Chicago - Patients who experience medical or neurological complications following stroke, such as pneumonia or brain swelling, are at a greater risk of dying in the hospital, according to an article in the September 13 issue of The Archives Internal Medicine, one of the JAMA/Archives journals.
According to information in the article, stroke will be the second leading cause of death and disability in the developed world in 2020. However, there is little information on factors that may be associated with dying in the hospital and the impact of neurological complications on early outcomes for patients with stroke.
Peter U. Heuschmann, M.D., M.P.H., of the University of Muenster, Germany, and colleagues studied stroke patients who were admitted to German hospitals between January 1, 2000 and December 31, 2000 to determine factors that may predict risk of death after ischemic stroke (when a blood clot prevents blood from getting to the brain). A total of 13,440 ischemic stroke patients were included in the study.
The researchers found that overall, 4.9 percent of the stroke patients died in the hospital. In women, higher age, severity of stroke, and atrial fibrillation (heart rhythm disorder) were independent predictors for dying in the hospital. In men, diabetes and previous stroke had a significant negative influence on early outcomes after stroke in addition to the factors identified for women. Increased intracranial pressure (a building of pressure inside the skull, often due to swelling of the brain) accounted for 94 percent of deaths for patients with this complication. Pneumonia was the complication that caused the most deaths among the stroke patients, accounting for 31.2 percent of all deaths. The researchers also found that more than half of all in-hospital deaths were caused by serious medical or neurological complications.
"In our study, age, stroke severity, and atrial fibrillation were found to be independent predictors for in-hospital mortality after ischemic stroke in routine clinical care," the authors write. "Diabetes and previous stroke demonstrated a significant impact on in-hospital mortality only in men. Therefore, future studies on early stroke outcome have to consider carefully potential variations in the impact of the investigated variables between men and women."
(Arch Intern Med. 2004;164: 1761-1768. Available post-embargo at www.archinternmed.comarchinternmed.com)
Editor's Note: The data analyses and the data pooling of the German Stroke Registers Study Group is supported by the German Federal Ministry of Research (BMBF) within the Competence Net Stroke.
