脑卒中患者急性期血糖水平与病情严重程度的关系

目的探讨脑卒中患者急性期血糖水平与病情严重程度的关系。方法采用前瞻性队列研究的方法检测2005-02～2008-02所有入院病程<24h的340例脑卒中患者(其中出血性卒中153例,缺血性卒中187例)的空腹血糖水平。采用斯勘的纳维亚卒中评分(SSS)量表评价患者入院时神经功能缺损程度。按卒中类型和空腹血糖水平分组,比较各组间指标差异。结果出血性卒中组空腹血糖水平及SSS评分高于缺血性卒中组(P<0.05);血糖升高组SSS评分高于正常血糖组(P<0.01)。结论急性脑卒中患者血糖越高,病情越重,其中出血性卒中更显著。对急性脑卒中患者检测血糖有利于病情的判断。     

Association of hyponatremia in acute stroke stage with three-year mortality in patients with first-ever ischemic stroke

Background: Hyponatremia is the most common electrolyte disorder in hospitalized patients, and is frequently a marker of a significant underlying disease. The prognostic value of hyponatremia in patients with acute first-ever ischemic stroke is not known. We aimed to analyze whether hyponatremia in the acute stroke stage contributed to the risk of mortality or recurrent stroke in these patients. Methods: We studied 925 patients presenting with acute first-ever ischemic stroke between 2002 and 2004. Sodium levels were obtained on arrival at the emergency room within 3 days of acute stroke onset. Hyponatremia was defined as a serum sodium concentration of 134 mmol/l or less. Clinical presentation, stroke risk factors, associated medical disease, and outcome were recorded. All patients were followed for 3 years for survival analysis. A multivariate Cox proportional hazards model was used to identify risk factors for 3-year mortality in these patients. We also constructed Kaplan-Meier survival curves, and compared groups with hyponatremia and normonatremia by means of log rank tests for significant differences. Results: Among the patients with acute first-ever ischemic stroke, 107 (11.6%) were hyponatremic. Among stroke risk factors, the prevalence of diabetes mellitus was significantly higher among hyponatremic patients (p < 0.001). Prevalence of chronic renal insufficiency was also higher in the hyponatremic group (p = 0.002). Clinical presentations, such as the length of acute ward stay, initial impaired consciousness, and clinical course in acute stroke were similar among normo- and hyponatremic patients. Among the complications, pneumonia and urinary tract infection were significantly higher in hyponatremic than in normonatremic patients. After multivariate logistic regression analysis, diabetes mellitus and chronic renal insufficiency were associated with hyponatremia in these patients. Kaplan-Meier analysis indicated that the survival rate was significantly lower in hyponatremic patients than in normonatremic patients (log rank test; p value <0.001). After multivariate Cox proportional hazards model analysis, hyponatremia was a significant predictor of 3-year mortality in these patients after adjustment for related variables (p value = 0.003, hazard ratio = 2.23, 95% confidence interval: 1.30-3.82). Conclusion: Hyponatremia in the acute stroke stage is a predictor of 3-year mortality in patients with acute first-ever ischemic stroke that is independent of other clinical predictors of adverse outcome.     

高血糖对急性缺血性卒中早期预后影响的初步研究

目的 探讨高血糖对急性缺血性卒中早期预后的影响。方法 采用前瞻性研究设计,连续纳入发病72h内入院的急性缺血性卒中患者143例。急诊入院时检测入院随机静脉血清血糖,高血糖定义为入院随机静脉血清血糖≥7.2mmol/L。入院时评定美国国立卫生研究院卒中量表（NIH Stroke Scale,NIHSS）评分,根据病史及辅助检查确定缺血性卒中类型（TOAST分型）。发病30d时进行改良Rankin’s评分（mRS）,作为评估早期预后的指标。结果 （1）本研究入选的143例急性缺血性卒中患者中,85例（59.4%）出现高血糖,单因素分析显示,年龄、糖尿病史、NIHSS评分是急性缺血性卒中合并高血糖的危险因素（P＜0.05）,logistic回归分析显示,糖尿病史、NIHSS评分是急性缺血性卒中合并高血糖的独立危险因素（P＜0.05）。（2）单因素分析显示,年龄、感染、高血糖、NIHSS评分和TOAST分型对mRS评分的影响有统计学差异（P＜0.05）,logistic回归分析显示,高血糖、NIHSS评分是预后不良的独立危险因素（P＜0.05）。结论 高血糖在急性缺血性卒中患者中的发生率较高,其出现与卒中的严重程度密切相关,可以作为反映急性缺血性卒中发病时病情较重的指标之一,高血糖是急性缺血性卒中早期预后不良的独立危险因素。     

Neurohormonal activation in ischemic stroke: effects of acute phase disturbances on long-term mortality

A stress response consisting of elevated levels of cortisol and catecholamines is common after acute stroke. The plasma levels of natriuretic peptides are known to be elevated after ischemic stroke, but the relations of these neurohormonal systems in the acute phase of stroke and their impact on long-term prognosis have not been studied previously. A series of 51 consecutive patients (mean age 68+/-11 years) with an ischemic first-ever stroke underwent a comprehensive clinical investigation, scoring of their neurologic deficit by Scandinavian Stroke Scale (SSS), Barthel Index (BI) and Modified Ranking Scale (MRS) as well as measurements of plasma cortisol, norepinephrine, epinephrine, ACTH and atrial (N-ANP) and brain (N-BNP) natriuretic peptides on the 2nd and 7th days after ischemic stroke. The patients were followed up for 44+/-21 months. Higher levels of cortisol, ACTH and natriuretic peptides were observed in the stroke patients who died (n=22) during the follow-up than in the stroke survivors. Cortisol levels associated significantly with the 2nd and 7th day N-ANP and N-BNP levels, catecholamine levels (r= 0.55 - 0.94, p<0.01 for all) and measures of neurologic deficit (r= 0.36 - -0.44, p<0.05). High acute phase cortisol levels assessed either in the morning (RR=5.4, p<0.05) or in the evening (RR=5.8, p<0.05) predicted long-term mortality after stroke in multivariate analysis. Activation of the hypothalamus-pituitary-adrenal axis in ischemic stroke is associated with elevated levels of natriuretic peptides. High cortisol and natriuretic peptide values predict long-term mortality after ischemic stroke, suggesting that this profound neurohumoral disturbance is prognostically unfavourable.     

The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke

Fasting serum glucose, glycosylated hemoglobin, and fructosamine concentrations were determined in 304 consecutive subjects admitted with acute stroke, within 48 hours of ictus. Based on the medical history and these results, subjects were divided into known diabetics, newly diagnosed diabetics, subjects with stress hyperglycemia, and nondiabetics. The type of stroke was classified as lacunar infarct, cerebral infarct, or intracerebral hemorrhage, based on clinical examination by a neurologist and computed tomographic brain scan and/or autopsy. Immediate and 3-month outcomes were examined in relation to (1) fasting glucose, glycosylated hemoglobin, and fructosamine levels by stroke subtypes, and (2) glucose tolerance categories by stroke subtypes. A high fasting glucose level was associated with an increased mortality, but this was observed only among patients with intracerebral hemorrhage. Patients with stress hyperglycemia, but not diabetics, had increased mortality. In spite of having similar glucose concentrations to those patients with stress hyperglycemia, diabetics did not have a worse outcome compared with nondiabetics. It is concluded that the association between glucose concentration and outcome is a reflection of stress relating to stroke severity, rather than a direct harmful effect of glucose on damaged neurons.     

Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke

BACKGROUND: Hyperglycemia at the time of acute ischemic stroke has been linked to worse outcome in both human and animal studies. OBJECTIVE: To describe the prevalence and severity of hyperglycemia on hospital admission among acute ischemic stroke patients, to examine the independent relationship of admission hyperglycemia to all-cause mortality, and to document the inpatient management of hyperglycemia. METHODS: Patients hospitalized with acute ischemic stroke at one hospital from July 1993 to June 1998 (n = 656) were identified. Demographic data, diagnoses, and blood glucose (BG) values were retrieved from the electronic medical record system. Admission stroke severity, fingerstick BG results, and new diabetes diagnoses were obtained by chart review. Hyperglycemia was defined as admitting random serum BG > or = 130 mg/dL. Hazard ratios (HR) for 30-day, 1-year, and 6-year mortality were calculated using multivariable Cox regression models. RESULTS: Hyperglycemia at admission to hospital was present in 40% of patients with acute stroke. Patients with hyperglycemia were more often women and more likely to have prior diagnoses of diabetes and heart failure. Almost all of these patients remained hyperglycemic during their hospital stay (mean BG = 206 mg/dL), and 43% received no inpatient hypoglycemic drugs. Hyperglycemic patients had longer hospital stay (7 vs 6 days, p = 0.015) and higher inpatient hospital charges ($6,611 vs $5,262, p < 0.001). Hyperglycemia independently increased the risk for death at 30 days (HR 1.87, p < or = 0.01), 1 year (HR 1.75, p < or = 0.01), and 6 years after stroke (HR 1.41, p 相似文献   

Hyperglycemia in acute ischemic stroke: physiopathological and therapeutic complexity

Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a number of non-diabetic patients after acute ischemic stroke, presumably as a stress response. The aim of this review is to summarize the main effects of hyperglycemia when associated to ischemic injury in acute stroke patients, highlighting the clinical and neurological outcomes in t...     

Microalbuminuria in nondiabetic patients with acute ischemic stroke: prevalence,clinical correlates,and prognostic significance

Microalbuminuria is a frequent finding in several acute clinical conditions and predicts poor outcome; its role in acute ischemic stroke, however, is unknown. This study was designed to investigate the prevalence and predictive power of microalbuminuria in acute stroke patients and to establish the relationship between microalbuminuria and the patients' clinical status. We studied 60 patients admitted within 24 h of their first ischemic stroke, 50 patients with a history of ischemic stroke, and 30 control subjects without known cerebrovascular diseases. Neurological deficit was assessed by the Scandinavian Stroke Scale (SSS) on admission and on days 1, 7, 14, and 30. Urinary albumin excretion was measured using immunonephelometric method, with 24-hour collections performed on day 2. Outcome was assessed by 30-day, 90-day and 1-year mortality. Microalbuminuria was found in 46.7% of patients with acute stroke, 16% of subjects with a history of stroke, and 16.7% of controls. On admission, acute stroke patients with microalbuminuria had more severe neurological deficit (median of SSS score on admission was 28 vs. 40, and on day 1, 22 vs. 39, both p < 0.05; Mann-Whitney U test) and more often had a decreased level of consciousness (32 vs. 10%, p < 0.05; Fisher exact test). Mortality was higher in the group of patients with microalbuminuria in acute stroke (21 vs. 3% after 30 days, 39 vs. 6% after 90 days and 50 vs. 9% after 1 year, p < 0.05 for all differences; Fisher exact test). In logistic regression analysis, microalbuminuria was found to be an independent predictor of 1-year mortality after ischemic stroke (OR = 6.0; p = 0.022; 95% CI = 1.3-27.7).     

Transient ischemic attack and risk of stroke recurrence: The Lehigh Valley Recurrent Stroke Study

We investigated the effect of transient ischemic attack occurring both before and after an initial stroke on risk of recurrent stroke in a population-based study. In the Lehigh Valley Recurrent Stroke Study, patients were enrolled between July 1987 and August 1989 and followed up regularly at about 6-month intervals for up to 4 years (mean, 2 years). In addition to history of transient ischemic attack before and after the initial stroke, information on comorbidities including hypertension, myocardial infarction, cardiac arrhythmia, and diabetes mellitus was collected at the baseline visit and at follow-up visits. The 621 patients with an initial ischemic stroke constituted the cohort analyzed in this report. A history of transient ischemic attack was present at enrollment in 114 (18.4%) patients. During follow-up, 20 patients experienced a transient ischemic attack, and 77 had a recurrent stroke. Using a Cox proportional hazards model taking comorbidities, sex, and age into account, we analyzed the relationship between transient ischemic attack and recurrent stroke in the 503 patients with at least one follow-up visit. History of transient ischemic attack before the initial stroke was associated with a decreased risk of recurrent stroke (Hazards ratio, 0.3; 95% confidence interval, 0.08 to 0.86; P=.03), whereas a new transient ischemic attack after the initial stroke was associated with an increased risk of recurrent stroke (Hazards ratio, 11.7; 95% C.I. confidence interval=3.45 to 39.83; P=.0001).     

急性缺血性脑卒中神经功能缺损对ADL的影响6个月随访研究

目的 探讨急性缺血性脑卒中神经功能缺损对日常生活能力（ADL）的影响.方法 以19岁～80岁的急性缺血性脑卒中患者为研究对象,斯堪的纳维亚脑卒中量表（SSS）评估神经功能,发病3个月及6个月时评定ADL（BI）.结果 缺血性卒中后3个月ADL依赖率为19%;6个月时15%,SSS与ADL呈正相关（P＜0.01）,ADL依赖患者的入院SSS评分低于非依赖者（P＜0.01）.Logistic回归分析发现：SSS是ADL独立影响因素.结论 缺血性脑卒中急性期神经功能缺损是患者ADL的独立影响因素.     

Factors influencing the survival of 451 transient ischemic attack patients

Four hundred fifty-one patients with transient ischemic attacks (TIA) occurring within 1 month of hospitalization, admitted during 1977-1983, were analyzed to establish the effect on survival of age, race, sex, distribution of TIA, cigarette smoking, previous cerebral infarction or hemorrhage, previous TIA, or history of ischemic heart disease, valvular heart disease, cardiac dysrhythmia, hypertension, and diabetes mellitus. Proportional hazards analysis revealed that decreased survival was associated with increasing age, carotid artery distribution TIAs (compared with vertebrobasilar distribution TIAs), cigarette smoking, previous contralateral stroke, ischemic heart disease, and diabetes mellitus. We found great variation in the estimated survival of TIA patients, ranging from 5-year survivals of greater than 95% for 60-year-old patients with none of these risk factors to less than 25% for patients with all of these risk factors. Although the survival of the strata differed, the average mortality rates for this series of patients was about one-half of that observed for 225 patients accessed and followed by our center during 1961-1973.     

Cardiovascular risk factors and 5-year mortality in the Copenhagen Stroke Study

BACKGROUND: The treatment of cardiovascular risk factors has improved over the recent years and may have improved survival. The aim of this study was to investigate the up-to-date prognostic significance of cardiovascular risk factors for 5-year survival in a large unselected ischemic stroke population. METHODS: We studied 905 ischemic stroke patients from the community-based Copenhagen Stroke Study. Patients had a CT scan and stroke severity was measured by the Scandinavian Stroke Scale on admission. A comprehensive evaluation was performed by a standardized medical examination and questionnaire for cardiovascular risk factors, age, and sex. Follow-up was performed 5 years after stroke, and data on mortality were obtained for all, except 6, who had left the country. Five-year mortality was calculated by the Kaplan-Meier procedure and the influence of multiple predictors was analyzed by Cox proportional hazards analyses adjusted for age, gender, stroke severity, and risk factor profile. RESULTS: In Kaplan-Meier analyses atrial fibrillation (AF), ischemic heart disease, diabetes, and previous stroke were associated with increased mortality, while smoking and alcohol intake were associated with decreased mortality. No association was found for hypertension or intermittent claudication. In the final Cox proportional hazard model predictors of 5-year mortality were AF (hazard ratio, HR 1.4; 95% CI 1.1-1.7), diabetes (HR 1.3; 95% CI 1.0-1.6), smoking (HR 1.2; 95% CI 1.0-1.4), and previous stroke (HR 1.4; 95% CI 1.1-1.7), after adjustment for age, gender, and stroke severity. CONCLUSIONS: AF, diabetes, smoking, and previous stroke significantly affect long-term survival. Although smoking and daily alcohol consumption appeared to be associated with improved survival in the univariate analyses, adjustment for other factors and especially age revealed the lethal effect of smoking, while the positive effect of alcohol disappeared. More focus on secondary preventive measures, such as anticoagulation for AF, smoking cessation, and proper treatment of diabetes may significantly improve long-term survival.     

进展性脑梗死患者红细胞分布宽度的动态变化及预后风险评估

目的观察进展性缺血性脑卒中(PIS)患者的红细胞分布宽度(RDW)、氧化低密度脂蛋白(ox-LDL)与超敏C反应蛋白(hs-CRP)水平的动态变化,探讨其对PIS病情严重程度及评估预后的价值。方法选择急性脑梗死患者100例,分为进展组(PIS组)50例、非进展组(非PIS组)50例,分别测定两组患者发病24h、2d、3d、7d、14d RDW、ox-LDL与hs-CRP水平及SSS评分,并随访患者3月时改良Rankin量表(m RS)评分,采用Cox比例风险回归分析进展性缺血性脑卒中预后。结果治PIS组RDW、ox-LDL与hs-CRP水平在发病24h、第2、3、7、14d明显高于非PIS组(P0.01);Pearson相关分析显示,RDW与ox-LDL、hs-CRP及SSS评分水平呈显著正相关(P0.01)。Cox回归分析显示RDW、ox-LDL、hs-CRP是患者预后不良的支持因素(P0.01)。结论 RDW联合ox-LDL与hs-CRP可提高对PIS病情严重程度的判断能力,同时有助于评估患者预后。     

Factor VIIa and tissue factor procoagulant activity in diabetes mellitus after acute ischemic stroke: impact of hyperglycemia

Alterations in blood coagulation may explain the poorer neurological outcome with diabetes mellitus and hyperglycemia after acute ischemic stroke. We studied the relationships between diabetes mellitus, hyperglycemia, whole blood tissue factor procoagulant activity (TF-PCA) and plasma factorVIIa (FVIIa) in ten patients with type 2 diabetes mellitus and 11 non-diabetic patients at baseline and 6, 12, 24, and 48 hours (h) after presentation for acute stroke. In addition, we examined plasma prothrombin fragment 1+2 (F1.2) and thrombin-antithrombin complexes (TAT) as markers of thrombin generation. Stroke severity, assessed by National Institute of Health Stroke Scale (NIHSS), was similar at baseline (p=0.26) but worse in diabetic (8.20+/-4.3) than nondiabetic patients (2.67+/-2.1, p=0.023) at 48 h. At presentation, diabetic patients had higher FVIIa (p=0.004) and lower TF-PCA (p=0.027) than non-diabetic patients but both were higher than in normal control subjects. FVIIa levels remained higher in diabetic patients at 6, 12 and 24 h after stroke. In diabetic patients, FVIIa (r=0.40, p=0.02) and TF-PCA (r=0.50, p=0.02) correlated with blood glucose; and, FVIIa correlated with plasma F1.2 (r=0.34, p=0.002) and TAT levels (r=0.62, p<0.0001). In non-diabetic patients, TF-PCA, but not FVIIa, correlated with F1.2 (r=0.402, p=0.010) and TAT (r=0.39, p=0.011). Combining both groups, NIHSS scores were positively related to FVIIa levels (r=0.50, p=0.021) and inversely related to TF-PCA levels (r=-0.498, p=0.02). Acute ischemic stroke patients with diabetes and hyperglycemia have a more intense procoagulant state compared with nondiabetic patients. This is related to glucose levels and provides a potential mechanism for the observed worse prognosis in such patients after acute stroke.     

Serum-cortisol reflects severity and mortality in acute stroke

BACKGROUND: The adrenal glucocorticoid stress response in humans causes catabolism, increasing blood glucose and heart rate, and possibly potentiates ischaemic damage to neurons. These effects could induce secondary brain damage in acute stroke. MATERIALS AND METHODS: This prospective study was based on a single determination of s-cortisol in 172 patients included within 24 h of stroke onset, 50% within 12 h of stroke onset. All patients were admitted to hospital within 6 h of stroke onset. We investigated the relations of s-cortisol to neurological deficit measured by Scandinavian Stroke Scale (SSS), lesion volume on CT-scan, blood glucose on admission, pulse rate, blood pressure, body temperature, deteriorating stroke, cytokines and cytokine receptors, and outcome. RESULTS: In a multivariate logistic regression analysis, s-cortisol was independently related to death within 7 days of stroke onset, odds ratio (OR) Cortisol(+100 nmol/l) 1.9 (95% CI 1.01-3.8); serum-cortisol was, however, not a predictor of death or dependency within 3 months. S-cortisol correlated to SSS (rho=-0.45, p<0.001), body temperature (rho=0.27, p<0.001), pulse rate (rho=0.26, p<0.001), and lesion volume (rho=0.33, p<0.001). S-cortisol was related to the presence of insular damage. CONCLUSION: Acute stroke mortality related to increasing serum-cortisol levels. S-cortisol was associated with stroke severity and markers reflecting stroke severity.     

Impact of Relative Blood Glucose Changes on Mortality Risk of Patient with Acute Ischemic Stroke and Treated with Mechanical Thrombectomy

Background and purpose: The impacts of stress hyperglycemia and hypoglycemia on mortality of acute ischemic stroke patients treated with mechanical thrombectomy (MT) are largely unclear. This study aimed to use stress hyperglycemia ratio (SHR) to evaluate the influence of pretreatment relative blood glucose changes on mortality risk after MT. Methods: The study retrospectively enrolled 321 acute ischemic stroke patients treated with MT. SHR was calculated as random blood glucose at admission divided by average blood glucose which estimated by glycosylated hemoglobin (HbA1c). Patients with HbAlc greater than or equal to 6.5% were considered to have background hyperglycemia, patients were tertiled according to their SHR. Binary logistic regression was used to analyze 90 days mortality between SHR categories. Results: Compared with the middle tertiles group (Q2) which the blood glucose is closet to baseline glycaemia, patients in the lowest tertiles group (Q1) and highest tertiles group (Q3) have a higher mortality risk (odds ratio [OR], 3.80; 95% confidence interval [CI], 1.31-11.06) (OR, 3.18; 95% CI, 1.25-8.12), the differences is still significant after further adjusted for admission hyperglycemia (≥11.1 mmol/L). In patients without background hyperglycemia, the mortality risk is significantly higher in Q3 group (OR, 3.01; 95% CI, 1.06-8.53), no significant differences was found between three groups after adjusted for admission hyperglycemia (≥11.1 mmol/L). Conclusions: SHR identified acute ischemic stroke patients with relative hyperglycemia and hypoglycemia may have higher mortality risk after MT.     

急性脑梗死时糖代谢特点

目的 :探讨急性脑梗死时血糖升高的原因及其对神经功能的影响。方法 :前瞻性分析 180例急性脑梗死患者空腹血糖(FBG)、胰岛素 (Ins)、胰岛素敏感指数的变化 (ISI) ,并分析其与脑梗死神经功能缺损和恢复的相关性。结果 :脑梗死急性期出现血糖水平升高者共 12 1例 ,85例为已确诊的糖尿病患者 ,11例为漏诊的糖尿病和糖耐量减低者 ,2 5例为一过性血糖升高的非糖尿病患者 ;一过性高血糖组恢复期的血糖水平较急性期明显下降 ,胰岛素水平则上升 ;糖尿病组急性期的胰岛素水平明显高于一过性高血糖组和血糖正常组 ;一过性高血糖组急性期的神经功能缺损较血糖正常组、糖尿病组严重 ,且其急性期血糖水平与其神经功能缺损评分呈正相关 ;结论 :急性脑梗死时血糖升高在非糖尿病患者和应激有关 ,其血糖升高程度与病变严重性相关。     

Influence of admission body temperature on stroke mortality

BACKGROUND AND PURPOSE: The influence of body temperature on stroke outcome remains uncertain. The aim of this study was to investigate the prognostic role of admission body temperature on short-term and long-term mortality in a retrospective cohort study of patients with acute stroke. METHODS: A retrospective cohort of 509 patients with acute stroke, admitted to a tertiary hospital between July 1, 1995, and June 30, 1997, was studied. The relationship between admission body temperature and mortality both in-hospital and at 1-year mortality was evaluated. Body temperature on admission was classified as hypothermia (36.5 degrees C and 37.5 degrees C). Logistic regression and proportional hazards function analysis were performed after adjustment for clinical predictors of stroke outcome. RESULTS: In ischemic stoke, mortality was lower among patients with hypothermia and higher among patients with hyperthermia. The odds ratio for in-hospital mortality in hypothermic versus normothermic patients was 0.1 (95% CI, 0.02 to 0.5). The relative risk for 1-year mortality of hyperthermic versus normothermic patients was 3.4 (95% CI, 1.6 to 7.3). A similar but nonsignificant trend for in-hospital mortality was seen among patients with hemorrhagic stroke. CONCLUSIONS: An association between admission body temperature and stroke mortality was noted independent of clinical variables of stroke severity. Hyperthermia was associated with an increase in 1-year mortality. Hypothermia was associated with a reduction in in-hospital mortality.     

Subtypes and one-year survival of first-ever stroke in Chinese patients: The Nanjing Stroke Registry

BACKGROUND: Morbidity and mortality of stroke have been investigated extensively in Western populations, while data concerning case fatality and cause of death after stroke are very limited in mainland China. This study aimed to analyze the 1-year survival and predictors of case fatality in Chinese patients with first-ever stroke. METHODS: Subjects are patients registered in the Nanjing Stroke Registry Program. Information concerning cardiovascular risk factors and stroke characteristics were collected, and patients were followed after registration. Ischemic strokes were classified according to TOAST criteria as large-artery atherosclerosis (LAA), cardiac embolism stroke (CES), small-vessel stroke (SVS), or other determined and undetermined causes (UND). One-year case fatality was analyzed by the Kaplan-Meier method, and predictors of case fatality were evaluated by the Cox proportional hazards model. RESULTS: A total of 752 patients with first-ever stroke were included, of which 142 (18.9%) were identified as intracerebral hemorrhage (ICH), 120 (16.0%) as LAA, 123 (16.4%) as SVS, 160 (21.3%) as CES and 216 (28.7%) as UND. The overall survival rate was 86.4% at the end of the 1-year follow-up. Patients with SVS have the highest survival rate (92.7%), followed by UND (89.4%), CES (88.1%) and LAA (84.2%). Patients with ICH have the lowest survival rate (76.8%). Survival rates of patients with different subtypes of stroke presented a significant difference (chi2 = 19.3, p < 0.001). For patients deceased during the first year after the index stroke, 33.3% of deaths were caused by the first stroke, 18.6% by recurrent stroke, 16.7% by cardiovascular comorbidities, 14.7% by nonvascular conditions and 16.7% died of undetermined causes. Advanced age, hypertension, hyperlipidemia, diabetes mellitus (DM), atrial fibrillation (AF), history of transient ischemic attack and cigarette smoking were associated with an increased risk of death 1 year after stroke. CONCLUSIONS: The case fatality rate and predictors for mortality of Chinese patients with first-ever stroke are similar to those reported for other populations. The significant influence of cardiovascular disease on the first-year survival rate emphasizes the importance of acute stroke management and control of hypertension, DM, AF and other predictors for decreasing case fatality and improving prognosis.     

The Scandinavian stroke scale predicts outcome in patients with mild ischemic stroke

BACKGROUND: The prognostic value of the Scandinavian Stroke Scale (SSS) in patients with mild ischemic stroke has not previously been examined. We investigated if differences in SSS score predicted risk of death or dependency within 12 months after stroke onset. PATIENTS AND METHODS: The analysis included 353 patients with acute cerebral infarction and SSS of at least 40 points on admission, 157 of whom with SSS of at least 50 points. Patients with 40-49 points on the SSS were compared with patients with 50-58 points; and patients with SSS 50-53 were compared to patients with 54-58 points on the SSS. Death or dependency was defined as 3-6 points on the modified Rankin scale (MRS), 3 and 12 months after stroke onset. The frequencies of death or dependency were compared between groups by chi2; the risk of death or dependency 1 year after stroke was calculated by multiple logistic regression analysis, adjusting for age, gender, prestroke MRS, arterial hypertension and tobacco smoking. RESULTS: The risk of death or dependency 1 year after stroke onset was higher in patients with SSS 40-49 than with SSS 50-58, OR 2.0 (CI 95% 1.2-3.5). Three months after stroke, 46.5% of patients with SSS 40-49 were dead or dependent in comparison with 23.9% of patients with SSS > 49, p < 0.001. One year after stroke, 53.6% of patients with SSS 40-49 were dead or dependent in comparison with 30.1% of patients with SSS > 49, p <0.001. A significant 15% difference in living in own home was observed 1 year after stroke onset between patients with SSS 40-49 and SSS > 49. In very mild stroke, 32.7% of patients with SSS 50-53 were dead or dependent 3 months after stroke in comparison with 18.1% of patients with SSS 54-58 on admission, p = 0.048. CONCLUSIONS: The SSS predicts death and dependence in patients with mild ischemic stroke.