BACKGROUND AND OBJECTIVES Acute stroke is associated with a spectrum of functional deficits. The objective of this analysis was to explore whether the importance of individual risk factors differ by stroke severity, which may be of relevance to public health strategies to reduce disability. METHODS INTERSTROKE is an international case-control study of risk factors of first acute stroke (recruitment 2007-August 2015) in 32 countries. Stroke severity was measured using the modified Rankin Scale (mRS) score within 72 hours of admission to hospital. Severe stroke is defined as mRS scores of 4-6 (and non-severe stroke, score of 0-3). We used multinomial logistic regression to estimate comparative odds ratios (ORs; 95% CIs) for severe and non-severe stroke and tested for heterogeneity (pheterogeneity). We also conducted a matched case-case analysis (matched for age, sex, country, and primary stroke subtype) to determine whether the prevalence of risk factors differed significantly between severe and non-severe stroke. A significant difference in the association of a risk factor of severe stroke compared with non-severe stroke was defined as p < 0.05 for both pheterogeneity and pcase-case. RESULTS Of patients with acute stroke (n = 13,460), 64.0% (n = 8,612) were reported to have mRS scores of 0-3 and 36.0% (n = 4,848) scores of 4-6. The mean age was 61.7 years for patients with non-severe stroke and 62.9 years for patients with severe stroke (p = 0.72). 38.1% (n = 3,278) of patients with non-severe stroke and 44.6% (n = 2,162) of patients with severe stroke were female. Hypertension (OR 3.21; 95% CI 2.97-3.47 for severe stroke, OR 2.87; 95% CI 2.69-3.05 for non-severe stroke; pheterogeneity = 0.03; pcase-case < 0.001), atrial fibrillation (OR 4.70; 95% CI 4.05-5.45 for severe stroke, OR 3.61; 95% CI 3.16-4.13 for non-severe stroke; pheterogeneity = 0.009; pcase-case < 0.001), and smoking (OR 1.87; 95% CI 1.72-2.03 for severe stroke, OR 1.65; 95% CI 1.54-1.77 for non-severe stroke; pheterogeneity = 0.02; pcase-case < 0.001) had a stronger association with severe stroke, compared with non-severe stroke. The waist-to-hip ratio had a stronger association with non-severe stroke compared with severe stroke (pheterogeneity < 0.001; pcase-case < 0.001). DISCUSSION Hypertension, atrial fibrillation, and smoking had a stronger magnitude of association with severe stroke (compared with non-severe stroke) while the increased waist-to-hip ratio had a stronger magnitude of association with non-severe stroke.

中文翻译：

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血管风险与严重与非严重中风的关联：INTERSTROKE 研究分析。


背景和目标 急性中风与一系列功能缺陷有关。该分析的目的是探讨个体风险因素的重要性是否因中风的严重程度而异，这可能与减少残疾的公共卫生策略有关。方法 INTERSTROKE 是一项国际病例对照研究，涉及 32 个国家/地区的首次急性中风 （2007 年 8 月招募-2015 年 8 月） 的危险因素。在入院后 72 小时内使用改良 Rankin 量表 （mRS） 评分测量卒中严重程度。严重中风定义为 mRS 评分为 4-6（非严重中风，评分为 0-3）。我们使用多项式 logistic 回归来估计重度和非重度卒中的比较比值比 （ORs;95% CIs），并检验异质性 （pheterogeneity）。我们还进行了匹配的病例分析（根据年龄、性别、国家和原发性卒中亚型匹配），以确定重度和非重度中风之间危险因素的患病率是否显著差异。与非严重中风相比，严重中风危险因素相关性的显著差异定义为异质性和 pcase 病例的 p < 0.05。结果 在急性卒中患者 （n = 13,460） 中，据报道 64.0% （n = 8,612） 的 mRS 评分为 0-3,36.0% （n = 4,848） 评分为 4-6。非严重中风患者的平均年龄为 61.7 岁，严重中风患者的平均年龄为 62.9 岁 （p = 0.72）。38.1% （n = 3,278） 的非严重中风患者和 44.6% （n = 2,162） 的严重中风患者是女性。高血压 （OR 3.21;严重卒中为 95% CI 2.97-3.47，非严重卒中为 OR 2.87;95% CI 2.69-3.05;异质性 = 0.03;pcase-case < 0.001）、心房颤动 （OR 4.70;95% CI 4.05-5.严重中风为 45，或 3.61;非重度卒中为 95% CI 3.16-4.13;异质性 = 0.009;pcase-case < 0.001）和吸烟（OR 1.87;严重卒中为 95% CI 1.72-2.03，非严重卒中为 OR 1.65;95% CI 1.54-1.77;pheterogeneity = 0.02;pcase-case < 0.001）与非严重卒中相比，与严重卒中相比，与严重卒中的相关性更强。与重度中风相比，腰臀比与非重度中风的相关性更强 （异质性 < 0.001;pcase-case < 0.001）。讨论 高血压、心房颤动和吸烟与严重中风的相关性更强（与非严重中风相比），而腰臀比增加与非严重中风的相关性更强。