Objective Gastrointestinal(GI)bleeding in patients who had a stroke is strongly associated with a higher risk of death and loss of independence.However,it is unknown whether GI bleeding increases risk for recurrence o...Objective Gastrointestinal(GI)bleeding in patients who had a stroke is strongly associated with a higher risk of death and loss of independence.However,it is unknown whether GI bleeding increases risk for recurrence of stroke.In this study,we assess the potential relationship between GI bleeding and stroke recurrence in patients within 12 months of an acute ischaemic stroke(AIS),using the China National Stroke Registry(CNSR).Methods This study included 22216 patients who had an ischaemic stroke included in the CNSR from 2007 to 2008.We analysed baseline patient characteristics,GI bleeding and outcomes of patients who had an AIS,specifically stroke recurrence at 3,6 and 12 months.We used multivariable logistic regression to evaluate a possible association between GI bleeding and stroke recurrence.results Of the 12415 patients included in our study,12.3%,15.5%and 17.7%had a stroke recurrence at 3,6 and 12 months,respectively.GI bleeding was an independent stroke recurrence risk factor in patients after ischaemic stroke at 3 months(adjusted OR 1.481,95%CI 1.118 to 1.962),6 months(adjusted OR 1.448,95%CI 1.106 to 1.896)and 12 months(adjusted OR 1.350;95%CI 1.034 to 1.763).Conclusion GI bleeding was associated with the increased risk of stroke recurrence after an AIS.展开更多
Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China.This study aimed to assess clinical characteristics,in-hospital and afte...Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China.This study aimed to assess clinical characteristics,in-hospital and after-discharge management characteristics and prognosis for stroke types in China.Methods A nationwide registry recruited 14244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007-2008,recording presenting characteristics,diagnostic procedures and in-hospital treatment.After hospital discharge,patients were followed up for 6 months.Conventional statistical methods were used to examine the patterns of management and prognosis.Results Overall,68.7%,26.9%and 4.4%were ischaemic stroke(IS),intracerebral haemorrhage(ICH),and subarachnoid haemorrhage(SAH),respectively.Only 20%were managed in a dedicated stroke unit.Among IS,1.3%received thrombolysis within 3 hours after symptom onset,whereas the proportions of receiving in-hospital antiplatelet therapy,neuroprotective agents and traditional Chinese medicines(TCM)were 88.4%,69.7%and 70.6%,respectively.For ICH,63.3%and 36.3%received neuroprotective agents and TCM in hospital,respectively.At discharge,70.7%and 38.0%of the patients with IS were given antiplatelet and statin therapies,respectively,decreasing to 64.8%and 23.9%,respectively,at 6 months.In-hospital mortality was 3.2%,9.3%and 10.1%for IS,ICH and SAH,respectively,with a further 8.6%,18.2%and 22.0%,respectively,died by 6 month.Meanwhile,in-hospital recurrence rate was 2.6%,1.9%and 7.2%for IS,ICH and SAH,respectively,with a further 8.0%,5.1%and 7.5%,respectively,recurred by 6 month.Conclusions In China,the mortality rate of stroke is lower than that reported from west populations,though most strokes are not managed in specialised stroke unit.There is widespread use of some unproven therapies but limited proven treatments,especially after discharge,leading to unnecessary recurrent risks.展开更多
Aim To investigate clinical characteristics,risk factors(RFs),neurologic deficits and medical care provided in children who had a stroke in China.Methods We conducted a retrospective case-series study using the medica...Aim To investigate clinical characteristics,risk factors(RFs),neurologic deficits and medical care provided in children who had a stroke in China.Methods We conducted a retrospective case-series study using the medical records of children aged 1 month to 18 years with arterial ischaemic stroke(AIS)or haemorrhagic stroke(HS)(with the entry codes I60,I61,I62,I63(ICD-10)),who were admitted to different hospitals in Beijing,between January 2018 and December 2018.We obtained the following information from the charts:demographic characteristics,clinical presentations,RFs for paediatric stroke,laboratory examination,neuroimaging records and neurologic sequelae.Results We identified 312 first admissions for stroke(172 AIS and 140 HS).The mean age at onset was 8.6±3.9 years for patients who had an AIS and 8(5–13)years for patients who had an HS.There were more males than females in both groups(AIS:59.88%vs 40.12%;HS:52.14%vs 47.86%).A known aetiology was identified in 92.44%and 86.43%of patients who had an AIS and HS,respectively.The leading cause of AIS was cerebrovascular diseases including moyamoya(68.6%),while that for HS was arteriovenous malformation(51.43%).The most common initial clinical presentation was hemiplegia(86.05%)in patients who had an AIS and headache(67.86%)in patients who had an HS.The use of healthcare,including acute treatment(antithrombotic in 17.44%,anticoagulant in 5.23%)and secondary prevention(antithrombotic in 6.39%,anticoagulant in 1.16%),varied and was significantly lower among patients who had an AIS.The most common complications were epilepsy(22.09%)and pneumonia(4.65%)in patients who had an AIS and epilepsy(17.14%)and hydrocephalus(12.14%)in patients who had an HS.Neurological deficits occurred in 62.8%of patients who had an AIS and 72.86%of patients who had an HS.Conclusion Cerebral arteriopathy was a major RF for both AIS and HS in children living in China.Large epidemiological studies are required to identify RFs to prevent stroke as well as appropriate interventions.展开更多
background The 1-month case fatality of ischaemic stroke is an essential epidemiological metric.Whereas the case fatality after ischaemic stroke and the temporal trend is uncertain.We aimed to estimate the 1-month cas...background The 1-month case fatality of ischaemic stroke is an essential epidemiological metric.Whereas the case fatality after ischaemic stroke and the temporal trend is uncertain.We aimed to estimate the 1-month case fatality of ischaemic stroke and its temporal trend,as well as its regional variation.Methods We searched PubMed and Embase to identify the studies for 1-month case fatality of ischaemic stroke.The population-based studies were included.Two investigators extracted the data and assessed the quality independently.One-month case fatality of ischaemic stroke was estimated using a random effects model.The temporal trend was evaluated using a mixed-effect meta-regression model.results A total of 59 articles with 77 time periods were included.The worldwide 1-month case fatality of ischaemic stroke was 13.5%(95%CI 12.3%to 14.7%).The case fatality was 10.8%(95%CI 8.3%to 13.5%)in Asia,14.2%(95%CI 12.6%to 15.9%)in Europe,14.0%(95%CI 11.2%to 17.1%)in South America and Caribbean,14.0%(95%CI 9.5%to 19.1%)in North America and 12.5%(95%CI 11.1%to 13.9%)in Australia and New Zealand.Overall,there was a non-significant decrease of 0.1%per year in case fatality.It decreased significantly in Europe(−0.2%annually,95%CI−0.4%to−0.01%)and North America(−0.2%annually,95%CI−0.4%to−0.04%),increased significantly in Australia and New Zealand(0.2%annually,95%CI 0.1%to 0.4%),while no evidence of change in other regions.Conclusion The 1-month case fatality of ischaemic stroke and its temporal trend were divergent across regions.Further studies are needed to address the reason of the regional difference,which will be helpful to guide the effort of reducing stroke burden.展开更多
基金supported by grants from the National Key Research and Development Program from the Ministry of Science and Technology of China(2018YFC1312400)the Ministry of Science and Technology of the People’s Republic of China(2016YFC0901002,2016YFC0901001,2017YFC1310901,2017YFC1307905 and 2018YFC1312903)+3 种基金grants from Beijing Municipal Administration of Hospitals’Mission Plan(SML20150502)grants from National Natural Science Foundation of China(81600999)grants from Beijing Municipal Science&Technology Commission(D171100003017002 and D151100002015003)grants from National Science and Technology Major Project(2017ZX09304018).
文摘Objective Gastrointestinal(GI)bleeding in patients who had a stroke is strongly associated with a higher risk of death and loss of independence.However,it is unknown whether GI bleeding increases risk for recurrence of stroke.In this study,we assess the potential relationship between GI bleeding and stroke recurrence in patients within 12 months of an acute ischaemic stroke(AIS),using the China National Stroke Registry(CNSR).Methods This study included 22216 patients who had an ischaemic stroke included in the CNSR from 2007 to 2008.We analysed baseline patient characteristics,GI bleeding and outcomes of patients who had an AIS,specifically stroke recurrence at 3,6 and 12 months.We used multivariable logistic regression to evaluate a possible association between GI bleeding and stroke recurrence.results Of the 12415 patients included in our study,12.3%,15.5%and 17.7%had a stroke recurrence at 3,6 and 12 months,respectively.GI bleeding was an independent stroke recurrence risk factor in patients after ischaemic stroke at 3 months(adjusted OR 1.481,95%CI 1.118 to 1.962),6 months(adjusted OR 1.448,95%CI 1.106 to 1.896)and 12 months(adjusted OR 1.350;95%CI 1.034 to 1.763).Conclusion GI bleeding was associated with the increased risk of stroke recurrence after an AIS.
基金National Key R&D Plan of the Ministry of Science and Technology of China(2016YFC1301604,2017YFC1307702)National Natural Science Foundation of China(81870907)+1 种基金Ministry of Science and Technology and the Ministry of Health of China(2006BA101A11 and 2009CB521905)Beijing Municipal Administration of Hospitals’Mission Plan(SML20150502).
文摘Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China.This study aimed to assess clinical characteristics,in-hospital and after-discharge management characteristics and prognosis for stroke types in China.Methods A nationwide registry recruited 14244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007-2008,recording presenting characteristics,diagnostic procedures and in-hospital treatment.After hospital discharge,patients were followed up for 6 months.Conventional statistical methods were used to examine the patterns of management and prognosis.Results Overall,68.7%,26.9%and 4.4%were ischaemic stroke(IS),intracerebral haemorrhage(ICH),and subarachnoid haemorrhage(SAH),respectively.Only 20%were managed in a dedicated stroke unit.Among IS,1.3%received thrombolysis within 3 hours after symptom onset,whereas the proportions of receiving in-hospital antiplatelet therapy,neuroprotective agents and traditional Chinese medicines(TCM)were 88.4%,69.7%and 70.6%,respectively.For ICH,63.3%and 36.3%received neuroprotective agents and TCM in hospital,respectively.At discharge,70.7%and 38.0%of the patients with IS were given antiplatelet and statin therapies,respectively,decreasing to 64.8%and 23.9%,respectively,at 6 months.In-hospital mortality was 3.2%,9.3%and 10.1%for IS,ICH and SAH,respectively,with a further 8.6%,18.2%and 22.0%,respectively,died by 6 month.Meanwhile,in-hospital recurrence rate was 2.6%,1.9%and 7.2%for IS,ICH and SAH,respectively,with a further 8.0%,5.1%and 7.5%,respectively,recurred by 6 month.Conclusions In China,the mortality rate of stroke is lower than that reported from west populations,though most strokes are not managed in specialised stroke unit.There is widespread use of some unproven therapies but limited proven treatments,especially after discharge,leading to unnecessary recurrent risks.
文摘Aim To investigate clinical characteristics,risk factors(RFs),neurologic deficits and medical care provided in children who had a stroke in China.Methods We conducted a retrospective case-series study using the medical records of children aged 1 month to 18 years with arterial ischaemic stroke(AIS)or haemorrhagic stroke(HS)(with the entry codes I60,I61,I62,I63(ICD-10)),who were admitted to different hospitals in Beijing,between January 2018 and December 2018.We obtained the following information from the charts:demographic characteristics,clinical presentations,RFs for paediatric stroke,laboratory examination,neuroimaging records and neurologic sequelae.Results We identified 312 first admissions for stroke(172 AIS and 140 HS).The mean age at onset was 8.6±3.9 years for patients who had an AIS and 8(5–13)years for patients who had an HS.There were more males than females in both groups(AIS:59.88%vs 40.12%;HS:52.14%vs 47.86%).A known aetiology was identified in 92.44%and 86.43%of patients who had an AIS and HS,respectively.The leading cause of AIS was cerebrovascular diseases including moyamoya(68.6%),while that for HS was arteriovenous malformation(51.43%).The most common initial clinical presentation was hemiplegia(86.05%)in patients who had an AIS and headache(67.86%)in patients who had an HS.The use of healthcare,including acute treatment(antithrombotic in 17.44%,anticoagulant in 5.23%)and secondary prevention(antithrombotic in 6.39%,anticoagulant in 1.16%),varied and was significantly lower among patients who had an AIS.The most common complications were epilepsy(22.09%)and pneumonia(4.65%)in patients who had an AIS and epilepsy(17.14%)and hydrocephalus(12.14%)in patients who had an HS.Neurological deficits occurred in 62.8%of patients who had an AIS and 72.86%of patients who had an HS.Conclusion Cerebral arteriopathy was a major RF for both AIS and HS in children living in China.Large epidemiological studies are required to identify RFs to prevent stroke as well as appropriate interventions.
基金supported by the Ministry of Science and Technology of the People’s Republic of China(2017YFC1307702)Capital’s Funds for Health Improvement and Research(2020-1-2041)Beijing Municipal Administration of Hospitals’Sail Plan(XMLX201712).
文摘background The 1-month case fatality of ischaemic stroke is an essential epidemiological metric.Whereas the case fatality after ischaemic stroke and the temporal trend is uncertain.We aimed to estimate the 1-month case fatality of ischaemic stroke and its temporal trend,as well as its regional variation.Methods We searched PubMed and Embase to identify the studies for 1-month case fatality of ischaemic stroke.The population-based studies were included.Two investigators extracted the data and assessed the quality independently.One-month case fatality of ischaemic stroke was estimated using a random effects model.The temporal trend was evaluated using a mixed-effect meta-regression model.results A total of 59 articles with 77 time periods were included.The worldwide 1-month case fatality of ischaemic stroke was 13.5%(95%CI 12.3%to 14.7%).The case fatality was 10.8%(95%CI 8.3%to 13.5%)in Asia,14.2%(95%CI 12.6%to 15.9%)in Europe,14.0%(95%CI 11.2%to 17.1%)in South America and Caribbean,14.0%(95%CI 9.5%to 19.1%)in North America and 12.5%(95%CI 11.1%to 13.9%)in Australia and New Zealand.Overall,there was a non-significant decrease of 0.1%per year in case fatality.It decreased significantly in Europe(−0.2%annually,95%CI−0.4%to−0.01%)and North America(−0.2%annually,95%CI−0.4%to−0.04%),increased significantly in Australia and New Zealand(0.2%annually,95%CI 0.1%to 0.4%),while no evidence of change in other regions.Conclusion The 1-month case fatality of ischaemic stroke and its temporal trend were divergent across regions.Further studies are needed to address the reason of the regional difference,which will be helpful to guide the effort of reducing stroke burden.