卒中后感染对急性缺血性卒中患者出院结局的影响

doi:10.3969/j.issn.1673-5765.2023.08.006

摘要/Abstract

摘要： 目的探讨急性缺血性卒中（acute ischemic stroke，AIS）不良出院结局的影响因素，以及感染对出院结局的影响。
方法回顾性连续纳入2019年6月—2022年6月在首都医科大学附属北京天坛医院神经内科住院治疗的AIS患者，根据出院结局分为结局良好组（mRS评分＜3分）和结局不良组（mRS评分≥3分或住院期间死亡），比较两组患者的临床特点和卒中后感染（肺部感染、尿路感染及中枢神经系统感染）等指标的差异。进一步采用多因素logistic回归分析AIS患者不良出院结局的影响因素。
结果共纳入AIS患者1024例，平均年龄（60.3±12.4）岁，其中男性788例（77.0%），出院结局良好组761例（74.3%），结局不良组263例（25.7%）。85例患者出现卒中后感染，总体感染发生率为8.3%，其中69例（6.7%）为肺部感染，16例（1.6%）为尿路感染，3例（0.3%）为中枢神经系统感染。多因素分析结果显示，卒中后出现肺部感染（OR 2.522，95%CI 1.318～4.828，P=0.005）、合并糖尿病（OR 1.486，95%CI 1.048～2.106，P=0.026）、入院NIHSS评分升高（OR 1.286，95%CI 1.233～1.342，P＜0.001）和血白细胞计数升高（OR 1.094，95%CI 1.014～1.180，P=0.020）为AIS患者不良出院结局的危险因素。
结论肺部感染可显著增加AIS患者出院结局不良的风险。

文章导读： 本研究通过对较大样本量的AIS患者住院期间资料的回顾性分析发现，肺部感染、尿路感染和中枢神经系统感染的发生率分别为6.7%、1.6%和0.3%。卒中后出现肺部感染为AIS患者不良出院结局的危险因素。

关键词: 卒中; 缺血性卒中; 出院结局; 感染; 影响因素

Abstract: Objective To explore the risk factors of adverse discharge outcomes in patients with acute ischemic stroke (AIS), and the effects of post-stroke infection on discharge outcomes.
Methods AIS patients who were hospitalized in the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University from June 2019 to June 2022 were retrospectively included in this study. The patients were divided into good outcome group (mRS score<3) and poor outcome group (mRS score≥3 or death during hospitalization) according to discharge outcome. The clinical characteristics and post-stroke infection(pulmonary infection, urinary tract infection and central nervous system infection) were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors for adverse discharge outcomes in AIS patients.
Results A total of 1024 patients with AIS were included in this study, with a mean age of (60.3±12.4) years old and 788 males (77.0%). There were 761 (74.3%) patients in the good outcome group and 263(25.7%) patients in the poor outcome group. 85 (8.3%) patients developed infection after stroke, of which 69 (6.7%) were pulmonary infections, 16 (1.6%) were urinary tract infections, and 3 (0.3%) were central nervous system infections. Multivariate analysis showed that pulmonary infection (OR 2.522, 95%CI 1.318-4.828, P=0.005), diabetes (OR 1.486, 95%CI 1.048-2.106, P=0.026), increased NIHSS score on admission (OR 1.286, 95%CI 1.233-1.342, P<0.001) and increased white blood cell count (OR 1.094, 95%CI 1.014-1.180, P=0.020) were risk factors for poor discharge outcomes in AIS patients.
Conclusions Pulmonary infection may significantly increase the risk of poor discharge outcomes in patients with AIS.

Key words: Stroke; Ischemic stroke; Discharge outcome; Infection; Risk factors

程实, 李静, 郭军平, 胡爱香, 于鑫玮, 韩玮, 梁瑛, 冀瑞俊, 张越巍. 卒中后感染对急性缺血性卒中患者出院结局的影响[J]. 中国卒中杂志, 2023, 18(8): 885-890.

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