title: Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit.
abstract: OBJECTIVE
  To determine the extent that demographics, clinical characteristics, comorbidities, and complications contribute to the risk of in-hospital mortality and morbidity in acute stroke.
  
  
  METHODS
  Data of consecutive patients admitted to 14 stroke units cooperating within the Berlin Stroke Register were analyzed. The association of demographics, clinical characteristics, comorbidities, and complications with the risk of in-hospital death and poor outcome at discharge was assessed, and independent attributable risks were calculated, applying average sequential attributable fractions.
  
  
  RESULTS
  In a 3-year period, 16,518 consecutive patients with ischemic or hemorrhagic stroke were documented. In-hospital mortality was 5.4%, and 45.7% had a poor outcome (modifed Rankin Scale score ≥3). In patients with length of stay (LOS) ≤7 days, 37.5% of in-hospital deaths were attributed to stroke severity, 23.1% to sociodemographics (age and prestroke disability), and 28.9% to increased intracranial pressure (iICP) and other complications. In those with LOS >7 days, age and stroke severity accounted for 44.1%, whereas pneumonia (12.2%), other complications (12.6%), and iICP (8.3%) contributed to one-third of in-hospital deaths. For poor outcome, attributable risks were similar for prestroke disability, stroke severity, pneumonia, and other complications regardless of the patient's LOS.
  
  
  CONCLUSIONS
  Approximately two-thirds of early death and poor outcome in acute stroke is attributed to nonmodifiable predictors, whereas main modifiable factors are early complications such as iICP, pneumonia, or other complications, on which stroke unit treatment should focus to further improve the prognosis of acute stroke.
authors.affiliation: Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany. hans-christian.koennecke@vivantes.de
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Koennecke
authors.forename: W
authors.initials: W
authors.lastname: Belz
authors.forename: D
authors.initials: D
authors.lastname: Berfelde
authors.forename: M
authors.initials: M
authors.lastname: Endres
authors.forename: S
authors.initials: S
authors.lastname: Fitzek
authors.forename: F
authors.initials: F
authors.lastname: Hamilton
authors.forename: P
authors.initials: P
authors.lastname: Kreitsch
authors.forename: B-M
authors.initials: BM
authors.lastname: Mackert
authors.forename: D G
authors.initials: DG
authors.lastname: Nabavi
authors.forename: C H
authors.initials: CH
authors.lastname: Nolte
authors.forename: W
authors.initials: W
authors.lastname: Pöhls
authors.forename: I
authors.initials: I
authors.lastname: Schmehl
authors.forename: B
authors.initials: B
authors.lastname: Schmitz
authors.forename: M
authors.initials: M
authors.lastname: von Brevern
authors.forename: G
authors.initials: G
authors.lastname: Walter
authors.forename: P U
authors.initials: PU
authors.lastname: Heuschmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D019586:Intracranial Hypertension / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011014:Pneumonia / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics / Q000453:epidemiology* / Q000401:mortality*; D016896:Treatment Outcome