Comparison of Factors Affecting Quality of Life in Patients with Acute Ischemic Stroke Across Different Stroke Severities

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2025年4月29日

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Yuxuan Lu,
Weiping Sun,
Yining Huang,
Zhaoxia Wang,
Zhiyuan Shen,
Wei Sun,
Ran Liu,
Fan Li,
Junlong Shu,
Qing Peng,
Jingjing Jia,
Peng Sun,
Yijun Song,
Haiqiang Jin,
Xiaomu Wu,
Zhiyu Nie,
Xiangzhe Liu,
Junfeng Shi,
Li Ding,
Dai Huang,
Ning Wang,
Ruiyou Guo,
Xuerong Qiu,
Jun Wu,
Yan Liu,
Lianbo Gao,
Xingjuan Zhao,
Yuhui Han,
Xinling Meng,
Xuhai Gong,
Jie Han,
Yongbo Zhang,
Jinzhao Wang,
Shuhong Ju,
Zhilin Jiang,
Shuyan Zhang,
Deyang Li,
Wenwei Yun,
Xueqiang Hu,
Juming Yu,
Junyan Liu,
Zhiyun Wang,
Deqin Geng,
Yukai Wang,
Peiyuan Lv,
Danhong Wu,
Yangtai Guan,
Cuilan Wang,
Qingchun Gao,
Xuejun Zhang,
Hongmei Liu,
Tao Gong,
Shujuan Tian,
Shuijiang Song,
Shaoshi Wang,
Haiqing Song,
Zuneng Lu,
Xiaoxiang Peng,
Qi Fang,
Wendan Tao,
Shilie Wang,
Ping Zhang,
Xiaojie Wang,
Qiang Zhang,
Weishu Xue,
Liping Wei,
Weiliang Luo,
Yuling Jin,
Juan Feng,
Xinyan Wu,
Yongzhong Lin,
Hongbing Nie,
Wei Liu,
Hui Cao,
Qi Tan,
Yude Zhang,
Youqing Deng,
Guangxian Nan,
Lishu Wan,
Xiaoping Yin,
Wenyan Zhuo,
Bingzhen Cao

摘要

Introduction

Research investigating the differences in determinants affecting the quality of life (QoL) in patients with acute ischemic stroke (AIS) of varying severities remains limited, and how these factors influence QoL remains unclear. The aim of this study was to address this critical issue, refining treatments to enhance long-term QoL and optimize resource use.

Methods

In this multicenter prospective study conducted in China, patients with AIS were assessed using the EuroQol-5 Dimension (EQ-5D) questionnaire at admission and 1 year later. Univariate and multivariate analyses were conducted to identify QoL determinants. Motor function-related outcomes (MFRO) and non-motor function-related outcomes (NMFRO) were defined based on the EQ-5D questionnaire to explore how factors influence outcomes through mediation analysis.

Results

The study included 8598 patients with AIS (median age 64 years; 65.7% male), 3927 of whom had minor stroke severity (National Institutes of Health Stroke Scale [NIHSS] scores ≤ 3). The median QoL score improved from 0.597 at admission to 1.000 after 1 year. Compared to patients with minor stroke, more patients with non-minor stroke had non-motor function-related problems (NMFRP) at admission (78.2% vs. 56.6%). Age, stroke history, QoL at admission, infection, hospitalization costs, and discharge outcomes were found to be factors influencing QoL in both cohorts. In the non-minor stroke cohort, analysis revealed that additional factors include diabetes mellitus, geographical region, speech impairment, and thrombolysis, while in the minor stroke cohort, hypertension, coronary heart disease, cancer, prolonged length of stay, and hemorrhage were found to be relevant factors. The impact of most factors on QoL was mediated by MFRO, while the effects of age, speech impairment, and geographical region were also mediated by NMFRO. Hospitalization costs beyond 15,000 China Yuan (CNY) did not improve QoL for the patients with non-minor stroke, with a threshold of 10,000 CNY for the patients with minor stroke.

Conclusions

Over half of the patients in the study population had NMFRP, necessitating greater medical attention. Patients with different stroke severities had distinct QoL determinants. Age, speech impairment, and geographical region may exert an impact partly mediated through NMFRO. Higher hospitalization costs did not consistently improve QoL beyond a certain threshold.

Trial Registration

ClinicalTrials.gov Identifier: NCT02470624.