Anna Therese Bjerkreim, Andrej Netland Khanevski, Henriette Aurora Selvik, Ulrike Waje-Andreassen, Lars Thomassen, Halvor Naess, Nicola Logallo
{"title":"缺血性脑卒中亚型对30天再入院的影响","authors":"Anna Therese Bjerkreim, Andrej Netland Khanevski, Henriette Aurora Selvik, Ulrike Waje-Andreassen, Lars Thomassen, Halvor Naess, Nicola Logallo","doi":"10.1155/2018/7195369","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality.</p><p><strong>Methods: </strong>All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality.</p><p><strong>Results: </strong>Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality.</p><p><strong>Conclusions: </strong>Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2018-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7195369","citationCount":"9","resultStr":"{\"title\":\"The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions.\",\"authors\":\"Anna Therese Bjerkreim, Andrej Netland Khanevski, Henriette Aurora Selvik, Ulrike Waje-Andreassen, Lars Thomassen, Halvor Naess, Nicola Logallo\",\"doi\":\"10.1155/2018/7195369\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality.</p><p><strong>Methods: </strong>All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality.</p><p><strong>Results: </strong>Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality.</p><p><strong>Conclusions: </strong>Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.</p>\",\"PeriodicalId\":22054,\"journal\":{\"name\":\"Stroke Research and Treatment\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2018-12-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1155/2018/7195369\",\"citationCount\":\"9\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Stroke Research and Treatment\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2018/7195369\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2018/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke Research and Treatment","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2018/7195369","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 9
摘要
背景:由于危险因素、功能结局和治疗的差异,卒中病因可能影响缺血性卒中(IS)和短暂性缺血发作(TIA)后再入院的风险和原因。我们的目的是根据卒中亚型检查30天再入院的频率、原因和风险,确定30天再入院的预测因素,并研究30天再入院对一年内死亡率的影响。方法:对2007年7月至2013年12月收治的所有存活的IS或TIA患者进行随访,并回顾出院后30天内所有意外再入院的医疗记录。卒中亚型分为大动脉粥样硬化(LAA)、心脏栓塞(CE)、小血管闭塞(SVO)、其他原因确定的卒中(SOE)或原因不明的卒中(SUE)。采用Cox回归分析评估卒中亚型患者30天再入院的风险,确定30天再入院的预测因素及其对1年死亡率的影响。结果:1874例患者中,200例(10.7%)在30天内再次入院[LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788(8.3%)]。再入院最常见的原因是卒中相关事件、感染、复发性卒中/ TIA和心脏病。在调整了年龄、性别、功能结局、住院时间和风险因素负担后,LAA和SOE亚型患者因任何原因、复发性卒中或TIA以及卒中相关事件再入院的风险明显更高。30天再入院的预测因素为较高的年龄、外周动脉疾病、肠内喂养和LAA亚型。30天再入院是1年死亡率的独立预测因子。结论:LAA或SOE患者30天再入院的风险较高,可能是由于卒中复发和卒中相关事件的风险增加所致。意识到不同原因的再入院风险,并根据卒中亚型进行适当处理,可能有助于预防卒中后再入院。
The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions.
Background: Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality.
Methods: All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality.
Results: Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality.
Conclusions: Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.