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Impact of stroke-associated infection on long-term survival: a cohort study

Impact of stroke-associated infection on long-term survival: a cohort study
Impact of stroke-associated infection on long-term survival: a cohort study
Background and objective: the effects of stroke-associated infection (SAI) on long-term survival are unclear. We performed a prospective evaluation to explore risk factors of SAI, and compared survival status over the 3?years following stroke onset between those who experienced SAI and those who did not.

Methods: consecutive patients with acute stroke admitted to a stroke unit between April 2005 and December 2006 were invited to participate. We prospectively collected data on demographics, pathological and clinical stroke subtype, stroke severity, and neurological and functional consequences, and abstracted additional data on occurrence and timing of SAI in hospital from medical notes. Survival status 3?years after stroke onset was obtained.

Results: we recruited 413 acute stroke patients, 161 (39%) experienced SAI. After excluding patients with infection at onset, patients with intracerebral haemorrhage (p=0.014), dysphagia (p=0.003) and urinary incontinence/catheterisation (p=0.000) were at higher risk of infection after controlling for case mix. The risk of death in hospital was greater following an SAI (HR 3.56; 95% CI 1.94 to 6.53; p=0.000), as was risk of death calculated over the whole 3-year follow-up period among those acquiring SAI within 2?weeks of onset (HR 1.66; 95% CI 1.14 to 2.40; p=0.031).

Conclusion: SAIs have long-lasting effects on patient survival. This serves to emphasise the importance of immediate access to organised stroke unit care for people with acute stroke, with active physiological monitoring and protocols for early detection and treatment of SAIs
1468-330X
297-304
Kwan, Joseph
2f6e316b-60bc-48a4-8b96-464b965ea6a5
Pickering, Ruth M.
4a828314-7ddf-4f96-abed-3407017d4c90
Kunkel, Dorit
6b6c65d5-1d03-4a13-9db8-1342cd43f352
Fitton, Carolyn
6288734e-9b6e-470d-b420-33c16d65b879
Jenkinson, Damian
43e842b8-bb66-4f94-a35e-8f9dec5e8fc4
Perry, V. Hugh
8f29d36a-8e1f-4082-8700-09483bbaeae4
Ashburn, Ann
818b9ce8-f025-429e-9532-43ee4fd5f991
on behalf of the Stroke Association Rehabilitation Research Centre
Kwan, Joseph
2f6e316b-60bc-48a4-8b96-464b965ea6a5
Pickering, Ruth M.
4a828314-7ddf-4f96-abed-3407017d4c90
Kunkel, Dorit
6b6c65d5-1d03-4a13-9db8-1342cd43f352
Fitton, Carolyn
6288734e-9b6e-470d-b420-33c16d65b879
Jenkinson, Damian
43e842b8-bb66-4f94-a35e-8f9dec5e8fc4
Perry, V. Hugh
8f29d36a-8e1f-4082-8700-09483bbaeae4
Ashburn, Ann
818b9ce8-f025-429e-9532-43ee4fd5f991

Kwan, Joseph, Pickering, Ruth M., Kunkel, Dorit, Fitton, Carolyn, Jenkinson, Damian, Perry, V. Hugh and Ashburn, Ann , on behalf of the Stroke Association Rehabilitation Research Centre (2013) Impact of stroke-associated infection on long-term survival: a cohort study. Journal of Neurology, Neurosurgery, and Psychiatry, 84 (3), 297-304. (doi:10.1136/jnnp-2012-302552). (PMID:23160703)

Record type: Article

Abstract

Background and objective: the effects of stroke-associated infection (SAI) on long-term survival are unclear. We performed a prospective evaluation to explore risk factors of SAI, and compared survival status over the 3?years following stroke onset between those who experienced SAI and those who did not.

Methods: consecutive patients with acute stroke admitted to a stroke unit between April 2005 and December 2006 were invited to participate. We prospectively collected data on demographics, pathological and clinical stroke subtype, stroke severity, and neurological and functional consequences, and abstracted additional data on occurrence and timing of SAI in hospital from medical notes. Survival status 3?years after stroke onset was obtained.

Results: we recruited 413 acute stroke patients, 161 (39%) experienced SAI. After excluding patients with infection at onset, patients with intracerebral haemorrhage (p=0.014), dysphagia (p=0.003) and urinary incontinence/catheterisation (p=0.000) were at higher risk of infection after controlling for case mix. The risk of death in hospital was greater following an SAI (HR 3.56; 95% CI 1.94 to 6.53; p=0.000), as was risk of death calculated over the whole 3-year follow-up period among those acquiring SAI within 2?weeks of onset (HR 1.66; 95% CI 1.14 to 2.40; p=0.031).

Conclusion: SAIs have long-lasting effects on patient survival. This serves to emphasise the importance of immediate access to organised stroke unit care for people with acute stroke, with active physiological monitoring and protocols for early detection and treatment of SAIs

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e-pub ahead of print date: 17 November 2012
Published date: March 2013
Organisations: Faculty of Medicine, Faculty of Health Sciences, Primary Care & Population Sciences, Centre for Biological Sciences

Identifiers

Local EPrints ID: 346505
URI: https://eprints.soton.ac.uk/id/eprint/346505
ISSN: 1468-330X
PURE UUID: fd0ae51b-7d18-435c-b3ec-b4938151dd1a
ORCID for Dorit Kunkel: ORCID iD orcid.org/0000-0003-4449-1414

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Date deposited: 03 Jan 2013 14:11
Last modified: 18 Jul 2019 15:09

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