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Association Between Common Infections and Incident Post-Stroke Dementia: A Cohort Study Using the Clinical Practice Research Datalink

机译:常见感染与事件之间的关联后卒中后痴呆:使用临床实践研究DataLink的队列研究

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Purpose: To investigate the association between common infections and post-stroke dementia in a UK population-based cohort. Materials and Methods: A total of 60,392 stroke survivors (51.2% male, median age 74.3 years, IQR 63.9– 82.4 years) were identified using primary care records from the Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) with no history of dementia. Primary exposure was any GP-recorded infection (lower respiratory tract infection (LRTI), urinary tract infection (UTI) requiring antibiotics, skin and soft tissue infection requiring antibiotics) occurring after stroke. The primary outcome was incident all-cause dementia recorded in primary care records. In sensitivity analyses, we restricted to individuals with linked hospital records and expanded definitions to include ICD-10 coded hospital admissions. We used multivariable Cox regression to investigate the association between common infections and dementia occurring from 3 months to 5 years after stroke. Results: Of 60,392 stroke survivors, 20,969 (34.7%) experienced at least one infection and overall 4512 (7.5%) developed dementia during follow-up. Early dementia (3 months to 1-year post-stroke) risk was increased in those with at least one GP-recorded infection (HR 1.44, 95% CI 1.21– 1.71), with stronger associations when hospitalised infections were included (HR 1.84, 95% CI 1.58– 2.14). Late dementia (1– 5 years) was only associated with hospitalised, but not with GP-recorded, infections. Conclusion: There was evidence of an association between common infections and post-stroke dementia, strongest in the 3– 12 months following stroke. Better understanding of this relationship could help inform knowledge of pathways to dementia post-stroke and targeting of preventive interventions.
机译:目的:探讨英国人口群落中常见感染与中风后痴呆的关联。材料和方法:使用来自临床实践研究DataLink(CPRD)的初级保健记录,共鉴定了60,392名中风幸存者(51.2%的男性,中位数74.3岁,IQR 63.9-82.4岁)与医院发作统计数据(HES)相关联没有痴呆症的历史。主要暴露是在中风后发生任何GP记录的感染(低呼吸道感染(LRTI),需要抗生素,皮肤和软组织感染的尿路感染(UTI)。主要结果是在初级保健记录中记录的所有导致痴呆症。在敏感性分析中,我们仅限于有关相关医院记录的个人和扩展定义,包括ICD-10编码医院入学。我们使用多变量的Cox回归来研究患有卒中后3个月至5年的常见感染和痴呆之间的关联。结果:60,392例中风幸存者,20,969名(34.7%)在后续行动期间经历了至少一种感染,总共4512(7.5%)发育痴呆。早期痴呆(3个月至1年后卒中后)风险增加了至少一个GP记录的感染(HR 1.44,95%CI 1.21- 1.71),其中包括所住院感染时的较强的关联(HR 1.84, 95%CI 1.58- 2.14)。晚期痴呆(1- 5岁)只与住院治疗,但没有与GP记录的感染相关联。结论:常见感染和中风后痴呆之间存在关联,在中风后3-12个月最强。更好地理解这种关系可以帮助了解痴呆症后冲程后的途径和预防性干预措施的途径。

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