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Infections up to 76 days after stroke increase disability and death

Learoyd, Annastazia; Woodhouse, Lisa J.; Shaw, Laurence; Sprigg, Nikola; Bereczki, Daniel; Berge, Eivind; Caso, Valeria; Christensen, Hanne; Collins, Ronan; Czlonkowska, Anna; El Etribi, Anwar; Farr, Tracy D.; Gommans, John; Laska, Ann Charlotte; Ntaois, George; Ozturk, Serefnur; Pocock, Stuart J.; Prasad, Kameshwar; Wardlow, Joanna M.; Fone, Kevin C.F.; Bath, Philip M.W.; Trueman, Rebecca C.

Authors

Annastazia Learoyd

Lisa J. Woodhouse

Laurence Shaw

NIKOLA SPRIGG nikola.sprigg@nottingham.ac.uk
Professor of Stroke Medicine

Daniel Bereczki

Eivind Berge

Valeria Caso

Hanne Christensen

Ronan Collins

Anna Czlonkowska

Anwar El Etribi

Tracy D. Farr

John Gommans

Ann Charlotte Laska

George Ntaois

Serefnur Ozturk

Stuart J. Pocock

Kameshwar Prasad

Joanna M. Wardlow

Kevin C.F. Fone

Philip M.W. Bath

Rebecca C. Trueman



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.

Citation

Learoyd, A., Woodhouse, L. J., Shaw, L., Sprigg, N., Bereczki, D., Berge, E., …Trueman, R. C. (in press). Infections up to 76 days after stroke increase disability and death. Translational Stroke Research, https://doi.org/10.1007/s12975-017-0553-3

Journal Article Type Article
Acceptance Date Jul 3, 2017
Online Publication Date Jul 27, 2017
Deposit Date Aug 2, 2017
Publicly Available Date Mar 29, 2024
Journal Translational Stroke Research
Print ISSN 1868-4483
Electronic ISSN 1868-601X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1007/s12975-017-0553-3
Keywords stroke, infection, Glyceryl trinitrate, diability
Public URL https://nottingham-repository.worktribe.com/output/874307
Publisher URL https://link.springer.com/article/10.1007%2Fs12975-017-0553-3

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