Three-year survival after first-ever ischemic stroke is predicted by initial stroke severity: A hospital-based study.
OBJECTIVE
We aimed to report 3-year survival and causes of death of first-ever ischemic stroke stratified by initial stroke severity.


METHODS
From September 1998 to October 1999, 360 acute first-ever ischemic stroke patients consecutively admitted were followed up prospectively. Patients' vital status and causes of death were identified from the National Death Registry, till December 31, 2002. Potential prognostic factors available at admission were evaluated using Cox proportional hazards regression analysis with bootstrap validation.


RESULTS
Three hundred and sixty patients, 58% males with age 64.9 years on average, were followed up for 43.4 months with no lost follow-up. Ninety-two (25.6%) patients died, 25 in the first month. The cumulative case-fatality rates were 12.2%, 15.8%, 20.5% and 25.6% for years 1-4. The proportion of vascular deaths was 84% during the first 30 days and 71% for the subsequent 5 months. The hazard ratio (95% CI) was 1.08 (1.05-1.11) for age (1-year increment), 335.90 (20.72-5446.23) for NIHSS 16-38, 2.48 (1.39-4.42) for NIHSS 7-15, and 0.95 (0.91-0.99) for an interaction term of age and NIHSS 16-38.


CONCLUSIONS
This study confirmed that the initial stroke severity and age were early prognostic factors for 3-year survival after first-ever ischemic stroke, and further demonstrated that the influence of age on survival time was slightly lower in patients with severe stroke.
Chang
Ku-Chou
KC
Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Lee
Hsuei-Chen
HC
Tseng
Mei-Chiun
MC
Huang
Yu-Ching
YC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality*; D002423:Cause of Death; D003625:Data Collection; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality*; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult