0.736(95%CI:0.677~0.796,P <0.001)。结论:本列线图对轻型急性缺血性卒中后END的发生具有一定的预测价值。
