Effect of upper gastrointestinal bleeding on prognosis of middle-aged patients with acute ischemic stroke: a retrospective study

Abstract

Background: Upper gastrointestinal bleeding (UGIB) is a common complication of acute ischemic stroke (AIS), but the effect of UGIB on the prognosis of middle-aged AIS patients is not clear.Methods: Patients with AIS admitted to our hospital from January 2011 to December 2015 were eligible to be included in this study. All included patients were divided into UGIB and non-UGIB groups. Some clinical characteristics were retrospectively collected. Primary outcomes were all-cause mortality within 1, 3, and 5 years, as well as the incidence of stroke recurrence. Cox proportional hazards regression analyses were used to determine the effect of UGIB on 5-year mortality and the incidence of stroke recurrence. Logistic regression was also used to identify the predictors of UGIB in AIS patients.Results: A total of 405 AIS patients were included in this study and then divided into UGIB and non-UGIB groups. The mean age of the UGIB group and non-UGIB group was 61.5±9.6 and 53.1±14.0 years, respectively (P<0.001). The baseline score of the National Institute of Health Stroke Scale (NIHSS) was significantly higher in the UGIB group than in the non-UGIB group (P<0.001). AIS patients in the UGIB group had a higher 1-, 3-, and 5-year mortality and a higher incidence of stroke recurrence (all P<0.001).Kaplan-Meier curves showed that AIS patients with UGIB had a higher 5-year mortality and a higher incidence of stroke recurrence (both P<0.001). Cox proportional hazards regression models indicated that the occurrence of UGIB, older age, a high NIHSS score, and stroke recurrence were related to a higher 5-year mortality. Similarly, the occurrence of UGIB, older age, a high NIHSS score, and hypertension increased the incidence of stroke recurrence. According to the multivariate logistic regression analysis, older age, a high NIHSS score, and previous anticoagulant use were identified as predictors of UGIB.Conclusions: UGIB has important effects on the prognosis of AIS patients. The incidence of UGIB increases with older age, a high NIHSS score, and previous anticoagulant use, which provides important evidence for the treatment and nursing of AIS patients.

Risk Factors and Prognosis Analysis of Upper Gastrointestinal Bleeding in Patients With Acute Severe Cerebral Stroke

“…Previous studies have indicated that the occurrence of UGIB was correlated with a higher 5-year mortality rate, 26 which is in contrast to our findings. The reason for this discrepancy may be that the UGIB rate in the cohort of patients we considered was too low, we also focused on in-hospital mortality rather than 5-year mortality.…”

Association of Proton Pump Inhibitor Prophylaxis on Clinical Outcome in Acute Ischemic Stroke in China: A Multicenter Retrospective Cohort Study

“…We noticed that, from the results of subgroup analysis, most of the groups that did not reveal the association of PPI prophylaxis with poor outcome after one year were the ones that included patients who had a high risk of GIB. For example, it is commonly recognized that patients receiving antithrombotic agents experience an increased risk of GIB [ 29 , 30 ]. Blood glucose in patients with GIB was 0.8 mmol/L higher than that in patients without GIB.…”