Impact of comorbidity on ischemic stroke outcome

Fischer, Urs; Arnold, Marcel; Nedeltchev, Krassen; Schoenenberger, Ronald A.; Kappeler, Liliane; Höllinger, Peter; Schroth, Gerhard; Ballinari, Poetro; Mattle, Heinrich

doi:10.1111/j.1600-0404.2005.00551.x

Cited by 98 publications

(98 citation statements)

References 12 publications

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“…Thus, the greater the neurological deficit at admission, the more pronounced is the patient's level of disability. [35][36][37][38] For communication deficits, these differences were detected in the scores at time of discharge only and not in scores at 6 months.…”

Section: Variablementioning

confidence: 90%

Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study

López-Espuela

Pedrera‐Zamorano

Jiménez-Caballero

et al. 2016

American Journal of Critical Care

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Background Stroke is a major public health problem. Objective To use the Barthel Index to evaluate basic activities of daily living in stroke survivors and detect any predictors of functional outcome at 6 months after stroke. Methods In an observational longitudinal study, data were gathered on consecutive patients admitted to the comprehensive stroke unit at Hospital San Pedro de Alcantara, Cáceres, Spain. Sociodemographic and clinical data were obtained prospectively at hospital admission and during follow-up 6 months later. Information on type of stroke, score on the Barthel Index, findings from the neurological evaluation, and other relevant data were collected. Results Of 236 patients admitted, 175 participated in the study. Mean age was 69.60 (SD, 12.52) years, 64.6% were men, and mortality was 12.8%. Six months after experiencing a stroke, 84.8% of patients had returned to their own homes, 8.0% were institutionalized, and the others were residing at a family member’s home. Scores on the Barthel Index 6 months after stroke correlated with baseline scores on the National Institute of Health Stroke Scale (r = −0.424; P < .001) and with depressive mood 6 months after stroke (r = −0.318; P < .001). Age was negatively associated with Barthel Index scores at the time of hospital discharge and 6 months after stroke. Conclusions Functional status 6 months after stroke was influenced by age, sex, stroke severity, type of stroke, baseline status, mood, and social risk. Comorbid conditions, socioeconomic level, and area of residence did not affect patients’ functional status.

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Section: Variablementioning

confidence: 90%

Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study

López-Espuela

Pedrera‐Zamorano

Jiménez-Caballero

et al. 2016

American Journal of Critical Care

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“…The Charlson comorbidity index (CMI) (Charlson et al 1987) is more than adequate in predicting the functional outcome of stroke patients after case-mix adjustments (Tessier et al 2008). However, most of the CMI adjusted stroke outcome studies included either ischemic stroke (Goldstein et al 2004;Fischer et al 2006) or hemorrhagic stroke (Bar and Hemphill 2011) rather than including both two diseases in the studies.…”

Section: Introductionmentioning

confidence: 99%

Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

Chen

Lee

et al. 2014

Tohoku J. Exp. Med.

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Long-term follow-up and comparison of serial changes in the one-year mortality after stroke are important in assessing the quality of stroke management. This study determined the one-year survival rate and prognostic factors of hospitalized hemorrhagic and ischemic stroke patients from 1991 to 2008 in a teaching hospital in Taiwan. We also evaluated the improvements in the one-year mortality after stroke during an 18-year study period. Patients admitted for cerebral hemorrhage (n = 3,678) and cerebral infarction (n = 16,010), identified from an in-patient electronic database, were linked to the National Death Registry of Taiwan. Actuarial analysis was used to determine the one-year survival rates, and Cox proportional hazard regression model was used to investigate the predictors for the one-year mortality of stroke patients. For patients with cerebral hemorrhage and infarction and who were admitted from 1991 to 2008, the one-year survival rates were 71% and 84%, respectively. In addition, stroke patients who also suffered from myocardial infarction, chronic renal illness, and pneumonia and had high Charlson comorbidity index scores showed increased risks of mortality due to cerebral hemorrhage and infarction. Compared with the patients admitted from 1991 to 1996, those admitted from 1997 to 2002 and from 2003 to 2008 showed 15%-20% and 20%-25% reduction in one-year mortality risk in cerebral hemorrhage and infarction, respectively. This result demonstrates the continuous quality improvement of stroke management in the hospital from 1991 to 2008. Further reduction in one-year mortality can be achieved by early recognition and prompt treatment of certain comorbidities.

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“…However, IHD and IS represent different nosological entities. The prognosis is poorer in patients with coincidental occurrence of these two diagnoses 9 . To date, one cannot clearly predict, whether an IS patient also suffers from IHD and or not.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, the diagnosis of IHD was based upon clinical and ECG findings, as used in everyday clinical practice, not on the basis of radiological findings, such as coronarography, as used in previous studies [7][8][9][10] or laboratory findings as emerging studies suggest. Coronarography is a very sensitive and specific method for evaluation of degree of coronary stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, a great deal of effort is devoted to IHD identification and its proper management [6][7][8] . It is not clear to date, why IHD is present only in some IS patients and not in others 9,10 . IHD and IS traditional risk factors have been well-studied and documented individually on large prospective cohorts [11][12][13][14][15] and there are new studies appearing.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with ischemic heart disease occurence in acute ischemic stroke patients

Kováčik¹,

Madarasz²,

Král³

et al. 2013

BIOMED PAP

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Aims. At specific time periods following ischemic stroke (IS), acute coronary syndrome as ischemic heart disease (IHD) represents a higher risk of death than IS. Not all IS patients can undergo specific examination for IHD detection. The aim of this study was to assess exclusive risk factors (RFs) associated with IHD occurrence in IS patients. Knowledge of these RFs should help in stratifying IS patients for IHD detection. Materials and methods. This was a hospital-based, retrospective, single centre study. The sample consisted of 192 consecutive IS patients, divided into two subgroups -Subgroup 1 (54 patients without IHD; 55.6% males; 63.1 ± 11.8 years) and Subgroup 2 (138 patients with IHD; 39.1% males; 76.3 ± 9.6 years). The following factors were identified: age; sex; presence of arterial hypertension, atrial fibrillation, diabetes mellitus; plasma levels of total cholesterol, triglycerides, low-density cholesterol, high-density cholesterol; body mass index; presence of carotid plaques. Logistic regression analysis was used for statistical evaluation. Results. Of all identified risk factors only age (OR=1.109; 95% CI: 1.069 -1.150, P=0.001) and the presence of arterial hypertension (OR=6.298; 95% CI: 2.215 -17.905, P=0.003) were exclusively and significantly associated with the presence of IHD in IS patients. Conclusions. Age and arterial hypertension may be exclusive risk factors associated with IHD in IS patients.

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Impact of comorbidity on ischemic stroke outcome

Abstract: Comorbidity has a significant impact on stroke outcome. In addition to stroke severity, atrial fibrillation, coronary artery disease and diabetes were predictors of outcome after stroke, but not the sum of the CCI.

Cited by 98 publications

References 12 publications

Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study

Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study

Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

Risk factors associated with ischemic heart disease occurence in acute ischemic stroke patients

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