Sepsis in Patients With Large Vessel Occlusion Stroke–Clinical Characteristics and Outcome

Abstract

BackgroundInfections are an important complication after stroke and negatively affect clinical outcome. While pneumonia and urinary tract infections are well recognized after stroke, the incidence and consequences of sepsis remain unclear. The aim of this study was to evaluate the frequency and characteristics of sepsis in patients undergoing endovascular therapy for large vessel occlusion stroke, and its association with clinical outcome.MethodsWe analyzed a cohort of patients who underwent endovascular therapy at a single center between 2016 and 2020. The diagnosis and timing of infections and Sequential Organ Failure Assessment scores were evaluated retrospectively to identify patients with sepsis. Patients with sepsis were compared to controls regarding clinical characteristics and outcome.ResultsFifty-four of 406 patients (13.3%) were found to have sepsis. The median onset of sepsis was 2 days after admission. The majority of cases (85.2%) was caused by pneumonia. At 3 months, 72.5% of patients with sepsis were bedridden or dead compared to 25.7 and 42.7% of controls and patients with an infection without sepsis, respectively. The adjusted odds ratio (95% confidence interval) for a poor outcome was 5.4 (1.6–17.6) for patients with sepsis vs. controls, and 2.0 (0.8–5.2) for patients with sepsis vs. patients with an infection without sepsis.ConclusionsSepsis is a frequent complication after large vessel occlusion stroke, and may be associated with a poor clinical outcome. More studies are needed to determine specific risk factors and measures to early recognize and reduce the possibly negative impact of sepsis on outcome after stroke.

Outcomes and risk factors for infection after endovascular treatment in patients with acute ischemic stroke

“…UTI was defined based on the presence of relevant clinical symptoms and/or signs (e.g., dysuria and changes in urinary frequency) with positive microbiological cultures, negative cultures with leukocytosis, fever (temperature ≥38°C), or both 19 . Septicemia was defined as: (1) at least one of the following signs or symptoms: fever (>38°C), chills, or hypotension; and (2) positive blood cultures (common skin‐contaminating bacteria such as Staphylococcus epidermidis need to be isolated from 2 or more blood cultures) 20 …”

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

“…We considered as urinary disorders: urinary retention, urinary incontinence and the use of bladder catheter. Sepsis was defined as acute organ dysfunction with evidence of a clear source of infection and isolation of specific pathogens on blood cultures without evidence of contamination 36 . Other symptomatic infectious complications were diagnosed according to the clinical history with evidence of positive cultures without evidence of contamination.…”

Derivation and validation of a screening tool for stroke-associated sepsis

“…Stroke-associated infections may lead to sepsis which is characterized by a dysregulated host response to the infection and subsequent organ dysfunction leading to high mortality and morbidity [ 6 ]. Previous studies reported sepsis in 2 to 13% after stroke [ 7 – 12 ]. These incidence numbers vary based on the studied cohorts and applied methodology: The lowest incidence was reported in a study that used data from a healthcare policy registry and included all patients with a diagnosis of ischemic stroke, while the highest incidence was reported in a study that specifically collected data on sepsis in a more severely affected cohort of patients with large vessel occlusion stroke [ 7 , 12 ].…”

“…Previous studies reported sepsis in 2 to 13% after stroke [ 7 – 12 ]. These incidence numbers vary based on the studied cohorts and applied methodology: The lowest incidence was reported in a study that used data from a healthcare policy registry and included all patients with a diagnosis of ischemic stroke, while the highest incidence was reported in a study that specifically collected data on sepsis in a more severely affected cohort of patients with large vessel occlusion stroke [ 7 , 12 ]. Regarding the association of sepsis with clinical outcome, the results of previous studies are rather consistent.…”

“…Regarding the association of sepsis with clinical outcome, the results of previous studies are rather consistent. The odds for a poor outcome, indicated by in-hospital mortality in most studies, were increased around twofold in patients with sepsis compared to stroke patients without sepsis [ 7 – 12 ].…”