title: Complications in acute stroke in India (CAST-I): a multicenter study.
abstract: The prognosis and final outcome in patients who sustain stroke are significantly affected by medical complications occurring during the acute phase of stroke. Only limited information is available from India and other developing countries regarding acute complications of stroke. This study examined the frequency of acute stroke and the factors associated with complications of stroke in India. In this prospective multicenter study, running from March 2008 to September 2009, 6 hospitals collected information on complications of first-ever stroke during admission. Complications were defined in accordance with standard criteria. Outcome at 30 days poststroke was assessed using the modified Rankin Scale. Stroke characteristics, length of hospital stay, and stroke severity (based on the National Institutes of Health Stroke Scale) were documented. Hematologic (ie, hemoglobin) and biochemical (ie, total proteins and albumin) parameters also were obtained. A total of 449 patients out of the recruited 476 completed follow-up. The mean age was 58.1 ± 13.7 years (range, 16-96 years), and the majority were men (n = 282; 62.8%). The mean National Institutes of Stroke Scale score was 10.2 ± 5.3. Overall, 206 patients (45.9%) experienced complications during admission. In the logistic regression analysis, limb weakness (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02-0.67; P = .01), anemia (OR, 0.35; 95% CI, 0.15-0.81; P = .01), length of hospital stay (OR, 0.89; 95% CI, 0.85-0.94; P < .0001), and stroke severity (OR, 0.27; 95% CI, 0.10-0.72; P = .01) were the variables associated with complications. Such complications as urinary tract infection (OR, 0.31; 95% CI, 0.13-0.78; P = .01), chest infection (OR, 1.81; 95% CI, 1.12-2.93; P = .02), bedsores (OR, 3.52; 95% CI, 1.02-12.08; P = .05), other pain (OR, 0.21; 95% CI, 0.09-0.49; P < .0001), and depression (OR, 2.22; 95% CI, 1.30-3.80; P < .01) were associated with poor outcome. Our study shows high rates of complication in acute stroke. Limb weakness, stroke severity, length of hospital stay, and anemia were the factors associated with complications. Other complications, such as urinary tract infection, chest infection, bedsores, other pain, and depression, can lead to poor outcome.
authors.affiliation: Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, Punjab, India. jeyarajpandian@hotmail.com
authors.forename: Jeyaraj D
authors.initials: JD
authors.lastname: Pandian
authors.forename: Arshpreet
authors.initials: A
authors.lastname: Kaur
authors.forename: Rashmi
authors.initials: R
authors.lastname: Jyotsna
authors.forename: Padmavati N
authors.initials: PN
authors.lastname: Sylaja
authors.forename: Pamidimukkala
authors.initials: P
authors.lastname: Vijaya
authors.forename: Madakasira V
authors.initials: MV
authors.lastname: Padma
authors.forename: Kolichana
authors.initials: K
authors.lastname: Venkateswaralu
authors.forename: Sajith
authors.initials: S
authors.lastname: Sukumaran
authors.forename: Robert
authors.initials: R
authors.lastname: Mathew
authors.forename: Parmdeep
authors.initials: P
authors.lastname: Kaur
authors.forename: Yash P
authors.initials: YP
authors.lastname: Singh
authors.forename: Kurupath
authors.initials: K
authors.lastname: Radhakrishnan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007194:India; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018908:Muscle Weakness / Q000150:complications; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers