营养不良对经导管主动脉瓣置换术（TAVR）围手术期缺血性卒中的影响：一项全国住院患者样本的回顾性队列研究

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL

Health Science Reports Pub Date : 2025-05-26 DOI:10.1002/hsr2.70860

Haowei Li, Guangzhi Cong, Xueping Ma, Bo Shi, Congyan Ye, Rui Yan, Shizhe Fu, Kairu Wang, Shaobin Jia, Jingjing Wang

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引用次数: 0

摘要

背景和目的缺血性卒中是经导管主动脉瓣置换术（TAVR）患者的严重风险。营养不良与tavr后缺血性卒中之间的关系尚不清楚。本研究使用国家住院病人样本（NIS）数据调查这种关联。方法采用2012 - 2021年NIS数据进行回顾性观察研究。我们纳入了接受TAVR并根据ICD-9和ICD-10编码诊断为营养不良的患者。排除18岁以下、术前有卒中史、缺血性和出血性卒中或资料不完整的患者。采用Logistic回归来评估营养不良与缺血性卒中之间的关系，并对潜在的混杂因素进行校正。敏感性分析包括分层分析和倾向评分匹配。结果364580例TAVR患者中，10415例（2.86%）诊断为营养不良。营养不良患者年龄较大（78.04比77.40），以白人为主（85.69%），缺血性脑卒中发生率较高（11.47%比7.25%,p < 0.001）。在校正了常见的缺血性卒中危险因素后，营养不良与缺血性卒中风险增加显著相关(aOR: 1.51；95% ci: 1.31-1.74)。这种关联在倾向匹配的队列中仍然显著。亚组分析一致显示营养不良与中风风险之间存在各种人口统计学和临床因素的关联。时间趋势分析显示，有无脑栓塞保护装置的营养不良患者围手术期缺血性卒中年发生率无统计学差异（p = 0.439）。结论营养不良与TAVR术后缺血性脑卒中的高风险相关，强调有针对性干预的必要性。

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The Impact of Malnutrition on Perioperative Ischemic Stroke in Transcatheter Aortic Valve Replacement (TAVR): A Retrospective Cohort Study of the National Inpatient Sample

Background and Aims

Ischemic stroke is a serious risk for patients undergoing transcatheter aortic valve replacement (TAVR). The relationship between malnutrition and post-TAVR ischemic stroke remains unclear. This study investigates this association using the National Inpatient Sample (NIS) data.

Methods

A retrospective observational study was conducted using NIS data from 2012 to 2021. We included patients who underwent TAVR and were diagnosed with malnutrition based on ICD-9 and ICD-10 codes. Patients under 18 years, with a history of preoperative stroke, with both ischemic and hemorrhagic strokes, or with incomplete data were excluded. Logistic regression was performed to evaluate the association between malnutrition and ischemic stroke, adjusting for potential confounders. Sensitivity analyses included stratified analysis and propensity score matching.

Results

Among 364,580 TAVR patients, 10,415 (2.86%) were diagnosed with malnutrition. Malnourished patients were older (78.04 vs. 77.40), predominantly white (85.69%), and had a higher incidence of ischemic stroke (11.47% vs. 7.25%, p < 0.001). After adjusting for common ischemic stroke risk factors, malnutrition was significantly associated with an increased risk of ischemic stroke (aOR: 1.51; 95% CI: 1.31–1.74). This association remained significant in the propensity-matched cohort. Subgroup analyses consistently showed associations between malnutrition and stroke risk across various demographic and clinical factors. Time trend analysis showed no significant difference in the annual incidence of perioperative ischemic stroke between malnourished patients with or without cerebral embolic protection devices (p = 0.439).