Impact of acute-phase complications and interventions on 6-month survival after stroke. A prospective observational study

Abstract

The outcome of stroke patients is complex and multidimensional. We evaluated the impact of acute-phase variables, including clinical state, complications, resource use and interventions, on 6-month survival after first-ever stroke, taking into account baseline conditions exerting a possible effect on outcome.As part of a National Research Program, we performed a prospective observational study of acute stroke patients in four Italian Regions. Consecutive patients admitted for a period of 3 months to the emergency rooms of participating hospitals were included.A total of 1030 patients were enrolled (median age 76.0 years, 52.1% males). At 6 months, 816 (79.2%) were alive, and 164 (15.9%) deceased. Survival status at the 6-month follow-up was missing for 50 (4.9%). Neurological state in the acute phase was significantly worse in patients deceased at 6 months, who showed also higher frequency of acute-phase complications. Cox regression analysis adjusted for demographics, pre-stroke function, baseline diseases and risk factors, indicated as significant predictors of 6-month death altered consciousness (HR, 1.70; 95% CI, 1.14–2.53), total anterior circulation infarct (HR, 2.13; 95% CI, 1.44–3.15), hyperthermia (HR, 1.70; 95% CI, 1.18–2.45), pneumonia (HR, 1.76; 95% CI, 1.18–2.61), heart failure (HR, 2.87; 95% CI, 1.34–6.13) and nasogastric feeding (HR, 2.35; 95% CI, 1.53–3.60), while antiplatelet therapy during acute phase (HR, 0.56; 95% CI, 0.39–0.79), and early mobilisation (HR, 0.55; 95% CI, 0.36–0.84) significantly increased 6-month survival.In a prospective observational study, stroke severity and some acute-phase complications, potentially modifiable, significantly increased the risk of 6-month death, independently of baseline variables. Early mobilisation positively affected survival, highlighting the role of early rehabilitation after stroke.

<p>Survival of Stroke Patients According to Hypertension Status in Northern Ethiopia: Seven Years Retrospective Cohort Study</p>

“…We found that at any particular point in time, the hazard of death among adult stroke patients who had any of the neuro-medical stroke complications was seven times higher than those who had no complications, after adjusting for potential confounders. This finding was in line with the studies done in Italy, 25 Taiwan, 26 Saudi Arabia, 1 this can be explained by the effect of stroke-related depressed immunity; depressed gag-reflex, and delayed mobilization of admitted patients. Early management of complications along with early mobilization and rehabilitation of patients, could significantly lower the incidence of complications, shortens the length of hospital stay and disability after the onset of stroke symptoms.…”

Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry

“…worse survival among IS cases and older age and the first studied time cohorts (1986–1990 and 1997–2001) increased the likelihood of death in ICH cases. The data from prospective observational study of 1,030 stroke patients in four regions of Italy showed that predictors of increased mortality rates over six months controlling data by demographic factors, pre-stroke functions, underlying illnesses and risk factors were altered consciousness, hyperthermia, pneumonia, and heart failure, while antiplatelet therapy and early mobilisation significantly increased survival during 6 months after stroke [43]. Among SAH stroke events any of investigated variables were not associated with better or worse 1- and 5-year survival after stroke.…”

“…This may be due to the fact that people who had a stroke controlled their blood pressure sufficiently well when using antihypertensive drugs [35]. According to other researchers, AH was also not a predictor of death for 6 months after the stroke that increased the chance of death for both total and ischemic stroke, although the frequency of AH among the dead within 6 months post-stroke subjects was significantly higher compared to survivors [43]. Similar results are confirmed by other researchers.…”

“…It is interesting to note that the type of stroke did not lead to a worse 1 and 5 year survival for those who survived the first 28 days after the stroke, although having assessed all cases of stroke, we noticed that the hemorrhagic and subarachnoid type of stroke significantly led to higher mortality. It can be argued that long-term survival was more influenced not by clinical signs or complications, but by chronic concomitant illness, bad control of stroke risk factors or harmful lifestyle [43, 46, 47].…”

Perkembangan dan Faktor-faktor yang Memengaruhi Tingkat Kemandirian Pasien Strok Selama Rawat Inap di Yogyakarta berdasar atas Skor Modifikasi Indeks Barthel

“…Data tersebut selaras dengan penelitian sebelumnya yang menyatakan bahwa pasien strok yang berada pada tingkat ketergantungan total dan parah masih menjadi kelompok pasien dengan jumlah terbanyak saat keluar rumah sakit dan tidak mengalami peningkatan yang signifikan. 18 Kemampuan AKS pada saat masuk rumah sakit dan selama menjalani rawat inap dapat memprediksi skor AKS atau outcome skor AKS pada saat keluar rumah sakit. Semakin tinggi tingkat ketergantungan AKS pada saat masuk rumah sakit, perubahan status tingkat ketergantungan AKS atau outcome skor AKS pada saat keluar rumah sakit tidak akan jauh berbeda.…”