Infection tied to increased hazard of early stroke recurrence

Infection during hospitalization is an important risk factor for early stroke recurrence during hospitalization in patients with acute ischaemic stroke (AIS), although there is no evidence of a sustained effect on long-term recurrence risk, a study has found.  

Researchers used data from AIS patients in two stroke registries: the Chinese Stroke Center Alliance (CSCA; n=789,596; median age, 67 years; 62.6 percent male) programme, which recorded medical data during hospitalization, and the Third China National Stroke Registry (CNSR-III; n=13,549; median age, 63 years; 68.7 percent male), which provided data a during hospitalization and 1 year after.

In the CSCA cohort, infection (pneumonia or urinary tract infection) during hospitalization occurred in 9.6 percent of patients. This group was older, had higher NIHSS score, and were more likely to have prestroke history, atrial fibrillation/flutter, and heart failure compared with the group of patients who did not develop infection.

Multivariable logistic regression analysis showed that patients with vs without infection were at higher risk of stroke recurrence (10.4 percent vs 5.2 percent; adjusted odds ratio [aOR], 1.70, 95 percent confidence interval [CI], 1.65–1.75; p<0.0001). A risk increase was also observed for ischaemic stroke, intracerebral haemorrhage, haemorrhagic transformation, combined vascular events, and all-cause death during hospitalization.

In the CNSR-III cohort, 6.5 percent of patients developed infection during hospitalization. This was significantly associated with the risk of recurrent stroke in the short term (7.4 percent vs 3.9 percent; aOR, 1.40, 95 percent CI, 1.05–1.86; p=0.02) but not in the long term (7.2 percent vs 5.2 percent; adjusted hazard ratio, 1.16, 95 percent CI, 0.88–1.52; p=0.30). There also was a short-term elevation in the risks of ischaemic stroke, haemorrhagic transformation, combined vascular events, and all-cause death.