title: Long-Term Mortality and Its Risk Factors in Stroke Survivors.
abstract: BACKGROUND
  Stroke is one of the leading causes of mortality worldwide. Understanding the risk factors associated with stroke mortality is important to improve patient management. Few studies have examined long-term mortality and its associated predictive risk factors.
  
  
  METHODS
  We examined long-term mortality in 1137 patients with acute stroke and compared it to a geographically age- and sex-matched, stroke-free control group. We followed the stroke patients for as long as 16.4 years. In 1018 of these patients we assessed the effect of demographic, clinical, and hematological factors on mortality.
  
  
  RESULTS
  At the end of the study period, 51.7% of the patients and 32.7% of the stroke-free control individuals had died (hazard ratio 2.2, confidence interval 1.9-2.5, P < .001). A total of 72.5% of the patients and 53% of the controls with 12 years' follow-up (n = 570) had died (P < .001). Regression analyses indicate that, in addition to known risk factors such as age, diabetes, and stroke severity, both low cholesterol (P < .001) and hemoglobin (P < .002), hyperhomocysteinemia (P = .005), and elevated serum creatinine (P < .001) at index stroke are associated with increased long-term mortality.
  
  
  CONCLUSIONS
  Stroke patients surviving the first year after stroke have a markedly increased mortality rate as seen in long-term follow-up. Furthermore, the results from this study indicate that changes in creatinine, homocysteine, and hemoglobin should be followed more carefully as standard practice after acute stroke.
authors.affiliation: Department of Neurology, Stavanger University Hospital, Stavanger, Norway; The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway. Electronic address: sara.maria.mathisen@sus.no.
authors.forename: Sara Maria
authors.initials: SM
authors.lastname: Mathisen
authors.affiliation: The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Dalen
authors.affiliation: The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Jan Petter
authors.initials: JP
authors.lastname: Larsen
authors.affiliation: Department of Neurology, Stavanger University Hospital, Stavanger, Norway; Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Martin
authors.initials: M
authors.lastname: Kurz
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006710:Homocysteine / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology* / Q000401:mortality*; D017741:Survivors / Q000706:statistics & numerical data*
chemical_list: D006454:Hemoglobins; D006710:Homocysteine; D003404:Creatinine
keywords: Stroke; creatinine; homocysteine; long-term; mortality; risk factors