In-hospital medical complications and long-term mortality after ischemic stroke.
OBJECTIVE
Inhospital medical complications account for a considerable portion of deaths during the early stage of stroke. However, relatively few studies have examined their long-term effects on mortality in stroke patients.


METHODS
We prospectively and consecutively collected data on 579 patients with acute ischemic stroke from November 1998 to February 2001. Mortality was confirmed using national death certificate data from 1999 to 2003.


RESULTS
During admission, one or more medical complications requiring intervention developed in 160 of these 579 patients (27.6%). For these 160 subjects, the 30-day, 90-day, 1-year, 2-year, 3-year, and 4-year mortalities were 16.3, 29.4, 46.9, 55.6, 61.3, and 70.7%, whereas the mortality figures for those without such complications (n=419) were 1.4, 3.8, 8.8, 15.0, 19.1, and 22.4 (P<0.001 with log-rank test). To eliminate the short-term effects of these complications and thus reveal their long-term effects, we investigated differences in mortality versus the presence of inhospital complications at more than 30 days, 90 days, 1 year, 2 years, and 3 years after stroke, respectively. Cox's proportional hazard regression analysis was applied at these times after stroke and showed that all hazard ratios of medical complications in terms of mortality were statistically larger than one, regardless of adjusting for effects of potential predictors on mortality.


CONCLUSIONS
Our study shows that stroke patient mortality is influenced by inhospital medical complications significantly up to the chronic stage. This finding suggests that the appropriate prevention and management of inhospital complications could improve short-term and long-term prognoses after stroke.
Bae
Hee-Joon
HJ
Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
Yoon
Doo-Sang
DS
Lee
Juneyoung
J
Kim
Byung-Kun
BK
Koo
Ja-Seong
JS
Kwon
Ohyun
O
Park
Jong-Moo
JM
D000368:Aged; D002545:Brain Ischemia / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006761:Hospitals; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000473:pathology