Stroke: infection increases short-term recurrence risk

  • Xu J & al.
  • Stroke
  • 26 Jun 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Patients with acute ischemic stroke who developed infection (pneumonia or UTI) during hospitalization have a higher risk for recurrent stroke before discharge.

Why this matters

  • Infection is prevalent among patients with stroke.

Study design

  • Chinese registry-based retrospective dual cohort study of 789,596 and 13,549 patients hospitalized for acute ischemic stroke.
  • Main outcome: recurrent stroke short term (during hospitalization) and long term (30 days to 1 year after stroke onset).
  • Funding: Ministry of Science and Technology; others.

Key results

  • In the first cohort, incidence of infection during hospitalization was 9.6%.
  • Patients with vs without infection had higher risk for recurrent stroke during hospitalization:
    • Incidence: 10.4% vs 5.2%.
    • aOR: 1.70 (P<.0001>
  • In the second cohort, incidence of infection during hospitalization was 6.5%.
  • In patients with vs without infection, stroke risk:
    • Significantly increased short term:
      • Incidence: 7.4% vs 3.9%.
      • aOR: 1.40 (P=.02).
    • Did not significantly increase in the long term:
      • Incidence: 7.2% vs 5.2%.
      • aHR: 1.16 (P=.30).
  • Prestroke infection (within 2 weeks of stroke onset) also increased risk for recurrence during hospitalization (aOR, 1.73; P=.04).

Limitations

  • Specific date of infection was not available.
  • Stroke severity was not captured for some patients.
  • Lack of adjustment for antibiotic therapy.
  • Unmeasured, residual confounding.
  • Unknown generalizability.