Clinical and pharmacotherapeutic factors as survival and death predictors in hospitalized post-stroke patients
DOI:
https://doi.org/10.31117/neuroscirn.v6i2.180Keywords:
Hemorrhagic Stroke, Ischemic Stroke, Survival Analysis, Proportional Hazards Models, Death PredictorsAbstract
Stroke is a neurological disease. High mortality and sequelae that cause physical or psychological disability demand greater efforts for adequate therapeutic management. The present study aimed to identify signs, symptoms, comorbidities, and therapeutic agents associated with decreased survival time and increased death risk in hospitalized stroke patients. Medical records of stroke patients hospitalized in 2016 at a Peruvian hospital were included. Post-stroke survival time was determined using the Kaplan-Meier method. A comparison of the mean survival time of ischemic and hemorrhagic stroke patients was carried out with the Mantel-Cox test. In addition, the death risk or hazard ratio (HR) was determined using Cox proportional hazards model. The mean survival time was 34.37 (95% CI, 31.89-36.85) and 16.96 (95% CI, 12.35-21.56) days in post-ischemic and hemorrhagic stroke patients, respectively. Dyspnea, peripheral edema, sensory disorder, diffuse cerebral edema and previous stroke are associated with a decrease in survival time. In addition, multivariate analysis revealed that chronic kidney failure (HR=11.98; 95% CI, 2.33-61.68; p=0,003), dyslipidemia (HR=5.19; 95% CI, 1.65-16.32; p=0.005), previous stroke (HR=1.51; 95% CI, 0.41-5.63; p=0.043), and use of antihemorrhagic (HR=1.12; 95% CI, 0.79-1.59; p=0.002) or antiepileptic drugs (HR=1.08; 95% CI, 0.70-1.68; p=0.016) could be considered as death predictors. Clinical and pharmacotherapeutic factors associated with a decrease in mean survival time and increased death risk in hospitalized stroke patients were identified. These factors should be an alarm sign to provide special and timely medical care that reduces the risk of death in patients.
References
Abbott, A. L., Silvestrini, M., Topakian, R., Golledge, J., Brunser, A. M., de Borst, G. J., Harbaugh, R. E., Doubal, F. N., Rundek, T., Thapar, A., Davies, A. H., Kam, A., & Wardlaw, J. M. (2017). Optimizing the definitions of stroke, transient ischemic attack, and infarction for research and application in clinical practice. Frontiers in Neurology, 8(OCT), 537. https://doi.org/10.3389/fneur.2017.00537
Abd ElHafeez, S., D’Arrigo, G., Leonardis, D., Fusaro, M., Tripepi, G., & Roumeliotis, S. (2021). Methods to analyze time-to-event data: The Cox regression analysis. Oxidative Medicine and Cellular Longevity, 2021, 1–6. https://doi.org/10.1155/2021/1302811
Abdo, R., Abboud, H., Salameh, P., El Hajj, T., & Hosseini, H. (2019). Mortality and predictors of death poststroke: Data from a multicenter prospective cohort of Lebanese stroke patients. Journal of Stroke and Cerebrovascular Diseases, 28(4), 859–868. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.033
Adoukonou, T., Agbétou, M., Bangbotché, R., Kossi, O., Fotso Mefo, P., Magne, J., Houinato, D., Preux, P. M., & Lacroix, P. (2020). Long-term mortality of stroke survivors in Parakou: 5-year follow-up. Journal of Stroke and Cerebrovascular Diseases, 29(6), 1–11. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104785
Ahangar, A. A., Saadat, P., Heidari, B., Taheri, S. T., & Alijanpour, S. (2018). Sex difference in types and distribution of risk factors in ischemic and hemorrhagic stroke. International Journal of Stroke, 13(1), 83–86. https://doi.org/10.1177/1747493017724626
Alvarez-Sabín, J., Ribó, M., Masjuan, J., Tejada, J. R., & Quintana, M. (2011). Hospital care of stroke patients: Importance of expert neurological care. Neurología (English Edition), 26(9), 510–517. https://doi.org/10.1016/J.NRLENG.2010.12.007
Cho, S., & Yang, J. (2018). What do experimental models teach us about comorbidities in stroke? Stroke, 49(2), 501–507. https://doi.org/10.1161/STROKEAHA.117.017793
Cruz-Cruz, C., Moreno-Macías, H., Parra-Cabrera, M. del S., Hernández-Girón, C., & Calleja-Castillo, J. M. (2019). Survival after ischemic and hemorrhagic stroke: A 4-year follow-up at a Mexican hospital. Journal of Stroke and Cerebrovascular Diseases, 28(8), 2109–2114. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.04.002
DeZee, K. J., Shimeall, W. T., Douglas, K. M., Shumway, N. M., & O'Malley, P. G. (2006). Treatment of excessive anticoagulation with phytonadione (vitamin K). Archives of Internal Medicine, 166(4), 391–397. https://doi.org/10.1001/archinte.166.4.391
Fekadu, G., Chelkeba, L., & Kebede, A. (2019). Burden, clinical outcomes and predictors of time to in hospital mortality among adult patients admitted to stroke unit of Jimma university medical center: A prospective cohort study. BMC Neurology, 19(1), 213. https://doi.org/10.1186/s12883-019-1439-7
Feng, Y., Chao, D., He, X., Yang, Y., Kang, X., H Lazarus, L., & Xia, Y. (2009). A novel insight into neuroprotection against hypoxic/ischemic stress. Sheng Li Xue Bao, 61(6), 585–592.
Gaynor, E., Rohde, D., Large, M., Mellon, L., Hall, P., Brewer, L., Conway, O., Hickey, A., Bennett, K., Dolan, E., Callaly, E., & Williams, D. (2018). Cognitive impairment, vulnerability, and mortality post ischemic stroke: A five-year follow-up of the action on secondary prevention interventions and rehabilitation in stroke (ASPIRE-S) cohort. Journal of Stroke and Cerebrovascular Diseases, 27(9), 2466–2473. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.002
Grysiewicz, R. A., Thomas, K., & Pandey, D. K. (2008). Epidemiology of ischemic and hemorrhagic stroke: Incidence, prevalence, mortality, and risk factors. Neurologic Clinics, 26(4), 871–895. https://doi.org/10.1016/j.ncl.2008.07.003
Habibi-koolaee, M., Shahmoradi, L., Niakan Kalhori, S. R., Ghannadan, H., & Younesi, E. (2018). Prevalence of stroke risk factors and their distribution based on stroke subtypes in Gorgan: A retrospective hospital-based study—2015-2016. Neurology Research International, 2018, 1–7. https://doi.org/10.1155/2018/2709654
Heuschmann, P. U. (2004). Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: The German stroke registers study group. Archives of Internal Medicine, 164(16), 1761. https://doi.org/10.1001/archinte.164.16.1761
Jacob, L., & Kostev, K. (2020). Urinary and fecal incontinence in stroke survivors followed in general practice: A retrospective cohort study. Annals of Physical and Rehabilitation Medicine, 63(6), 488–494. https://doi.org/10.1016/j.rehab.2019.12.007
Le Gall, J.-R. (1993). A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA, 270(24), 2957. https://doi.org/10.1001/jama.1993.03510240069035
Mahtani, K. R., Heneghan, C. J., Nunan, D., & Roberts, N. W. (2014). Vitamin K for improved anticoagulation control in patients receiving warfarin. Cochrane Database of Systematic Reviews, 101(21), 1689–1690. https://doi.org/10.1002/14651858.CD009917.pub2
O'Donnell, M. J., Chin, S. L., Rangarajan, S., Xavier, D., Liu, L., Zhang, H., Rao-Melacini, P., Zhang, X., Pais, P., Agapay, S., Lopez-Jaramillo, P., Damasceno, A., Langhorne, P., McQueen, M. J., Rosengren, A., Dehghan, M., Hankey, G. J., Dans, A. L., Elsayed, A., . . . Yusuf, S. (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. The Lancet, 388(10046), 761–775. https://doi.org/10.1016/S0140-6736(16)30506-2
Ohura, T., Hase, K., Nakajima, Y., & Nakayama, T. (2017). Validity and reliability of a performance evaluation tool based on the modified Barthel index for stroke patients. BMC Medical Research Methodology, 17(1), 131. https://doi.org/10.1186/s12874-017-0409-2
Quinn, T. J., Singh, S., Lees, K. R., Bath, P. M., & Myint, P. K. (2017). Validating and comparing stroke prognosis scales. Neurology, 89(10), 997–1002. https://doi.org/10.1212/WNL.0000000000004332
Radisauskas, R., Tamosiunas, A., Kranciukaite-Butylkiniene, D., Milinaviciene, E., Malinauskiene, V., Bernotiene, G., Luksiene, D., Virviciute, D., & Rastenyte, D. (2019). Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry. PLOS ONE, 14(7), e0219392. https://doi.org/10.1371/journal.pone.0219392
Rankin, J. (1957). Cerebral vascular accidents in patients over the age of 60: II. Prognosis. Scottish Medical Journal, 2(5), 200–215. https://doi.org/10.1177/003693305700200504
Roy-O'Reilly, M., & McCullough, L. D. (2018). Age and sex are critical factors in ischemic stroke pathology. Endocrinology, 159(8), 3120–3131. https://doi.org/10.1210/en.2018-00465
Saba, L., Saam, T., Jäger, H. R., Yuan, C., Hatsukami, T. S., Saloner, D., Wasserman, B. A., Bonati, L. H., & Wintermark, M. (2019). Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. The Lancet Neurology, 18(6), 559–572. https://doi.org/10.1016/S1474-4422(19)30035-3
Saber, H., & Saver, J. L. (2020). Distributional validity and prognostic power of the national institutes of health stroke scale in US administrative claims data. JAMA Neurology, 77(5), 606. https://doi.org/10.1001/jamaneurol.2019.5061
Şahin, A. S., Duman, A., Atalik, E. K., Ögün, C. Ö., Şahin, T. K., Erol, A., & Özergin, U. (2005). The mechanisms of the direct vascular effects of fentanyl on isolated human saphenous veins in vitro. Journal of Cardiothoracic and Vascular Anesthesia, 19(2), 197–200. https://doi.org/10.1053/j.jvca.2005.01.031
Sayedahmed, A. M. S., & Alkhair, M. S. A. (2021). Comparative study of risk factors in young adults and elderly stroke patients in Sudan. Interdisciplinary Neurosurgery, 23, 100955. https://doi.org/10.1016/j.inat.2020.100955
Xing, L., Jing, L., Tian, Y., Liu, S., Lin, M., Du, Z., Ren, G., Sun, Q., Shi, L., Dai, D., & Liu, S. (2020). High prevalence of stroke and uncontrolled associated risk factors are major public health challenges in rural northeast China: A population-based study. International Journal of Stroke, 15(4), 399–411. https://doi.org/10.1177/1747493019851280
Yang, M., Li, Z., Zhao, Y., Zhou, F., Zhang, Y., Gao, J., Yin, T., Hu, X., Mao, Z., Xiao, J., Wang, L., Liu, C., Ma, L., Yuan, Z., Lv, J., Shen, H., Hou, P. C., & Kang, H. (2017). Outcome and risk factors associated with extent of central nervous system injury due to exertional heat stroke. Medicine, 96(44), e8417. https://doi.org/10.1097/MD.0000000000008417
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Nancy Victoria Castilla-Torres, Zoila Díaz-Tavera, Yovani Condorhuaman-Figueroa, Jimmy Ango-Bedriñana, Juan Kenedy Ramirez
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The observations and associated materials published or posted by NeurosciRN are licensed by the authors for use and distribution in accord with the Creative Commons Attribution license CC BY-NC 4.0 international, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
