Table 1_Delirium following mechanical thrombectomy for ischemic stroke – individuals at risk, imaging biomarkers and prognosis.docx

AimPost-stroke-delirium has been linked to worse outcome in patients with acute cerebrovascular disease; identification of individuals at risk may prevent delirium and thereby improve outcome. We investigate prognosis and factors associated with post-stroke-delirium in patients with large vessel occlusion (LVO) ischemic stroke treated by mechanical thrombectomy (MT).
Methods747 patients (53.4% female) prospectively enrolled in the Gutenberg-Stroke-Study from May 2018–November 2022 were analyzed with regard to diagnosis of delirium. Group comparison of patient-, stroke- and treatment characteristics as well as computed tomography(CT)-imaging based parameters of cerebral atrophy (global cortical atrophy [GCA], posterior atrophy [Koedam], medial temporal lobe atrophy [MTA] scores) and white matter lesions (Fazekas score) was conducted. Independent predictors of delirium and the association of delirium with functional outcome at 90-day follow-up was investigated by multiple logistic regression analyses.
ResultsWe report 8.2% of patients (61/747) developing delirium following MT of LVO. Independent predictors were older age (aOR[95%CI] per year: 1.034[1.005–1.065], p = 0.023), male sex (aOR[95%CI]: 2.173[1.182–3.994], p = 0.012), general anesthesia during MT (aOR[95%CI]: 2.455[1.385–4.352], p = 0.002), infectious complications (aOR[95%CI]: 1.845[1.031–3.305], p = 0.039), “other determined” etiology of stroke (aOR[95%CI]: 2.424[1.100–5.345], p = 0.028), and a MTA score exceeding age-specific cut-offs (aOR[95%CI]: 2.126[1.065–4.244], p = 0.033). Delirium was independently associated with worse functional outcome (aOR[95%CI]: 2.902[1.005–8.383], p = 0.049) at 90-day follow-up.
ConclusionDelirium is independently associated with worse functional outcome after MT of LVO, stressing the importance of screening and preventive measures. Besides conventional risk factors, pathological MTA scores and use of general anesthesia during MT may be easy-to-apply criteria to identify individuals at risk of delirium and implement prevention strategies.

卒中后谵妄（post-stroke delirium）已被证实与急性脑血管病患者的不良预后密切相关；识别高危个体或可预防谵妄发生，进而改善患者整体预后。本研究针对接受机械取栓术（mechanical thrombectomy, MT）治疗的大血管闭塞（large vessel occlusion, LVO）缺血性脑卒中患者，探究其卒中后谵妄的预后情况及相关影响因素。
方法 本研究对2018年5月至2022年11月期间前瞻性纳入古登堡卒中研究（Gutenberg-Stroke-Study）的747例患者（女性占比53.4%）进行分析，以明确其谵妄诊断情况。研究对患者的基线特征、卒中及治疗相关参数，以及基于计算机断层扫描（computed tomography, CT）影像的脑萎缩参数[整体皮层萎缩（global cortical atrophy, GCA）、后部萎缩（posterior atrophy, Koedam）评分、内侧颞叶萎缩（medial temporal lobe atrophy, MTA）评分]和脑白质病变（Fazekas评分）开展组间比较。通过多元逻辑回归分析（multiple logistic regression analyses），探究谵妄的独立预测因素，以及谵妄与患者90天随访时功能预后的关联。
结果 本研究中，8.2%的患者（61/747）在接受LVO的MT治疗后出现卒中后谵妄。独立预测因素包括：年龄增长（校正优势比[95%置信区间]：每年1.034[1.005–1.065]，p=0.023）、男性性别（校正优势比[95%置信区间]：2.173[1.182–3.994]，p=0.012）、MT术中实施全身麻醉（校正优势比[95%置信区间]：2.455[1.385–4.352]，p=0.002）、感染并发症（校正优势比[95%置信区间]：1.845[1.031–3.305]，p=0.039）、卒中病因归类为“其他明确病因”（校正优势比[95%置信区间]：2.424[1.100–5.345]，p=0.028），以及MTA评分超出年龄特异性临界值（校正优势比[95%置信区间]：2.126[1.065–4.244]，p=0.033）。谵妄与患者90天随访时的不良功能预后独立相关（校正优势比[95%置信区间]：2.902[1.005–8.383]，p=0.049）。
结论 卒中后谵妄与LVO患者接受MT治疗后的不良功能预后独立相关，凸显了早期筛查与预防性干预的重要性。除传统危险因素外，异常MTA评分及MT术中使用全身麻醉或可作为简便易用的识别指标，用于筛查卒中后谵妄高危人群并制定针对性预防策略。