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Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/ m 2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson-Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/ m 2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson-Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
AimsType 2 diabetes (T2D) is a risk factor for ischemic stroke (IS) and associated with an adverse prognosis. Both stroke and diabetes care has evolved substantially during the last decade.This study aimed to determine the prevalence of T2D among IS patients along with time trends in the risk profile, use of glucose‐lowering medications, quality‐of‐care and clinical outcomes, including stroke severity; length‐of‐stay; mortality, readmission and recurrent stroke in a large national cohort.MethodsRegistry‐based cohort study including all IS events in Denmark from 2004 to 2020.IS with co‐morbid T2D were compared to IS without diabetes while adjusting for age, sex, stroke severity, co‐morbidity and socio‐economic factors.ResultsThe study included 169,262 IS events; 24,479 with co‐morbid T2D. The prevalence of T2D in IS increased from 12.0% (2004–2006) to 17.0% (2019–2020). The adjusted absolute 30‐day mortality risk in IS with T2D decreased from 9.9% (2004–2006) to 7.8% (2019–2020). The corresponding adjusted risk ratios (aRR) were 1.22 95% confidence interval (1.09–1.37) and 1.29 (1.11–1.50), respectively. The aRR of 365‐day mortality was in 2004–2006: 1.20 (1.12–1.29) and in 2019–2020: 1.34 (1.22–1.47). The 30‐ and 365‐day readmissions rates were also consistently higher in IS with T2D.ConclusionsThe prevalence of T2D in IS increased over time. The 30‐ and 365‐day mortality rates decreased over the time‐period but were consistently higher in IS with co‐morbid T2D. Readmissions were also higher in IS with T2D. This highlights an urgent need for strategies to further improve the prognosis in IS patients with co‐morbid T2D.
Although various advancements have been made to control incidence of stroke, the overall incidence, and the rate of morbidity of stroke, still increase in developing countries.1-3 In last years, the epidemiologic studies on ischemic stroke have been widely increased in Turkey and Iran.1-3 These two countries are located in similar geography with a similar historical background, though the environmental factors and lifestyle of general population in these two neighboring countries show peculiar differences. In this study, we aimed to make a comparison between data from Turkey and from Iran, in terms of etiologies and risk factors of ischemic stroke, to reveal region-related similarities or country-related differences. We reviewed the files of 2534 patients with ischemic stroke followed up for 15 years in our Cerebrovascular Outpatient Clinics in Faculty of Neurology, Istanbul University (Cerrahpasa), Istanbul, Turkey. Data collection in Iran was made from 2314 patients with ischemic stroke followed up for 6 years in Stroke Unit, Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. In the etiological classification, both centers used the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria4 upon clinical data, neurological examinations findings, and neuroimaging characteristics. Risk factors were recorded in detail, the statistical analyses were performed with the SPSS software (version 21, IBM Corporation, Armonk, NY, USA). Statistical tests used in the analysis were as χ2 or Fisher’s test for independent categorical variables, Student’s t test for normally distributed independent numerical variables, and Mann-Whitney U for not normally distributed independent numerical variables. The effects of covariates and independent variables were investigated by logistic regression.
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