SAN DIEGO – The top two significant risk factors of in-hospital mortality following acute stroke are having a hemorrhagic stroke and having hyperhomocysteinemia, results from a large database analysis demonstrated.
Using information from the Nationwide Inpatient Database for 2006 to 2010, Dr. Nassim Naderi of the department of neurology at the University of California, Irvine, and colleagues set out to evaluate the effect of patient characteristics, comorbidities, stroke type, and teaching status of the hospital on in-patient mortality following acute stroke. They included patients admitted for acute stroke, excluded those admitted for transient ischemic attack, and used multivariate regression analysis to identify risk factors predictive of in-hospital mortality.
During a poster session at the annual meeting of the American Academy of Neurology, the researchers reported results from 2,567,100 patients admitted with a diagnosis of acute stroke. Most (82%) were ischemic while the remainder were hemorrhagic. Slightly more than half of the patients (52%) were female, 70% were white, and their mean age was 71 years. Hypertension was the most common associated comorbidity (77%), followed by hyperlipidemia (41%), diabetes (31%), coronary artery disease (24%), and atrial fibrillation and smoking (both at 21%).
The overall rate of in-hospital mortality was 8.42%. By stroke type, 5.43% of those with ischemic stroke died in the hospital, compared with 22.35% of those with hemorrhagic stroke. Multivariate regression analysis revealed eight major risk factors of in-hospital mortality for acute stroke: having hemorrhagic stroke (adjusted odds ratio of 4.89), hyperhomocysteinemia (AOR 4.70), hyperlipidemia (AOR 1.90), heart failure (AOR 1.49), age over 65 (AOR 1.42), chronic kidney disease (AOR 1.31), liver disease (AOR 1.31), and cocaine use (AOR 1.22).
Another seven risk factors had a statistically significant impact on the odds of in-hospital mortality following acute stroke, but they were less clinically significant. These were white race (AOR 1.15), female gender (AOR 1.11), coronary artery disease (AOR 1.09), being treated in a teaching hospital (AOR 1.09), peripheral vascular disease (AOR 1.07), chronic lung disease (AOR 1.04), and alcohol abuse (AOR 1.04).
"The present finding suggests that patients at increased risk of mortality can be identified and additional treatment for prevention might be warranted," the researchers concluded in their poster.
Dr. Naderi and all other authors except one said they had no relevant financial disclosures. One author reported receiving personal compensation for activities and research support from numerous companies.