Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term...Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term impacts of initial statin intensity following IS.Methods Consecutive patients using high-intensity,moderate-intensity or low-intensity statin early after IS(n=45512)were retrospectively studied using national registries in Finland.Differences were adjusted using multivariable regression.The primary outcome was all-cause death within 12-year follow-up(median 5.9 years).Secondary outcomes were recurrent IS,cardiovascular death and ICH studied using competing risk analyses.Results High-intensity therapy was initially used by 16.0%,moderate-intensity by 73.8%and low-intensity by 10.2%.Risk of death was lower with high-intensity versus moderate-intensity(adjusted HR(adj.HR)0.92;95%CI 0.87 to 0.97;number needed to treat(NNT)32.0),with moderate-intensity versus low-intensity(adj.HR 0.91;95%CI 0.87 to 0.95;NNT 27.5)and with high-intensity versus low-intensity(adj.HR 0.83;95%CI 0.78 to 0.89;NNT 14.6)statin.There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS(p<0.0001)and cardiovascular death(p<0.0001).The occurrence of ICH was not associated with initial statin intensity(p=0.646).Conclusions Following IS,more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH.These findings emphasise the importance of high statin intensity shortly after IS.展开更多
Objective To investigate the effects of ascites grading and the application of non-selective beta-blockers(NSBBs)on the 1-year prognosis of acute-on-chronic liver failure(ACLF).Methods 1386 ascitic cases with ACLF wer...Objective To investigate the effects of ascites grading and the application of non-selective beta-blockers(NSBBs)on the 1-year prognosis of acute-on-chronic liver failure(ACLF).Methods 1386 ascitic cases with ACLF were graded and followed up for one year.The 1-year prognostic effect of ascites grade and NSBBs was analyzed on ACLF by the Kaplan Meier Log-rank test,Cox stepwise regression,and multivariate regression.The t-test,Mann-Whitney U,or Kruskal-Wallis test were used for intergroup comparison of measurement data.The X test was used for intergroup comparison of numerical data.Results The incidence rate of ascites at admission was 77.56%in1386ACLFcases.The Log-rank(Mantel-Cox)of the 1-year survival curve test for 1386 ACLF patients with ascites grade was 21.384,P<0.01.Multivariate regression and Cox stepwise regression analysis showed that ascites grade,age,gastrointestinal bleeding,pulmonary infection,acute kidney injury,prothrombin activity(PTA),urea,MELD-Na score,and the use of NSBBs were closely related to the 1-year prognosis of ACLF.The log rank(Mantel-Cox)of NSBBs treatment in the grade 2/3 ascites group was 6.113,P=0.013,and the difference was statistically significant,suggesting that NSBBs treatment can help improve the 1-year survival rate in ACLF patients with grade 2 and 3 ascites.Conclusion Ascites grading and the use of NSBBs affect the prognostic factor of ACLF at one year.NSBBs may be beneficial for the long-term prognosis of ACLF,and treatment can be continued in patients who have already received NSBBs prior to the onset of ACLF.展开更多
基金supported by grant funding from the Finnish Foundation for Cardiovascular Research sr,and the Finnish State research funding.
文摘Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term impacts of initial statin intensity following IS.Methods Consecutive patients using high-intensity,moderate-intensity or low-intensity statin early after IS(n=45512)were retrospectively studied using national registries in Finland.Differences were adjusted using multivariable regression.The primary outcome was all-cause death within 12-year follow-up(median 5.9 years).Secondary outcomes were recurrent IS,cardiovascular death and ICH studied using competing risk analyses.Results High-intensity therapy was initially used by 16.0%,moderate-intensity by 73.8%and low-intensity by 10.2%.Risk of death was lower with high-intensity versus moderate-intensity(adjusted HR(adj.HR)0.92;95%CI 0.87 to 0.97;number needed to treat(NNT)32.0),with moderate-intensity versus low-intensity(adj.HR 0.91;95%CI 0.87 to 0.95;NNT 27.5)and with high-intensity versus low-intensity(adj.HR 0.83;95%CI 0.78 to 0.89;NNT 14.6)statin.There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS(p<0.0001)and cardiovascular death(p<0.0001).The occurrence of ICH was not associated with initial statin intensity(p=0.646).Conclusions Following IS,more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH.These findings emphasise the importance of high statin intensity shortly after IS.
文摘Objective To investigate the effects of ascites grading and the application of non-selective beta-blockers(NSBBs)on the 1-year prognosis of acute-on-chronic liver failure(ACLF).Methods 1386 ascitic cases with ACLF were graded and followed up for one year.The 1-year prognostic effect of ascites grade and NSBBs was analyzed on ACLF by the Kaplan Meier Log-rank test,Cox stepwise regression,and multivariate regression.The t-test,Mann-Whitney U,or Kruskal-Wallis test were used for intergroup comparison of measurement data.The X test was used for intergroup comparison of numerical data.Results The incidence rate of ascites at admission was 77.56%in1386ACLFcases.The Log-rank(Mantel-Cox)of the 1-year survival curve test for 1386 ACLF patients with ascites grade was 21.384,P<0.01.Multivariate regression and Cox stepwise regression analysis showed that ascites grade,age,gastrointestinal bleeding,pulmonary infection,acute kidney injury,prothrombin activity(PTA),urea,MELD-Na score,and the use of NSBBs were closely related to the 1-year prognosis of ACLF.The log rank(Mantel-Cox)of NSBBs treatment in the grade 2/3 ascites group was 6.113,P=0.013,and the difference was statistically significant,suggesting that NSBBs treatment can help improve the 1-year survival rate in ACLF patients with grade 2 and 3 ascites.Conclusion Ascites grading and the use of NSBBs affect the prognostic factor of ACLF at one year.NSBBs may be beneficial for the long-term prognosis of ACLF,and treatment can be continued in patients who have already received NSBBs prior to the onset of ACLF.
