Eric D Goldstein, Sabrina Q R Liew, Liqi Shu, Alicia Rocha, Shadi Yaghi
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引用次数: 0
Abstract
Objectives: Nearly 25% of those with a small vessel stroke will develop early neurological deterioration (END). The objectives of this study were to identify clinical risk factors for small vessel stroke-related END and its associated impact on functional outcomes in an ethnically diverse data set.
Methods: We performed a post hoc analysis of the "Secondary Prevention of Small Subcortical Strokes" trial. The primary outcome was END defined as progressive or stuttering stroke-related neurological symptoms. Standard descriptive and inferential statistical methods were used for analysis. Functional outcomes are reported by modified Rankin Scale score and analyzed by the Wilcoxon signed-rank test.
Results: In all, 69 participants met the inclusion criteria; 21 (30%) had END. Of the cohort, Spanish, Hispanic, or Latino ethnicity (grouping per trial definition) most frequently developed END [11 (52.4%) vs 4 (8.3%), P < 0.001] with a higher adjusted likelihood of END (odds ratio: 14.1, 95% CI: 2.57-76.7, P = 0.002). Black or African-American race less commonly had END [3 (14.3%) vs 21 (43.8%), P = 0.03] but lost significance after adjustment (odds ratio: 1.46, 95% CI: 0.26-8.17, P = 0.67) due to powering. END was associated with a higher mean modified Rankin Scale (2.06 ± 0.94 vs 1.17 ± 0.79, P = 0.006) but did not differ in the shift analysis.
Conclusions: We found that Spanish, Hispanic, or Latino ethnicity was the most consistent risk factor for END though it was without meaningful functional outcome differences.
目的:近25%的小血管卒中患者会出现早期神经功能恶化(END)。本研究的目的是在不同种族的数据集中确定小血管卒中相关END的临床危险因素及其对功能结局的相关影响。方法:我们对“轻度皮质下卒中的二级预防”试验进行了事后分析。主要终点为END,定义为进行性或口吃性卒中相关神经症状。采用标准的描述性和推断性统计方法进行分析。功能结果采用改良Rankin量表评分报告,并采用Wilcoxon sign -rank检验分析。结果:69名受试者符合纳入标准;21例(30%)发生END。在队列中,西班牙、西班牙裔或拉丁裔(按试验定义分组)最常发生END [11 (52.4%) vs 4 (8.3%), P < 0.001],发生END的调整可能性较高(优势比:14.1,95% CI: 2.57-76.7, P = 0.002)。黑人或非裔美国人较少发生END [3 (14.3%) vs 21 (43.8%), P = 0.03],但由于功率调整后无显著性(优势比:1.46,95% CI: 0.26-8.17, P = 0.67)。END与较高的平均修正Rankin量表相关(2.06±0.94 vs 1.17±0.79,P = 0.006),但在移位分析中没有差异。结论:我们发现西班牙、西班牙裔或拉丁裔种族是END最一致的危险因素,尽管它没有显著的功能结局差异。
期刊介绍:
The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.