title: Increased risk of stroke after septicaemia: a population-based longitudinal study in Taiwan.
abstract: Inflammation and infection have been noted to increase stroke risk. However, the association between septicaemia and increased risk of stroke remains unclear. This population-based cohort study, using a National Health Insurance database, aimed to investigate whether patients with septicaemia are predisposed to increased stroke risk. The study included all patients hospitalised for septicaemia for the first time between 2000 and 2003 without prior stroke. Patients were followed until the end of 2010 to evaluate incidence of stroke. An age-, gender- and co-morbidities-matched cohort without prior stroke served as the control. Cox's proportional hazards regressions were used to assess differences in stroke risk between groups. Based on hazard ratios (HRs), patients with septicaemia had greater stroke risk, especially in the younger age groups (age <45: HR = 4.16, 95% CI: 2.39-7.24, p<0.001; age 45-64: HR = 1.76, 95% CI: 1.41-2.19, p<0.001; age ≥ 65: HR = 1.05, 95% CI: 0.91-1.22, p>0.05). Haemorrhagic stroke was the dominant type (ischaemic stroke: HR = 1.20, 95% CI: 1.06-1.37, p<0.01; haemorrhagic stroke: HR = 1.82, 95% CI: 1.35-2.46, p<0.001) and patients without co-morbidities were at slightly higher risk (without co-morbidities: HR = 1.49, 95% CI: 1.02-2.17, p<0.05; with co-morbidities: HR = 1.24, 95% CI: 1.10-1.41, p<0.001). The impact of septicaemia on stroke risk was highest within 6 months of the event and gradually declined over time. Our results suggest that septicaemia is associated with an increase in stroke risk, which is greatest in haemorrhagic stroke. Closer attention to patients with history of septicaemia may be warranted for stroke preventive measures, especially for younger patients without co-morbidities.
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Jiunn-Tay
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Wen Ting
authors.initials: WT
authors.lastname: Chung
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Jin-Ding
authors.initials: JD
authors.lastname: Lin
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Giia-Sheun
authors.initials: GS
authors.lastname: Peng
authors.affiliation: Department of Public Health, China Medical University Hospital, Taichung, Taiwan, Republic of China ; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan, Republic of China.
authors.forename: Chi-Pang
authors.initials: CP
authors.lastname: Wen
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, Republic of China ; Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China ; Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China ; Department of Neurology, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Tseng
authors.affiliation: Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China ; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, Republic of China.
authors.forename: Chung Y
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D012306:Risk; D018805:Sepsis / Q000150:complications*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013624:Taiwan