社会经济剥夺对急性缺血性卒中后机械取栓效果的影响：来自伦敦多中心研究的结果

IF 2.6 1区医学

Journal of Investigative Medicine Pub Date : 2025-04-23 DOI:10.1136/svn-2024-003915

Lucio D'Anna, Soma Banerjee, Viva Levee, Katherine Chulack, Fahad Sheikh, Feras Fayez, Tsering Dolkar, Nina Mansoor, Matthew Fallon, Adelaida Gartner, Robert Simister, Liqun Zhang

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引用次数: 0

摘要

背景：机械取栓（MT）可改善因大血管闭塞（LVO）而发生急性缺血性卒中患者的预后。然而，社会经济地位（SES）可以影响恢复和预后。本研究通过多重剥夺指数（IMD）评估了SES对伦敦多中心队列MT结果的影响。方法：本回顾性研究纳入了2021年至2023年在伦敦三家医院接受MT治疗的前循环LVO患者。患者分为IMD1-5（较贫困）和IMD6-10（较贫困）。逆概率加权平衡基线特征。主要结局为90天功能独立性（修正Rankin量表（mRS） 0-2）和90天mRS移位。次要结局包括再通、早期神经系统改变、90天死亡率、症状性脑出血（sICH）和出血性转化（HT）。亚组分析探讨了IMD与人口统计学或临床因素之间的相互作用。LASSO（最小绝对收缩和选择算子）回归确定了功能独立性的预测因子，而接收者操作特征分析评估了IMD的预测值。结果：1219例经MT治疗的急性LVO缺血性卒中患者中，IMD1-5区533例（43.7%），IMD6-10区686例（56.3%）。IMD1-5患者在90天时功能独立的几率较低（RR 0.79, 95% CI 0.70至0.90），mr转移较差（OR 1.29, 95% CI 1.06至1.58）。他们也有较高的siich （RR 2.07, 95% CI 1.54 ~ 2.67）和HT（风险比1.47,95% CI 1.21 ~ 1.80）的风险。亚组分析强调了IMD在亚洲或混合种族群体中的预测重要性。结合IMD、年龄、性别、高血压和美国国立卫生研究院卒中量表（曲线下面积0.656）的模型显示了对90天功能独立性的预测准确性。结论：较低的社会经济地位与mt后较差的结果和较高的并发症相关，即使在普遍的医疗保健系统中也是如此。解决社会经济地位的差异可以改善中风护理的公平性。

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Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischaemic stroke: findings from a London-based multicentre study.

Background: Mechanical thrombectomy (MT) improves outcomes in patients who had an acute ischaemic stroke due to large vessel occlusion (LVO). However, socioeconomic status (SES) can influence recovery and prognosis. This study investigated the effect of SES, assessed via the Index of Multiple Deprivation (IMD), on MT outcomes in a multicentre London cohort.

Methods: This retrospective study included patients with anterior circulation LVO treated with MT between 2021 and 2023 at three London hospitals. Patients were grouped into IMD_1-5 (more deprived) and IMD_6-10 (less deprived). Inverse probability weighting balanced baseline characteristics. Primary outcomes were 90-day functional independence (modified Rankin Scale (mRS) 0-2) and 90-day mRS shift. Secondary outcomes included recanalisation, early neurological changes, 90-day mortality, symptomatic intracerebral haemorrhage (sICH) and haemorrhagic transformation (HT). Subgroup analyses explored interactions between IMD and demographic or clinical factors. LASSO (Least Absolute Shrinkage and Selection Operator) regression identified predictors of functional independence, while receiver operating characteristic analysis evaluated IMD's predictive value.

Results: Among 1219 patients with acute LVO ischemic stroke treated with MT, 533 (43.7%) were in IMD_1-5 and 686 (56.3%) in IMD_6-10. IMD_1-5 patients had lower odds of functional independence at 90 days (RR 0.79, 95% CI 0.70 to 0.90) and worse mRS shift (OR 1.29, 95% CI 1.06 to 1.58). They also had higher risks of sICH (RR 2.07, 95% CI 1.54 to 2.67) and HT (Risk Ratio 1.47, 95% CI 1.21 to 1.80). Subgroup analysis highlighted IMD's predictive importance in Asian or mixed ethnicity groups. A model incorporating IMD, age, sex, hypertension and National Institutes of Health Stroke Scale (area under the curve 0.656) demonstrated predictive accuracy for 90-day functional independence.

Conclusions: Lower SES correlates with worse outcomes and higher complications post-MT, even within a universal healthcare system. Addressing SES disparities could improve stroke care equity.

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来源期刊

Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL

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0.00%

发文量

111

期刊介绍： Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.