Abstract：
UNASSIGNED: Patients with acute stroke are at risk of respiratory or circulatory compromise resulting in vital instability, which can be captured through the widely used aggregated National Early Warning Score (NEWS). We aimed to assess the relation between vital instability (defined as NEWS of five or higher) and death or dependency at 90 days after stroke.
UNASSIGNED: In this observational cohort study we studied 763 patients with ischaemic stroke (n = 400), intracerebral haemorrhage (ICH) (n = 146) or subarachnoid haemorrhage (SAH) (n = 217), hospitalized to a Dutch tertiary referral hospital from 1 January 2017 to 31 December 2018. We calculated NEWS for each 8 h time span during the first 72 h after hospitalization. We also decomposed NEWS into its three components respiration, circulation and consciousness. The primary outcome was death or dependency (modified Rankin Scale score ⩾3) at 90 days after stroke. The association of vital instability with functional dependency was examined using Poisson regression.
UNASSIGNED: Two hundred and twenty-seven (58%) patients with ischaemic stroke, 101 (69%) with ICH and 142 (65%) with SAH had at least one episode of vital instability. In patients with ischaemic stroke or SAH, vital instability was associated after adjustment for confounders with death or dependency (adjusted relative risk 1.55 ((95% CI) 1.25-1.93 and 2.13 (1.35-3.36), respectively)). This was mainly driven by impaired consciousness, which was associated with death or dependency in all types of stroke. Respiratory insufficiency and circulatory instability were associated with death or dependency only in SAH.
UNASSIGNED: Vital instability in the first 72 h of hospitalization for ischaemic stroke or SAH is associated with death or dependency at 90 days. Impaired consciousness was the main driver of this relationship. NEWS may not be appropriate for patients with acute stroke, mainly due to the dichotomous manner in which the level of consciousness is classified, and modification of NEWS should be considered for these patients.
UNASSIGNED: In this observational cohort study we studied 763 patients with ischaemic stroke (n = 400), intracerebral haemorrhage (ICH) (n = 146) or subarachnoid haemorrhage (SAH) (n = 217), hospitalized to a Dutch tertiary referral hospital from 1 January 2017 to 31 December 2018. We calculated NEWS for each 8 h time span during the first 72 h after hospitalization. We also decomposed NEWS into its three components respiration, circulation and consciousness. The primary outcome was death or dependency (modified Rankin Scale score ⩾3) at 90 days after stroke. The association of vital instability with functional dependency was examined using Poisson regression.
UNASSIGNED: Two hundred and twenty-seven (58%) patients with ischaemic stroke, 101 (69%) with ICH and 142 (65%) with SAH had at least one episode of vital instability. In patients with ischaemic stroke or SAH, vital instability was associated after adjustment for confounders with death or dependency (adjusted relative risk 1.55 ((95% CI) 1.25-1.93 and 2.13 (1.35-3.36), respectively)). This was mainly driven by impaired consciousness, which was associated with death or dependency in all types of stroke. Respiratory insufficiency and circulatory instability were associated with death or dependency only in SAH.
UNASSIGNED: Vital instability in the first 72 h of hospitalization for ischaemic stroke or SAH is associated with death or dependency at 90 days. Impaired consciousness was the main driver of this relationship. NEWS may not be appropriate for patients with acute stroke, mainly due to the dichotomous manner in which the level of consciousness is classified, and modification of NEWS should be considered for these patients.
摘要：
■急性卒中患者存在呼吸或循环受损的风险，导致生命不稳定。可以通过广泛使用的汇总国家预警评分（NEWS）捕获。我们旨在评估卒中后90天的生命不稳定（定义为5或更高的新闻）与死亡或依赖性之间的关系。
■在这项观察性队列研究中，我们研究了763例缺血性卒中患者（n=400），脑出血（ICH）（n=146）或蛛网膜下腔出血（SAH）（n=217），2017年1月1日至2018年12月31日期间在荷兰三级转诊医院住院。我们计算了住院后第一个72小时内每8小时的新闻。我们还将新闻分解成三个组成部分的呼吸，循环和意识。主要结果是卒中后90天的死亡或依赖性（改良的Rankin量表评分3）。使用泊松回归检查了生命不稳定性与功能依赖性的关联。
■二百二十七（58%）缺血性卒中患者，101例（69％）ICH和142例（65％）SAH至少有一次重要的不稳定发作。在缺血性卒中或SAH患者中，在校正混杂因素与死亡或依赖关系后，至关重要的不稳定性相关(校正后相对风险1.55((95%CI)1.25-1.93和2.13(1.35-3.36)，分别）））。这主要是由意识受损引起的，这与所有类型卒中的死亡或依赖性相关。仅在SAH中，呼吸功能不全和循环不稳定与死亡或依赖相关。
■缺血性卒中或SAH住院前72小时的生命不稳定与90天的死亡或依赖相关。意识受损是这种关系的主要驱动力。新闻可能不适用于急性中风患者，主要是由于意识水平分类的二分法，对于这些患者，应考虑修改新闻。
■在这项观察性队列研究中，我们研究了763例缺血性卒中患者（n=400），脑出血（ICH）（n=146）或蛛网膜下腔出血（SAH）（n=217），2017年1月1日至2018年12月31日期间在荷兰三级转诊医院住院。我们计算了住院后第一个72小时内每8小时的新闻。我们还将新闻分解成三个组成部分的呼吸，循环和意识。主要结果是卒中后90天的死亡或依赖性（改良的Rankin量表评分
■二百二十七（58%）缺血性卒中患者，101例（69％）ICH和142例（65％）SAH至少有一次重要的不稳定发作。在缺血性卒中或SAH患者中，在校正混杂因素与死亡或依赖关系后，至关重要的不稳定性相关(校正后相对风险1.55((95%CI)1.25-1.93和2.13(1.35-3.36)，分别）））。这主要是由意识受损引起的，这与所有类型卒中的死亡或依赖性相关。仅在SAH中，呼吸功能不全和循环不稳定与死亡或依赖相关。
■缺血性卒中或SAH住院前72小时的生命不稳定与90天的死亡或依赖相关。意识受损是这种关系的主要驱动力。新闻可能不适用于急性中风患者，主要是由于意识水平分类的二分法，对于这些患者，应考虑修改新闻。
