Outcomes after Stroke in Patients with Previous Pressure Ulcer: A Nationwide Matched Retrospective Cohort Study

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• 作者：Shang-Yi Lee ; MD^* ; Chia-Lun Chou ; MD^&dagger ; ; Sanford P.C. Hsu ; MD^&Dagger ; ; Chun-Chuan Shih ; MD ; PhD^§ ; ; ^‖ ; Chun-Chieh Yeh ; MD ; PhD^¶ ; ; ^# ; Chih-Jen Hung ; MD^* ; Ta-Liang Chen ; MD ; PhD^** ; ^&dagger ; &dagger ; ; ^&Dagger ; &Dagger ; ; Chien-Chang Liao ; PhD ; MPH^** ; ^&dagger ; &dagger ; ; ^&Dagger ; &Dagger ; ; ^§ ; § ; ; ^{ccliao@tmu.edu.tw" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Complications ; mortality ; outcomes ; pressure ulcer ; stroke
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：25
• 期：1
• 页码：220-227
• 全文大小：127 K

文摘

Factors associated with poststroke adverse events were not completely understood. The purpose of this study was to investigate whether stroke patients with previous pressure ulcers had more adverse events after stroke.

Methods

Using the claims data from Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study matched by propensity score. Three thousand two first-ever stroke patients with previous pressure ulcer and 3002 first-ever stroke patients without pressure ulcer were investigated between 2002 and 2009. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of complications and 30-day mortality after stroke associated with previous pressure ulcer were calculated in the multivariate logistic regressions.

Results

Patients with pressure ulcer had significantly higher risk than control for poststroke urinary tract infection (OR: 1.56, 95% CI: 1.38-1.78), pneumonia (OR: 1.35, 95% CI: 1.16-1.58), gastrointestinal bleeding (OR: 1.31, 95% CI: 1.04-1.66), and epilepsy (OR: 1.84, 95% CI: 1.83-1.85). Stroke patients with pressure ulcer had increased 30-day poststroke mortality (OR: 2.01, 95% CI: 1.55-2.61), particularly in those treated with debridement (OR: 2.87, 95% CI: 1.85-4.44) or high quantity of antibiotics (OR: 4.01, 95% CI: 2.10-7.66). Pressure ulcer was associated with poststroke mortality in both genders and patients aged 60 years or older.

Conclusions

This study showed increased poststroke complications and mortality in patients with previous pressure ulcer, which suggests the urgent need for monitoring stroke patients for pressure ulcer history.