Abstract:

Objective  To investigate the risk factors for short-term poor outcome (at discharge and 90-day follow-up) among the young adults with first-ever ischemic stroke.

Methods  Patients with first-ever ischemic stroke within 72 hours aged 18 to 45 years were enrolled in this retrospective study. Demographic information, vascular risk factors, laboratory tests results, NIHSS scores at admission and discharge were collected. Poor outcome was defined as a mRS score ≥2. Multivariate logistic regression analysis was performed to determine the independent risk factors for short-term poor functional outcome.

Results  A total of 691 eligible patients were included in this study, with 234 (33.9%) patients having poor outcome at discharge and 154 (22.3%) at the 90-day follow-up. The independent risk factors for poor outcome at discharge included NIHSS score at admission (OR 2.76, 95%CI 2.07-3.68, P<0.01) and LDL-C level (OR 3.10, 95%CI 1.01-9.51, P=0.04). The independent protective factor of poor outcome at discharge included TC level (OR 0.37, 95%CI 0.14-0.96, P=0.04). The NIHSS score at admission (OR 2.42, 95%CI 1.79-3.28, P<0.01) and Hcy level (OR 1.02, 95%CI 1.01-1.04, P=0.04) were independently associated with poor prognosis at the 90-day follow-up.

Conclusions  High NIHSS score, high LDL-C level and a low TC level at admission were independent risk factors for poor outcome at discharge among young patients with ischemic stroke, and high NIHSS score and high Hcy level at admission were independent risk factors for poor outcome at the 90-day follow-up.

Key words: Young; Ischemic stroke; Poor prognosis; Risk factor; TOAST

摘要：

目的 分析首次青年缺血性卒中患者出院、发病90d预后不良的相关危险因素。

方法 回顾性纳入18～45岁、发病72 h内的首次缺血性卒中患者，收集患者人口学信息、血管危险因素、实验室检查结果、入院和出院时NIHSS，以出院时和发病90 d mRS≥2分为预后不良，分别比较预后不良组和预后良好组危险因素的差异和病因分型特点，并采用多因素logistic回归分析出院和90 d预后不良的独立危险因素。

结果 研究共纳入691例首次青年缺血性卒中患者，出院预后不良234例（33.9%），90 d预后不良154例（22.3%）。出院时预后的独立危险因素包括入院时高NIHSS（OR 2.76，95%CI 2.07～3.68，P <0.01），高LDL-C（OR 3.10，95%CI 1.01～9.51，P =0.04），独立保护因素高为TC（OR 0.37，95%CI 0.14～0.96，P =0.04）。90 d预后不良的独立危险因素包括入院时高NIHSS（OR 2.42，95%CI 1.79～3.28，P <0.01）和高Hcy（OR 1.02，95%CI 1.01～1.04，P =0.04）。

结论 入院时NIHSS升高、LDL-C升高、TC降低是青年缺血性卒中患者出院时预后的独立危险因素，而90 d预后的独立危险因素为入院时NIHSS升高和Hcy升高。

关键词: 青年; 缺血性卒中; 预后不良; 危险因素; TOAST分型