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Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial.
International Journal of Stroke ( IF 6.3 ) Pub Date : 2020-02-19 , DOI: 10.1177/1747493020908140
Menglu Ouyang 1, 2 , Laurent Billot 1 , Lili Song 1, 2 , Xia Wang 1 , Christine Roffe 3 , Hisatomi Arima 1, 4 , Pablo M Lavados 5 , Maree L Hackett 1, 6 , Verónica V Olavarría 5 , Paula Muñoz-Venturelli 1, 7 , Sandy Middleton 8 , Octavio M Pontes-Neto 9 , Tsong-Hai Lee 10 , Caroline L Watkins 6 , Thompson G Robinson 11 , Craig S Anderson 1, 2, 7, 12, 13
Affiliation  

BACKGROUND An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). METHODS Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as "poor outcome," scores 3-6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. RESULTS Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13-1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59-2.18). The number exposed to IUC for poor outcome was 13. CONCLUSIONS IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.

中文翻译:

急性卒中后早期导尿的预后意义:国际 HeadPoST 试验的二次分析。

背景技术通常插入留置导尿管 (IUC) 来治疗膀胱功能障碍,但其对预后的影响尚不确定。我们的目的是在国际、多中心、集群交叉、急性卒中头部定位试验 (HeadPoST) 中确定 IUC 使用与急性卒中后临床结果的关联。方法对随机分配到平躺或仰卧头位的 HeadPoST 参与者 (n = 11,093) 的数据进行分析。二项式、逻辑回归、分层混合模型用于确定在随机化后 7 天内早期插入 IUC 与死亡或残疾结果(定义为“不良结果”,在改良 Rankin 量表上得分 3-6)和任何90 天时的尿路感染,调整基线和随机化后管理协变量。结果 总体而言,1167 名 (12%) 患者有 IUC,但不同地区患者的使用频率和持续时间差异很大。IUC 的使用在老年患者、血管合并症、初始神经功能损害较大(根据美国国立卫生研究院卒中量表)和脑出血作为潜在卒中类型的患者中更为常见。IUC 的使用与不良结局独立相关(调整优势比(aOR):1.40,95% 置信区间(CI):1.13-1.74),但在调整抗生素治疗和住院分离时卒中严重程度后与尿路感染无关(aOR : 1.13, 95% CI: 0.59-2.18)。因预后不良而接受 IUC 的人数为 13。 结论 IUC 的使用与急性卒中后的不良预后相关。需要进一步研究以告知适当使用 IUC。1167 名 (12%) 患者有 IUC,但不同地区患者的使用频率和持续时间差异很大。IUC 的使用在老年患者、血管合并症、初始神经功能损害较大(根据美国国立卫生研究院卒中量表)和脑出血作为潜在卒中类型的患者中更为常见。IUC 的使用与不良结局独立相关(调整优势比(aOR):1.40,95% 置信区间(CI):1.13-1.74),但在调整抗生素治疗和住院分离时卒中严重程度后与尿路感染无关(aOR : 1.13, 95% CI: 0.59-2.18)。因预后不良而接受 IUC 的人数为 13。 结论 IUC 的使用与急性卒中后的不良预后相关。需要进一步研究以告知适当使用 IUC。1167 名 (12%) 患者有 IUC,但不同地区患者的使用频率和持续时间差异很大。IUC 的使用在老年患者、血管合并症、初始神经功能损害较大(根据美国国立卫生研究院卒中量表)和脑出血作为潜在卒中类型的患者中更为常见。IUC 的使用与不良结局独立相关(调整优势比(aOR):1.40,95% 置信区间(CI):1.13-1.74),但在调整抗生素治疗和住院分离时卒中严重程度后与尿路感染无关(aOR : 1.13, 95% CI: 0.59-2.18)。因预后不良而接受 IUC 的人数为 13。 结论 IUC 的使用与急性卒中后的不良预后相关。需要进一步研究以告知适当使用 IUC。
更新日期:2020-02-19
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