Relationship between Presence of Visceral Infarction and Functional Outcome among Patients with Acute Ischemic Stroke

Abstract

Introduction: Evidence of visceral infarction is often found in patients with acute ischemic stroke. It remains uncertain whether there exists a relationship between visceral infarction and functional outcomes among patients with stroke. Objective: The aim of this study was to evaluate whether evidence of visceral infarction is associated with functional outcomes among patients with stroke. Methods: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016, we included those with a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. Our outcome was ambulatory status at discharge from acute stroke hospitalization, categorized as walking without assistance, walking with assistance, and unable to walk. We used ordinal logistic regression to examine the association between visceral infarction and discharge ambulatory status after adjustment for demographics, stroke risk factors, stroke severity (NIH Stroke Scale), and stroke subtype. Results: Among 2,116 ischemic stroke patients registered in CAESAR from 2011 to 2016, 259 had contrast-enhanced abdominal computed tomographic imaging, of whom 48 (19%) had evidence of visceral infarction. After adjustment for demographics, stroke risk factors, stroke severity, and stroke subtype, the presence of visceral infarction was associated with a worse ambulatory status at discharge (global OR for better ambulatory status, 0.4; 95% CI, 0.2-1.0, p = 0.046). Conclusions: We found that the presence of visceral infarction was associated with poor functional outcomes at the time of hospital discharge. These findings suggest that such findings are not necessarily benign and are at the least a marker of poor outcomes.

Gastrointestinal Dysfunction in Stroke

“…Incidence post-stroke ranges from 12.5 to 38.6%. [120][121][122][123][124][125] In a study of 227 patients with acute-ischemic stroke, the prevalence of visceral infarct differed significantly by stroke type: 34.2% in cardioembolic strokes (95% CI: 7-44.6%), 23.9% in strokes of undetermined etiology (95% CI: 15.0-32.8%), and 12.5% for large-artery atherosclerotic strokes/small-vessel occlusions combined (95% CI: 1.8-23.2%) 124 ; this is consistent with prior studies. [120][121][122] Despite their frequency, the clinical significance, risk factors, and pathophysiology of visceral infarctions remain poorly understood.…”