title: Comparing withdrawal and non-withdrawal of life-sustaining treatment among patients who died from stroke.
abstract: BACKGROUND
  In severe stroke, a decision to withdraw life-sustaining treatment is sometimes made in cooperation with the family. The aim of this study was to study the time from withdrawing life-sustaining treatment to death in patients with severe ischemic or hemorrhagic stroke.
  
  
  METHODS
  In total, 2,506 patients with stroke admitted to Haukeland University Hospital between 2006 and 2011 were prospectively registered in the Bergen NORSTROKE database. Risk factors, stroke severity, etiology, and blood analyses were registered. Retrospectively, the patients' records were examined to determine the number of days from withdrawing all life-sustaining treatment to death in patients who died from severe stroke during the hospital stay.
  
  
  RESULTS
  Life-sustaining treatment was withheld in 50 patients with severe stroke. Median time to death after withdrawing life-sustaining treatment was 4 days, and a quarter lived at least 1 week (range =1-11 days). Cox regression analyses showed that short time from withdrawing life-sustaining treatment to death was associated with high age (Hazard ratio [HR] =1.05, P=0.07), male sex (HR =2.9, P=0.01), high C-reactive protein on admission (HR =1.01, P=0.001), and hemorrhagic stroke (versus ischemic stroke, HR =1.5, P=0.03).
  
  
  CONCLUSIONS
  One week after withdrawing life-sustaining treatment, a quarter of our patients with severe stroke remained alive. Short time to death was associated with high age, male sex, hemorrhagic stroke, and high C-reactive protein on admittance.
authors.affiliation: Department of Neurology, Haukeland University Hospital, Jonas Liesgt, Bergen, Norway.
authors.forename: Eirik
authors.initials: E
authors.lastname: Helvig
authors.affiliation: Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Thomassen
authors.affiliation: Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Waje-Andreassen
authors.affiliation: Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Naess
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002097:C-Reactive Protein / Q000032:analysis; D002423:Cause of Death; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008020:Life Support Care; D009664:Norway / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: prognosis; stroke; withdrawal of life-sustaining treatment