B PT -期刊文章盟马修·唐纳AU -井巷李盟萨曼莎卡特AU -萨利毕比AU -彼得·米Rothwell TI - Multimorbidity协会与中风严重性,子类型,发病前的残疾,和早期死亡率:牛津血管- 10.1212 / WNL研究援助。0000000000207479 DP - 2023年6月15日TA -神经病半岛投注体育官网学PG - 10.1212 / WNL。0000000000207479 4099 - http://n.半岛投注体育官网neurology.org/content/early/2023/06/15/WNL.0000000000207479.short 4100 - //www.ebmtp.com/content/early/2023/06/15/WNL.0000000000207479.full AB -背景和目标:multimorbidity患者在临床试验没有什么发言权。包含在中风试验通常是基于患病残疾受到排斥,担心严重中风后的结果在急性治疗试验,,并可能加大比例出血性和缺血性中风的预防试验。Multimorbidity与卒中后死亡率增加有关,但目前尚不清楚这是由于中风的严重程度增加,或者是由特定的中风亚型或发病前的残疾抱愧蒙羞。我们旨在确定独立multimorbidity协会与中风严重性考虑这些主要潜在的混杂因素。方法:以人群为基础的发病率研究(牛津血管的研究;2002 - 2017),pre-stroke multimorbidity (Charlson合并症Index-CCI;未加权的加权)在所有first-in-study中风有关急性严重性(≈24小时;NIH卒中Scale-NIHSS)、中风亚型(出血性与缺血性;审判组织10172年急性中风Treatment-TOAST),和患病残疾(改良Rankin得分/夫人≥2)使用年龄/ sex-adjusted物流和线性回归模型,并使用Cox比例风险模型90天的死亡率。结果:2492例患者(平均/ SD年龄= 74.5/13.9;1216/48.8%男性; 2160/86.7% ischaemic strokes; mean/SD NIHSS=5.7/7.1), 1402/56.2% had at least one CCI comorbidity, and 700/28.1% had multimorbidity. Although multimorbidity was strongly related to pre-morbid mRS≥2 (aOR for per CCI comorbidity=1.42, 1.31-1.54, p<0.001) and comorbidity burden was crudely associated with increased severity of ischaemic stroke (OR per comorbidity: 1.12, 1.01-1.23 for NIHSS 5-9, p=0.027; 1.15, 1.06-1.26, for NIHSS≥10; p=0.001), no association with severity remained after stratification by TOAST subtype (aOR=1.02, 0.90-1.14, p=0.78 for NIHSS 5-9 vs 0-4: 0.99, 0.91-1.07, p=0.75 for NIHSS≥10vs0-4), or within any individual subtype. The proportion of intracerebral haemorrhage versus ischaemic stroke was lower in patients with multimorbidity (aOR per comorbidity=0.80, 0.70-0.92, p<0.001), and multimorbidity was only weakly associated with 90-day mortality after adjustment for age, sex, severity, and pre-morbid disability (aHR per comorbidity=1.09, 1.04-1.14, p<0.001). Results were unchanged using the weighted CCI.Discussion: Multimorbidity is common in patients with stroke and is strongly related to pre-morbid disability, but is not independently associated with increased ischaemic stroke severity. Greater inclusion of patients with multimorbidity is unlikely therefore to undermine the effectiveness of interventions in clinical trials, but would increase external validity.