Evaluation of stroke mortality and related risk factors: A single-center cohort study from Gaziantep, Turkey
Keywords:Stroke, Mortality, C-reactive protein, Fibrinogen
Aim: In most cases diabetes worsens the outcome of acute stroke. Acute hyperglycemia, higher C-reactive protein (CRP) and fibrinogen levels predict increased risk of in-hospital mortality. However, pneumonia is found to be major causes of death after stroke. In this study we aimed to define the risk factors of mortality of ischemic stroke.
Methods: This study was an analysis of retrospectively collected data of patients treated in intensive care unit (ICU) due to ischemic stroke.
Results: One hundred twenty-eight patients’ files were evaluated. Mortality rate was 30.4% (n=39). The risk of stroke death was higher in presence of adverse events in ICU, presence of pneumonia findings, trans-tracheal intubation, long ICU stay, higher heart beats, lower SPO2 and pH levels, higher blood glucose and fibrinogen levels, higher CRP levels and the variation of CRP, higher APACHI-II, A2DS2 (risk of stroke) scores and lower GCS scores. Pneumonia was the most adverse event in ICU and the second most reason of the death.
Conclusions: APACHI-II, A2DS2 scores and GCS scores can predict the stroke death, and preventing the pneumonia may decrease acute mortality rate of ischemic stroke. CRP together with fibrinogen levels can be used as a prognostic factor in ischemic stroke.
Mittal SH, Goel D. Mortality in ischemic stroke score: A predictive score of mortality for acute ischemic stroke. Brain Circ. 2017 Jan-Mar;3(1):29-34.
Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008;371:1612–23.
Langhorne P, Dey P, Woodman M, Kalra L, Wood-Dauphinee S, Patel N, et al. Is stroke unit care portable? A systematic review of the clinical trials. Age Ageing. 2005;34:324–30.
Ekeh B, Ogunniyi A, Isamade E, Ekrikpo U. Stroke mortality and its predictors in a Nigerian teaching hospital. Afr Health Sci. 2015 Mar;15(1):74–81.
Alonso A, Ebert AD, Kern R, Rapp S, et al. Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment. Cerebrovasc Dis. 2015;40:10–7.
Eidelman RS, Hennekens CH. Fibrinogen: a predictor of stroke and marker of atherosclerosis. Eur Heart J. 2003;24:499–500.
Siegerink B, Rosendaal FR, Algra A. Genetic variation in fibrinogen; its relationship to fibrinogen levels and the risk of myocardial infarction and ischemic stroke. J Thromb Haemost. 2009;7:385–90.
Chuang SY, Bai CH, Chen WH, Lien LM, Pan WH. Fibrinogen independently predicts the development of ischemic stroke in a Taiwanese population: CVD FACTS study. Stroke. 2009;40:1578–84.
Wong AA, Read SJ. Early changes in physiological variables after stroke. Ann Indian Acad Neurol. 2008;11:207-20.
Yu B, Yang P, Xu X, Shao L. C-reactive protein for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis. Bioscience Reports. 2019 Feb 19;39(2):BSR20181135.
Balami J S, Chen R, Grunwald IQ, Buchan AN. Neurological complications of acute ischaemic stroke. Lancet Neuro. 2011;10:357-71.
Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke. 2003;34:975–81.
Walter U, Knoblich R, Steinhagen V, Donat M, Benecke R, Kloth A. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J Neurol. 2007;254:1323–9.
Yilmaz GR, Cevik MA, Erdinc FS, Ucler S, Tulek N: The risk factors for infections acquired by cerebral hemorrhage and cerebral infarct patients in a neurology intensive care unit in Turkey. Jpn J Infect Dis. 2007;60:87–91.
Dettenkofer M, Ebner W, Els T, et al: Surveillance of nosocomial infections in a neurology intensive care unit. J Neurol. 2001;248:959–64.
Sui R, Zhang L: Risk factors of stroke-associated pneumonia in Chinese patients. Neurol Res. 2011;33:508–13.
Yeh SJ, Huang KY, Wang TG, et al: Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. J Neurol Sci. 2011;306:38–41.
Kasuya Y, Hargett JL, Lenhardt R, et al. Ventilator-associated pneumonia in critically ill stroke patients: frequency, risk factors, and outcomes. J Crit Care. 2011;26:273–9.
Upadya A, Thorevska N, Sena KN, Manthous C, Amoateng-Adjepong Y. Predictors and consequences of pneumonia in critically ill patients with stroke. J Crit Care. 2004;19:16–22.
Kostadima E, Kaditis AG, Alexopoulos EI, Zakynthinos E, Sfyras D. Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients. Eur Respir J. 2005;26:106–11.
Hassan AE, Chaudhry SA, Zacharatos H, et al. Increased rate of aspiration pneumonia and poor discharge outcome among acute ischemic stroke patients following intubation for endovascular treatment. Neurocrit Care. 2012;16:246–50.
Yang CC, Shih NC, Chang WC, Huang SK, Chien CW. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study. BMC Health Serv Res. 2011;11:289.
Hannawi Y, Hannawi B, Rao CP, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013;35(5):430-43.
Towfighi A, Saver JL. Stroke declines from third to fourth leading cause of death in the United States: Historical perspective and challenges ahead. Stroke. 2011;42:2351-5.
Bhatia RS, Garg RK, Gaur SP, Kar AM, Shukla R, Agarwal A, et al. Predictive value of routine hematological and biochemical parameters on 30‑day fatality in acute stroke. Neurol India. 2004;52:220-3.
Zhang X, Yu S, Wei L, Ye R, Lin M, et al. The A2DS2 Score as a Predictor of Pneumonia and In-Hospital Death after Acute Ischemic Stroke in Chinese Populations. PLoS One. 2016 Mar 7;11(3):e0150298.
Hartmann A, Rundek T, Mast H, Paik MC, Boden-Albala B, et al. Mortality and causes of death after first ischemic stroke: The Northern Manhattan stroke study. Neurology. 2001;57:2000-5.
- 935 1903
How to Cite
Copyright (c) 2019 Betül Kocamer Şimşek, Gökhan Özer
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.