Infections Up to 76 Days After Stroke Increase Disability and Death

Annastazia E Learoyd; Lisa Woodhouse; Laurence Shaw; Nikola Sprigg; Daniel Bereczki; Eivind Berge; Valeria Caso; Hanne Christensen; Ronan Collins; Anna Czlonkowska; Anwar El Etribi; Tracy D Farr; John Gommans; Ann-Charlotte Laska; George Ntaios; Serefnur Ozturk; Stuart J Pocock; Kameshwar Prasad; Joanna M Wardlaw; Kevin C Fone; Philip M Bath; Rebecca C Trueman; ENOS Trial investigators

doi:10.1007/s12975-017-0553-3

Infections Up to 76 Days After Stroke Increase Disability and Death

Annastazia E Learoyd, Lisa Woodhouse, Laurence Shaw, Nikola Sprigg, Daniel Bereczki, Eivind Berge, Valeria Caso, Hanne Christensen, Ronan Collins, Anna Czlonkowska, Anwar El Etribi, Tracy D Farr, John Gommans, Ann-Charlotte Laska, George Ntaios, Serefnur Ozturk, Stuart J Pocock, Kameshwar Prasad, Joanna M Wardlaw, Kevin C FonePhilip M Bath, Rebecca C Trueman, ENOS Trial investigators

Department of Clinical Medicine

8 Citations (Scopus)

40 Downloads (Pure)

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 post-stroke 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.

Original language	English
Journal	Translational Stroke Research
Volume	8
Issue number	6
Pages (from-to)	541-548
Number of pages	8
ISSN	1868-4483
DOIs	https://doi.org/10.1007/s12975-017-0553-3
Publication status	Published - 1 Dec 2017

Access to Document

10.1007/s12975-017-0553-3Licence: CC BY

Infections Up to 76 Days After Stroke Increase Disability and DeathFinal published version, 690 KBLicence: CC BY

Cite this

Learoyd, A. E., Woodhouse, L., Shaw, L., Sprigg, N., Bereczki, D., Berge, E., Caso, V., Christensen, H., Collins, R., Czlonkowska, A., El Etribi, A., Farr, T. D., Gommans, J., Laska, A-C., Ntaios, G., Ozturk, S., Pocock, S. J., Prasad, K., Wardlaw, J. M., ... ENOS Trial investigators (2017). Infections Up to 76 Days After Stroke Increase Disability and Death. Translational Stroke Research, 8(6), 541-548. https://doi.org/10.1007/s12975-017-0553-3

Learoyd, AE, Woodhouse, L, Shaw, L, Sprigg, N, Bereczki, D, Berge, E, Caso, V, Christensen, H, Collins, R, Czlonkowska, A, El Etribi, A, Farr, TD, Gommans, J, Laska, A-C, Ntaios, G, Ozturk, S, Pocock, SJ, Prasad, K, Wardlaw, JM, Fone, KC, Bath, PM, Trueman, RC & ENOS Trial investigators 2017, 'Infections Up to 76 Days After Stroke Increase Disability and Death', Translational Stroke Research, vol. 8, no. 6, pp. 541-548. https://doi.org/10.1007/s12975-017-0553-3

@article{105e3cf4503045adb3efa2ad4c6685fc,

title = "Infections Up to 76 Days After Stroke Increase Disability and Death",

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 post-stroke 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.",

author = "Learoyd, {Annastazia E} and Lisa Woodhouse and Laurence Shaw and Nikola Sprigg and Daniel Bereczki and Eivind Berge and Valeria Caso and Hanne Christensen and Ronan Collins and Anna Czlonkowska and {El Etribi}, Anwar and Farr, {Tracy D} and John Gommans and Ann-Charlotte Laska and George Ntaios and Serefnur Ozturk and Pocock, {Stuart J} and Kameshwar Prasad and Wardlaw, {Joanna M} and Fone, {Kevin C} and Bath, {Philip M} and Trueman, {Rebecca C} and {ENOS Trial investigators}",

year = "2017",

month = dec,

day = "1",

doi = "10.1007/s12975-017-0553-3",

language = "English",

volume = "8",

pages = "541--548",

journal = "Translational Stroke Research",

issn = "1868-4483",

publisher = "Springer",

number = "6",

}

TY - JOUR

T1 - Infections Up to 76 Days After Stroke Increase Disability and Death

AU - Learoyd, Annastazia E

AU - Woodhouse, Lisa

AU - Shaw, Laurence

AU - Sprigg, Nikola

AU - Bereczki, Daniel

AU - Berge, Eivind

AU - Caso, Valeria

AU - Christensen, Hanne

AU - Collins, Ronan

AU - Czlonkowska, Anna

AU - El Etribi, Anwar

AU - Farr, Tracy D

AU - Gommans, John

AU - Laska, Ann-Charlotte

AU - Ntaios, George

AU - Ozturk, Serefnur

AU - Pocock, Stuart J

AU - Prasad, Kameshwar

AU - Wardlaw, Joanna M

AU - Fone, Kevin C

AU - Bath, Philip M

AU - Trueman, Rebecca C

AU - ENOS Trial investigators

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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 post-stroke 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.

AB - 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 post-stroke 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.

U2 - 10.1007/s12975-017-0553-3

DO - 10.1007/s12975-017-0553-3

M3 - Journal article

C2 - 28752410

SN - 1868-4483

VL - 8

SP - 541

EP - 548

JO - Translational Stroke Research

JF - Translational Stroke Research

IS - 6

ER -

Infections Up to 76 Days After Stroke Increase Disability and Death

Abstract

Access to Document

Fingerprint

Cite this