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Infections Up to 76 Days After Stroke Increase Disability and Death.

ABSTRACT: Early infection after stroke is associated with a poor outcome. We aimed to determine whether delayed infections (up to 76 days post-stroke) are associated with poor outcome at 90 days. Data came from the international Efficacy of Nitric Oxide Stroke (ENOS, ISRCTN99414122) trial. Post hoc data on infections were obtained from serious adverse events reports between 1 and 76 days following stroke in this large cohort of patients. Regression models accounting for baseline covariates were used to analyse fatalities and functional outcomes (modified Rankin Scale (mRS), Barthel Index, Euro-Qol-5D) at 90 days, in patients with infection compared to those without infection. Of 4011 patients, 242 (6.0%) developed one or more serious infections. Infections were associated with an increased risk of death (p < 0.001) and an increased likelihood of dependency (measured by mRS) compared to those of all other patients (p < 0.001). This remained when only surviving patients were analysed, indicating that the worsening of functional outcome is not due to mortality (p < 0.001). In addition, the timing of the infection after stroke did not alter its detrimental association with fatality (p = 0.14) or functional outcome (p = 0.47). In conclusion, severe post-stroke infections, whether occurring early or late after stroke, are associated with an increased risk of death and poorer functional outcome, independent of differences in baseline characteristics or treatment. Not only are strategies needed for reducing the risk of infection immediately after stroke, but also during the first 3 months following a stroke. This study is registered: ISRCTN registry, number ISRCTN99414122, ClinicalTrials.gov Identifier, NCT00989716.

SUBMITTER: Learoyd AE

PROVIDER: S-EPMC5818141 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Infections Up to 76 Days After Stroke Increase Disability and Death.

Learoyd Annastazia E AE Woodhouse Lisa L Shaw Laurence L Sprigg Nikola N Bereczki Daniel D Berge Eivind E Caso Valeria V Christensen Hanne H Collins Ronan R Czlonkowska Anna A El Etribi Anwar A Farr Tracy D TD Gommans John J Laska Ann-Charlotte AC Ntaios George G Ozturk Serefnur S Pocock Stuart J SJ Prasad Kameshwar K Wardlaw Joanna M JM Fone Kevin C KC Bath Philip M PM Trueman Rebecca C RC

Translational stroke research 20170727 6

Early infection after stroke is associated with a poor outcome. We aimed to determine whether delayed infections (up to 76 days post-stroke) are associated with poor outcome at 90 days. Data came from the international Efficacy of Nitric Oxide Stroke (ENOS, ISRCTN99414122) trial. Post hoc data on infections were obtained from serious adverse events reports between 1 and 76 days following stroke in this large cohort of patients. Regression models accounting for baseline covariates were used to an ...[more]

PMID: 28752410

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Project description:Hypoxia is common in the first few days after acute stroke, is frequently intermittent, and is often undetected. Oxygen supplementation could prevent hypoxia and secondary neurological deterioration and thus has the potential to improve recovery.To assess whether routine prophylactic low-dose oxygen therapy was more effective than control oxygen administration in reducing death and disability at 90 days, and if so, whether oxygen given at night only, when hypoxia is most frequent, and oxygen administration is least likely to interfere with rehabilitation, was more effective than continuous supplementation.In this single-blind randomized clinical trial, 8003 adults with acute stroke were enrolled from 136 participating centers in the United Kingdom within 24 hours of hospital admission if they had no clear indications for or contraindications to oxygen treatment (first patient enrolled April 24, 2008; last follow-up January 27, 2015).Participants were randomized 1:1:1 to continuous oxygen for 72 hours (n?=?2668), nocturnal oxygen (21:00 to 07:00 hours) for 3 nights (n?=?2667), or control (oxygen only if clinically indicated; n?=?2668). Oxygen was given via nasal tubes at 3 L/min if baseline oxygen saturation was 93% or less and at 2 L/min if oxygen saturation was greater than 93%.The primary outcome was reported using the modified Rankin Scale score (disability range, 0 [no symptoms] to 6 [death]; minimum clinically important difference, 1 point), assessed at 90 days by postal questionnaire (participant aware, assessor blinded). The modified Rankin Scale score was analyzed by ordinal logistic regression, which yields a common odds ratio (OR) for a change from one disability level to the next better (lower) level; OR greater than 1.00 indicates improvement.A total of 8003 patients (4398 (55%) men; mean [SD] age, 72 [13] years; median National Institutes of Health Stroke Scale score, 5; mean baseline oxygen saturation, 96.6%) were enrolled. The primary outcome was available for 7677 (96%) participants. The unadjusted OR for a better outcome (calculated via ordinal logistic regression) was 0.97 (95% CI, 0.89 to 1.05; P?=?.47) for oxygen vs control, and the OR was 1.03 (95% CI, 0.93 to 1.13; P?=?.61) for continuous vs nocturnal oxygen. No subgroup could be identified that benefited from oxygen. At least 1 serious adverse event occurred in 348 (13.0%) participants in the continuous oxygen group, 294 (11.0%) in the nocturnal group, and 322 (12.1%) in the control group. No significant harms were identified.Among nonhypoxic patients with acute stroke, the prophylactic use of low-dose oxygen supplementation did not reduce death or disability at 3 months. These findings do not support low-dose oxygen in this setting.ISRCTN Identifier: ISRCTN52416964.

Project description:BackgroundOne fourth of the adult population in Europe suffer from respiratory allergy. Subcutaneous-allergen-specific-immunotherapy (SCIT) has long-term disease modifying effect on disease specific Health-Related Quality of Life (HRQoL). The purpose of this study was to assess the effect of SCIT on alternative disease outcomes in patients with grass-pollen and/or house dust mite induced allergic rhino-conjunctivitis and/or an asthma diagnosis. Focus was on expressing outcomes in terms of generic quality of life (Quality-Adjusted-Life-Years (QALY)) and reductions in sick days.MethodsThe study was a multi-centre study with prospective follow-up. 248 patients were initiated on SCIT. The disease specific Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ) and two generic (HRQoL) instruments 15D and EQ-5D were used at baseline and at follow-up. The outcome measures included change in; disease severity, RQLQ-scores, number of days with symptoms- and number of sick days per year and finally changes in generic HRQoL and thus, QALY. Disease severity was assessed by specialist doctors; severity of rhino-conjunctivitis was classified according to the Allergic Rhinitis and its Impact on Asthma (ARIA) and asthma severity according to the Global Initiative for Asthma (GINA guideline). The remaining outcome measures were assessed by the patients in questionnaires at baseline and at follow-up. An intension to treat approach was applied. For missing items imputation of sample mean base-line values or follow-up values were used after specified criteria. The effect of SCIT on rhino-conjunctivitis and/or asthma diagnoses was analysed at follow-up using three logistic regression models.ResultsThe disease severity showed significantly improved disease control. Mean RQLQ-score was reduced from 3.02 at baseline to 2.00 at follow-up. Average annual days with symptoms were reduced from 189 to 145 days whilst annual sick days were reduced from 3.7 to 1.2 days. The 15D-score increased from 0.83 to 0.86 and the EQ-5D-score from 0.70 to 0.77, which indicated an annual gain per patient of 0.03-0.06 QALY.ConclusionsAllergic patients suffering from rhino-conjunctivitis alone or rhino-conjunctivitis and asthma experience significantly increased HRQoL and they gain 0.03-0.06 QALY, when treated with SCIT for one year.Trial registrationThe study was registered at ClinicalTrials.gov with the identifier: NCT01486498.

Project description:Aim To explore the relationship between baseline bicarbonate levels and their changes with 30-day mortality in patients with acute ischemic stroke who were admitted to the intensive care unit (ICU). Methods This cohort study collected the data of 4,048 participants from the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV databases. Univariate and multivariable Cox proportional risk models were utilized to explore the relationship between bicarbonate T0 and Δbicarbonate with 30-day mortality in patients with acute ischemic stroke. The Kaplan–Meier curves were plotted to measure the 30-day survival probability of patients with acute ischemic stroke. Results The median follow-up time was 30 days. At the end of the follow-up, 3,172 patients survived. Bicarbonate T0 ≤ 21 mEq/L [hazard ratio (HR) = 1.24, a 95% confidence interval (CI): 1.02–1.50] or 21 mEq/L < bicarbonate T0 ≤ 23 mEq/L (HR = 1.29, 95%CI: 1.05–1.58) were associated with an increased risk of 30-day mortality in patients with acute ischemic stroke compared with bicarbonate T0 > 26 mEq/L. −2 mEq/L < Δbicarbonate ≤ 0 mEq/L (HR = 1.40, 95%CI: 1.14–1.71), 0 mEq/L < Δbicarbonate ≤ 2 mEq/L (HR = 1.44, 95%CI: 1.17–1.76), and Δbicarbonate >2 mEq/L (HR = 1.40, 95%CI: 1.15–1.71) were correlated with an elevated risk of 30-day mortality in acute ischemic stroke patients. The 30-day survival probability of acute ischemic stroke patients with 21 mEq/L < bicarbonate T0 ≤ 23 mEq/L, 23 mEq/L < bicarbonate T0 ≤ 26 mEq/L, or bicarbonate T0 >26 mEq/L was higher than that of patients with bicarbonate T0 ≤ 21 mEq/L. The 30-day survival probability was greater for patients in the Δbicarbonate ≤ -2 mEq/L group than for those in the Δbicarbonate >2 mEq/L group. Conclusion Low baseline bicarbonate levels and decreased bicarbonate levels during the ICU stay were associated with a high risk of 30-day mortality in acute ischemic stroke patients. Special interventions should be offered to those with low baseline and decreased bicarbonate levels during their ICU stay.

Dataset Information

Infections Up to 76 Days After Stroke Increase Disability and Death.

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Infections Up to 76 Days After Stroke Increase Disability and Death.

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