Infections up to 76 days after stroke increase disability and death

Learoyd, Annastazia and Woodhouse, Lisa J. and Shaw, Laurence and Sprigg, Nikola and Bereczki, Daniel and Berge, Eivind and Caso, Valeria and Christensen, Hanne and Collins, Ronan and Czlonkowska, Anna and El Etribi, Anwar and Farr, Tracy D. and Gommans, John and Laska, Ann Charlotte and Ntaois, George and Ozturk, Serefnur and Pocock, Stuart J. and Prasad, Kameshwar and Wardlow, Joanna M. and Fone, Kevin C.F. and Bath, Philip M.W. and Trueman, Rebecca C. (2017) Infections up to 76 days after stroke increase disability and death. Translational Stroke Research . pp. 1-8. ISSN 1868-601X

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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 poststroke 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.

Item Type: Article
Keywords: stroke, infection, Glyceryl trinitrate, diability
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Clinical Neuroscience
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Life Sciences
University of Nottingham, UK > Faculty of Science > School of Mathematical Sciences
Identification Number: 10.1007/s12975-017-0553-3
Depositing User: Eprints, Support
Date Deposited: 02 Aug 2017 13:45
Last Modified: 12 Oct 2017 23:27
URI: http://eprints.nottingham.ac.uk/id/eprint/44601

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