Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke

Hills, Nancy K.; Johnston, S. Claiborne; Sidney, Stephen; Zielinski, Brandon A.; Fullerton, Heather J.

doi:10.1002/ana.23688

Cited by 87 publications

(78 citation statements)

References 47 publications

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“…There is a moderately increased acute risk of stroke following hospitalization for several types of infection, and infections have been identified as triggers of stroke in children 8, 20, 21, 22, 23, 24, 25, 26, 27. Our study replicates these findings for ILI, a more prevalent type of infection than other studies have investigated, and highlights that the risk of stroke is particularly high shortly after hospitalization for an ILI, with the odds decreasing as time increases.…”

Section: Discussionmentioning

confidence: 99%

Influenza‐like illness as a trigger for ischemic stroke

Boehme

Luna

Kulick

et al. 2018

Ann Clin Transl Neurol

123

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ObjectiveWe hypothesized that ILI is associated with risk of incident stroke, and that the risk would be highest closest in time to the event.MethodsThis case‐crossover analysis utilized data obtained from the California State Inpatient Database of the Healthcare Cost and Utilization Project (HCUP). The outcome of interest was ischemic stroke. Exposure was defined as a visit to the emergency department or hospitalization for influenza‐like illness (ILI) 365, 180, 90, 30, or 15 days before stroke (risk period) or similar time intervals exactly 1 or 2 years before stroke (control period). Conditional logistic regression was used to calculate the odds ratio and 95% confidence interval (OR, 95% CI).ResultsIn 2009, 36,975 hospitalized ischemic strokes met inclusion criteria, and of these strokes, 554 (1.5%) had at least 1 episode of ILI in the 365‐day risk period prior to their stroke. Using non‐overlapping time intervals from ILI to stroke, the odds of ischemic stroke was greatest in the first 15 days post ILI (OR: 2.88, 95% CI: 1.86–4.47). The strength of the relationship decreased as the time from ILI increased, and was no longer significant after 60 days. There was a significant interaction (P = 0.017) with age and ILI; the odds of stroke associated increased 7% with each 10‐year decrease in age (OR per 10‐year age decrease 1.07, 95% CI: 1.03–1.35).InterpretationWe found that ILI increases short‐term risk of stroke, particularly in people under the age of 45, and therefore may be considered to act as a trigger for stroke.

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Section: Discussionmentioning

confidence: 99%

Influenza‐like illness as a trigger for ischemic stroke

Boehme

Luna

Kulick

et al. 2018

Ann Clin Transl Neurol

123

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“…Exposure to minor infection in the prior month is another independent risk factor, present in one third of cases (adjusted OR, 3.9; 95% CI, 2.0-7.4). 218 The effect of infection on pediatric stroke risk is short-lived, lasting for days; 80% of infections preceding childhood stroke are respiratory. 219 …”

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confidence: 99%

Prevalence of Excess Sodium Intake in the United States — NHANES, 2009–2012

Jackson¹,

King²,

Zhao³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

122

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“…Exposure to minor infection is both pervasive throughout childhood and linked to AIS in adults. [2][3][4][5][6][7][8] Minor infection may affect stroke risk either through systemic effects of inflammatory mediators causing a prothrombotic state or by direct or indirect effects on arteries through various mechanisms. 3 Several studies suggest that minor acute infection can trigger stroke in adults, particularly young adults.…”

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confidence: 99%

“…7 However, we lacked data to assess the effect of timing or the effect of multiple infections. For the current study, we collected detailed data on infectious exposures in the preceding 2 years to determine the effect of timing, duration, and cumulative number of minor infections on childhood stroke risk.…”

mentioning

confidence: 99%

“…METHODS The methods of case and control ascertainment for this nested case-control study, part of the Kaiser Pediatric Stroke Study (KPSS), have been previously described 7 ; for the current study, we performed additional chart abstraction on the same childhood AIS cases and controls drawn from the study cohort of 2.5 million children (.28 days and #19 years of age) enrolled in Kaiser Permanente Northern California (KPNC), 1993-2007 (figure 1). We included only strokes that occurred between 29 days and #19 years, excluding any strokes assumed to occur perinatally but diagnosed after the perinatal period.…”

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confidence: 99%

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Timing and number of minor infections as risk factors for childhood arterial ischemic stroke

2014

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Objective: In a population-based case-control study, we examined whether the timing and number of minor infections increased risk of childhood arterial ischemic stroke (AIS).Methods: Among 102 children with AIS and 306 age-matched controls identified from a cohort of 2.5 million children in a large integrated health care plan (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), we abstracted data on all medical visits for minor infection within the 2 years prior to AIS or index date for pairwise agematched controls. We excluded cases of AIS with severe infection (e.g., sepsis, meningitis). Using conditional logistic regression, we examined the effect of timing and total number of minor infections on stroke risk. Results:After adjusting for known pediatric stroke risk factors, the strongest association between infection and AIS was observed for infectious visits #3 days prior to stroke (odds ratio [OR] 12.1, 95% confidence interval [CI] 2.5, 57, p 5 0.002). Respiratory infections represented 80% of case infections in that time period. Cases had more infectious visits, but not significantly so, for all time periods $4 days prior to the stroke. A greater cumulative number of infectious visits over 2 years did not increase risk of AIS.Conclusions: Minor infections appear to have a strong but short-lived effect on pediatric stroke risk, while cumulative burden of infection had no effect. Proposed mechanisms for the link between minor infection and stroke in adults include an inflammatory-mediated prothrombotic state and chronic endothelial injury. The transient effect of infection in children may suggest a greater role for a prothrombotic mechanism. Neurology ® 2014;83:890-897 GLOSSARY AIS 5 arterial ischemic stroke; CI 5 confidence interval; ICD-9 5 International Classification of Diseases, 9th revision; KPNC 5 Kaiser Permanente Northern California; KPSS 5 Kaiser Pediatric Stroke Study; OR 5 odds ratio.A minority of children with established stroke risk factors (e.g., congenital heart disease) ever has an arterial ischemic stroke (AIS), 1 suggesting that childhood AIS is multifactorial and potentially affected by environmental risk factors. Exposure to minor infection is both pervasive throughout childhood and linked to AIS in adults. 2-8Minor infection may affect stroke risk either through systemic effects of inflammatory mediators causing a prothrombotic state or by direct or indirect effects on arteries through various mechanisms.3 Several studies suggest that minor acute infection can trigger stroke in adults, particularly young adults. 6,[8][9][10][11][12][13] Infectious burden, the cumulative exposure to multiple infections over time as measured by laboratory assays, exacerbates atherosclerosis [14][15][16][17][18][19] and increases stroke risk in adults. 20,21 Children have negligible atherosclerosis and less time to accumulate chronic effects of infection, but are commonly exposed to minor acute infections. We hypothesized that minor infection can trigger child...

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Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke

Cited by 87 publications

References 47 publications

Influenza‐like illness as a trigger for ischemic stroke

Influenza‐like illness as a trigger for ischemic stroke

Prevalence of Excess Sodium Intake in the United States — NHANES, 2009–2012

Timing and number of minor infections as risk factors for childhood arterial ischemic stroke

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