Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT).

Autor: Rehman S; Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia., Phan HT; Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia., Reeves MJ; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA., Thrift AG; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia., Cadilhac DA; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia., Sturm J; Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia., Breslin M; Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia., Callisaya ML; Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia; Struttura Complessa di Neurologia, Ospedale Michele e Pietro Ferrero, Verduno (Cuneo), ASL CN2, Italy., Vemmos K; Hellenic Cardiovascular Research Society, Athens, Greece., Parmar P; National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand., Krishnamurthi RV; National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand., Barker-Collo S; School of Psychology, University of Auckland, Auckland, New Zealand., Feigin V; National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand., Chausson N; Stroke Unit, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France., Olindo S; Stroke Unit, University Hospital of Bordeaux, Bordeaux, France., Cabral NL; Deceased. Formerly Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil., Carolei A; Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy., Marini C; Department of Life, Health, and Environmental Sciences, University of L'Aquila, Italy., Degan D; Struttura Complessa di Neurologia, Ospedale Michele e Pietro Ferrero, Verduno (Cuneo), ASL CN2, Italy., Sacco S; Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy., Correia M; Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal., Appelros P; Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Kõrv J; Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia., Vibo R; Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia., Minelli C; Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation, Matão, SP, Brazil., Sposato L; Department of Neurology, Western University, London, Ontario, Canada., Pandian JD; Department of Neurology, Christian Medical College, Ludhiana, Punjab, India., Kaur P; Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada., Azarpazhooh MR; Department of Clinical Neurological Sciences, University of Western, London, Ontario, Canada., Morovatdar N; Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran., Gall S; Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia. Electronic address: Seana.Gall@utas.edu.au.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2022 Jan; Vol. 31 (1), pp. 106201. Date of Electronic Publication: 2021 Nov 15.
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106201
Abstrakt: Background: There are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types.
Methods: We pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints.
Results: Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year.
Conclusion: Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.
Competing Interests: Conflict of interest The Authors declare no conflict of interests.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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