title: Interrelationship among common medical complications after acute stroke: pneumonia plays an important role.
abstract: OBJECTIVE
  Medical complications are common among patients with stroke. However, little is known about the potential interrelationship among them. In the present study, we aimed to investigate the association between common in-hospital medical complications after acute ischemic stroke (AIS) and spontaneous intracerebral hemorrhage (ICH).
  
  
  METHODS
  We analyzed patients enrolled in the China National Stroke Registry from 2007 to 2008. The occurrence of 11 common stroke-associated medical complications during acute hospitalization was prospectively registered. Multivariable analysis using generalized estimation equation was performed to assess association between medical complications in AIS and ICH cohort, respectively.
  
  
  RESULTS
  A total of 14 702 patients with AIS and 5221 patients with ICH were enrolled. The median age was 65 years (interquartile range, 55-74 years), and 38.1% were female. The median length of hospital stay was 14 days (interquartile range, 10-20 days) for AIS and 18 days (interquartile range, 11-26 days) for ICH. Pneumonia was the most common medical complication after AIS (11.4%) and ICH (16.8%). In the AIS cohort, after adjusting for potential confounders, pneumonia was significantly associated with development of gastrointestinal bleeding (adjusted odds ratio [OR], 8.35; 95% confidence interval [CI], 6.27-11.1; P<0.001), decubitus ulcer (adjusted OR, 5.31; 95% CI, 3.39-8.31; P<0.001), deep vein thrombosis (adjusted OR, 4.27; 95% CI, 2.41-7.59; P<0.001), epileptic seizure (adjusted OR, 3.96; 95% CI, 2.67-5.88; P<0.001), urinary tract infection (adjusted OR, 3.34; 95% CI, 2.73-4.10; P<0.001), atrial fibrillation/flutter (adjusted OR, 3.17; 95% CI, 2.58-3.90; P<0.001), and recurrent stroke (adjusted OR, 2.65; 95% CI, 2.07-3.40; P<0.001). Similar significant association between pneumonia and development of several nonpneumonia medical complications was verified in ICH cohort as well.
  
  
  CONCLUSIONS
  Pneumonia is closely associated with the development of several nonpneumonia medical complications after AIS and ICH.
authors.affiliation: From the Department of Neurology, Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., G.L., P.W., Yilong Wang, H.L., Yongjun Wang); Department of Neurology, Illinois Neurological Institute, Peoria (D.W.); and Department of Statistics and Operation Research, University of North Carolina at Chapel Hill (H.S.).
authors.forename: Ruijun
authors.initials: R
authors.lastname: Ji
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.forename: Haipeng
authors.initials: H
authors.lastname: Shen
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.forename: Gaifen
authors.initials: G
authors.lastname: Liu
authors.forename: Penglian
authors.initials: P
authors.lastname: Wang
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D002681:China; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D012042:Registries; D020521:Stroke / Q000150:complications*
keywords: acute; hospitalization; interrelationship; medical complications; stroke