Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

Abstract

Objective: We sought to determine sex differences in outcomes in patients with severe stroke who had been admitted to inpatient rehabilitation.Methods: We studied 1,316 patients aged 18 to 99 (mean 72) classified as case-mix groups 0108, 0109, and 0110 of the Medicare case-mix classification system. These groups encompass the most severe strokes. Three outcomes were analyzed: (1) 3-year mortality from admission to rehabilitation; (2) combined outcome of transfer to acute care or death within 90 days from admission to rehabilitation; (3) functional outcome, including proportional recovery in motor functioning and good functional outcome as defined by achievement of a Functional Independence Measure (FIM)-motor score ≥65 points at discharge. Multivariable regression analyses were used to assess sex-difference in each outcome between women and men. The covariates examined included age, marital status, comorbidities, time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission.Results: Kaplan-Meier estimated 3-year mortality rate was 20.7% in women and 22.0% in men. The crude hazard ratio (HR) of death for women compared with men was 0.94 (95% CI 0.74-1.20). After adjustment for significant covariates, the HR of 3-year mortality was 0.73 (95% CIs 0.56-0.96; p = 0.025). Comorbidity, including diabetes, anemia, coronary artery disease, atrial fibrillation, and chronic obstructive pulmonary disease, significantly increased mortality risk by 49-88%. The incidence of the combined outcome was 8.3% in women and 8.4% in men. The crude HR of the combined end-point for women compared with men was 1.05 (95% CI 0.72-1.53). After adjustment for significant covariates, the HR was 0.95 (95% CIs 0.65-1.40; p = 0.810). Likewise, no significant difference in proportional recovery or in the rate of achievement of a good functional outcome between women and men was observed.Conclusion: Among patients admitted to inpatient rehabilitation after severe stroke, women and men had comparable crude mortality rates at 3 years. After multivariable Scrutinio et al.Sex Differences in Severe Stroke adjustment, however, women had lower mortality risk. No sex-differences in the risk of being transferred to acute care or dying within 90 days from admission to rehabilitation or in responsiveness to rehabilitation were observed.

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

“…It is not understood if gender affects prognosis after ischemic stroke. It has been reported that the proportion of patients in intensive care or who died within 90 days of anterior artery occlusion did not vary by gender [46]. Similarly, gender was not found to affect EVT benefits and outcomes [47].…”

Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation

“…The FIM is currently considered as the most widely used measure to describe the degree of impairment in activities of daily living in clinical practice ( 64 ). Based on Rasch analysis FIM motor scores were categorized in previous research ( 65 ) into three levels: good, fair, and poor outcomes.…”

Machine learning to predict mortality after rehabilitation among patients with severe stroke

“…The covariates examined included age (per 5-year increase), marital status (married/not married), hypertension, diabetes, COPD, history of CAD, AF, anemia, renal dysfunction, time from stroke onset to rehabilitation admission, ischemic stroke, dysphagia, neglect, and motor and cognitive FIM scores at admission. These variables were selected based on prior studies showing an association with the outcomes of interest 6,30,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] . A multivariate logistic regression analysis with backward stepwise selection (p > 0.20 for exclusion) was performed to assess the association of covariates with 3-year mortality.…”

“…Comorbidities were defined as described in a previous study 42 . Coronary artery disease (CAD) was diagnosed based on a documented history of myocardial infarction, percutaneous coronary angioplasty, or coronary artery bypass grafting, or a previous hospitalization for CAD.…”