Neurology:在脑出血幸存者中,超过四分之一的患者死于感染

2020-09-26 心关注 心关注

自发性、非创伤性脑出血仍然是卒中最具破坏性的形式。在ICH发病后一个月内,有40%的患者死亡,一年时这一数字增加到54%。尽管由于医疗条件的改善,ICH术后的短期死亡率有所下降,但长期死亡率仍然很高。

自发性、非创伤性脑出血(ICH)仍然是卒中最具破坏性的形式。在ICH发病后一个月内,有40%的患者死亡,一年时这一数字增加到54%。尽管由于医疗条件的改善,ICH术后的短期死亡率有所下降,但长期死亡率仍然很高。然而,ICH幸存者的长期死亡原因目前还不清楚。近日,发表在Neurology上的一项研究,对超过72,000名首次发生脑出血后存活下来的患者进行了纵向分析,发现感染是4年内这些患者死亡的主要原因。

研究人员从美国医疗成本和使用项目(Healthcare Cost and Utilization Project,HCUP)获得了行政索赔数据,对成年患者在纽约、加利福尼亚或佛罗里达因首次发生与外伤无关的自发性ICH出院后的预后结果进行回顾性纵向分析。随访期延长至死亡日期或最后可用随访时间。加州2005年~2011年、纽约和佛罗里达2005年~2014年的数据均可获得。

主要结果是任何导致死亡的再入院。研究人员将死亡原因定义为出院时的主要诊断。在104,011例首次自发性ICH患者中,72432例(70%)存活出院被纳入分析(平均年龄68岁;48%女性)。

在平均4年的随访中,18%的ICH幸存者(n=12,753)因导致死亡的事件再次入院。ICH后一年的累积死亡风险为9.5%(95%CI 9.2-9.7),所有患者的中位死亡时间为10个月,合并心房颤动的患者为7个月。

死亡的患者年龄比幸存者大(73岁比67岁),并且有更多的合并症(房颤病史[18% vs. 12%)、慢性肾病[13% vs. 8%]、充血性心力衰竭[11% vs. 6%]和糖尿病[25% vs. 21%])。死亡的主要原因包括感染(34%)、复发性ICH(14%)、心脏病(8%)、呼吸衰竭(8%)和缺血性卒中(5%)。

在4107例导致死亡的感染患者中,大多数(66%)是由于败血症,其次是吸入性肺炎(14%),病毒性和细菌性肺炎(11%),其他类型的感染包括由植入物或移植物引起的感染(6%)和尿路感染(3%)。

中位死亡时间因病因而异(感染:10个月;复发性ICH或心脏病:17个月;呼吸衰竭或恶性肿瘤:6个月;缺血性卒中:8个月)。心房颤动患者死于缺血性卒中的可能性更大(OR=2.4;95%CI 1.9-2.9),而死于复发性ICH的可能性较小(OR=0.7;95%CI 0.6-0.8)。

研究人员表示,这些结果提供了额外的证据,证明感染的风险“可能并不仅仅局限于”住院治疗期间,在长期随访中,感染也会造成重大的死亡风险,特别是对65岁以上的患者。这些发现将有助于优先考虑旨在改善ICH幸存者长期生存和康复的干预措施。

原始出处:

Lindsey R Kuohn, Audrey C Leasure, Julian N Acosta, et al.Cause of death in spontaneous intracerebral hemorrhage survivors: Multi-state longitudinal study.Neurology. 2020 Sep 11;10.1212/WNL.0000000000010736. doi: 10.1212/WNL.0000000000010736.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1229552, encodeId=8ec91229552da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Wed Jun 29 20:34:35 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=906581, encodeId=1c6a9065816f, content=<a href='/topic/show?id=d90484e1883' target=_blank style='color:#2F92EE;'>#脑出血#</a>幸存者中,超过四分之一的患者死于<a href='/topic/show?id=cfd353291f3' target=_blank style='color:#2F92EE;'>#感染#</a>,主要原因很多脑出血以后,患者面临残疾,如果长期卧床,感染就是最严重的并发症了, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=84718, encryptionId=d90484e1883, topicName=脑出血), TopicDto(id=53291, encryptionId=cfd353291f3, topicName=感染)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Thu Dec 10 08:49:14 CST 2020, time=2020-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001116, encodeId=e49b2001116a5, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Feb 13 22:43:19 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915070, encodeId=17309150e056, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Sat Jan 09 22:14:09 CST 2021, time=2021-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=888645, encodeId=a820888645fe, content=感染还是一个大问题, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Sep 27 08:21:40 CST 2020, time=2020-09-27, status=1, ipAttribution=)]
    2022-06-29 屋顶瞄爱赏月

    学习了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1229552, encodeId=8ec91229552da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Wed Jun 29 20:34:35 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=906581, encodeId=1c6a9065816f, content=<a href='/topic/show?id=d90484e1883' target=_blank style='color:#2F92EE;'>#脑出血#</a>幸存者中,超过四分之一的患者死于<a href='/topic/show?id=cfd353291f3' target=_blank style='color:#2F92EE;'>#感染#</a>,主要原因很多脑出血以后,患者面临残疾,如果长期卧床,感染就是最严重的并发症了, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=84718, encryptionId=d90484e1883, topicName=脑出血), TopicDto(id=53291, encryptionId=cfd353291f3, topicName=感染)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Thu Dec 10 08:49:14 CST 2020, time=2020-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001116, encodeId=e49b2001116a5, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Feb 13 22:43:19 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915070, encodeId=17309150e056, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Sat Jan 09 22:14:09 CST 2021, time=2021-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=888645, encodeId=a820888645fe, content=感染还是一个大问题, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Sep 27 08:21:40 CST 2020, time=2020-09-27, status=1, ipAttribution=)]
    2020-12-10 lifefamily

    #脑出血#幸存者中,超过四分之一的患者死于#感染#,主要原因很多脑出血以后,患者面临残疾,如果长期卧床,感染就是最严重的并发症了

    1

    展开1条回复
  3. [GetPortalCommentsPageByObjectIdResponse(id=1229552, encodeId=8ec91229552da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Wed Jun 29 20:34:35 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=906581, encodeId=1c6a9065816f, content=<a href='/topic/show?id=d90484e1883' target=_blank style='color:#2F92EE;'>#脑出血#</a>幸存者中,超过四分之一的患者死于<a href='/topic/show?id=cfd353291f3' target=_blank style='color:#2F92EE;'>#感染#</a>,主要原因很多脑出血以后,患者面临残疾,如果长期卧床,感染就是最严重的并发症了, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=84718, encryptionId=d90484e1883, topicName=脑出血), TopicDto(id=53291, encryptionId=cfd353291f3, topicName=感染)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Thu Dec 10 08:49:14 CST 2020, time=2020-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001116, encodeId=e49b2001116a5, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Feb 13 22:43:19 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915070, encodeId=17309150e056, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Sat Jan 09 22:14:09 CST 2021, time=2021-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=888645, encodeId=a820888645fe, content=感染还是一个大问题, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Sep 27 08:21:40 CST 2020, time=2020-09-27, status=1, ipAttribution=)]
    2021-02-13 yinhl1978
  4. [GetPortalCommentsPageByObjectIdResponse(id=1229552, encodeId=8ec91229552da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Wed Jun 29 20:34:35 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=906581, encodeId=1c6a9065816f, content=<a href='/topic/show?id=d90484e1883' target=_blank style='color:#2F92EE;'>#脑出血#</a>幸存者中,超过四分之一的患者死于<a href='/topic/show?id=cfd353291f3' target=_blank style='color:#2F92EE;'>#感染#</a>,主要原因很多脑出血以后,患者面临残疾,如果长期卧床,感染就是最严重的并发症了, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=84718, encryptionId=d90484e1883, topicName=脑出血), TopicDto(id=53291, encryptionId=cfd353291f3, topicName=感染)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Thu Dec 10 08:49:14 CST 2020, time=2020-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001116, encodeId=e49b2001116a5, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Feb 13 22:43:19 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915070, encodeId=17309150e056, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Sat Jan 09 22:14:09 CST 2021, time=2021-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=888645, encodeId=a820888645fe, content=感染还是一个大问题, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Sep 27 08:21:40 CST 2020, time=2020-09-27, status=1, ipAttribution=)]
    2021-01-09 zb1235672

    学习了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1229552, encodeId=8ec91229552da, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Wed Jun 29 20:34:35 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=906581, encodeId=1c6a9065816f, content=<a href='/topic/show?id=d90484e1883' target=_blank style='color:#2F92EE;'>#脑出血#</a>幸存者中,超过四分之一的患者死于<a href='/topic/show?id=cfd353291f3' target=_blank style='color:#2F92EE;'>#感染#</a>,主要原因很多脑出血以后,患者面临残疾,如果长期卧床,感染就是最严重的并发症了, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=84718, encryptionId=d90484e1883, topicName=脑出血), TopicDto(id=53291, encryptionId=cfd353291f3, topicName=感染)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Thu Dec 10 08:49:14 CST 2020, time=2020-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001116, encodeId=e49b2001116a5, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Feb 13 22:43:19 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915070, encodeId=17309150e056, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Sat Jan 09 22:14:09 CST 2021, time=2021-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=888645, encodeId=a820888645fe, content=感染还是一个大问题, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Sep 27 08:21:40 CST 2020, time=2020-09-27, status=1, ipAttribution=)]
    2020-09-27 易水河

    感染还是一个大问题

    0

相关资讯

脑出血患者的心电图怎么了?

如果遇到一个脑出血患者同时合并心电图异常,肌钙蛋白升高呢,是不是脑出血合并心肌梗死呢?下面给大家分享一则病例,遇到这类患者应该怎么办?

JAHA:不同病因的脑出血患者血压与结局的关系

BP与ICH患者结局之间的关联可能取决于其亚型,并且脑淀粉样血管病在病理上可能与其他病理特征不同。需要进一步开展降压的个性化策略研究,以验证这些结果。

Stroke:如何准确地评价颅内血肿变化?

血肿扩大的定义的重点在于脑室体积的变化。脑室内出血(IVH)是预后不良的预测指标,但目前对于血肿增大的定义中并未纳入IVH扩大。本研究旨在评估是否纳入IVH扩大对当前血肿扩大评估90天预后有影响。

年轻男性反复发热半年后突发脑出血,幕后元凶竟是TA!

主诉:1年前反复发热半年,半年前突发脑出血

Stroke:脑出血患者收缩压降低与急性肾损伤

基线血肌酐水平较高和接受较高剂量尼卡地平的脑出血患者发生AKI和肾AE的风险较高。AKI的发生与3个月时较高的死亡率或致残率相关。

不同脑出血时期MRI表现,你掌握了吗?

CT和MRI在脑出血的诊断检查中可称为“双雄”,二者各有所长。临床拟诊为急性脑内出血的病例可首选CT检查;对于亚急性或慢性血肿,MRI检查比CT更为敏感,对出血原因的判断也优于