Abstract
Introduction: Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. Methods: Patient-level data from the Australian Stroke Clinical Registry (2010–13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. Results: Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% developed a chest infection within 30 days. Associated factors included: admission to intensive care (OR: 8.26, 95% CI: 4.07, 16.76); and urinary tract infection (OR: 3.09, 95% CI: 1.89, 5.04). Patients not treated in stroke units had a two-fold greater odds of chest infections (OR: 1.96, 95% CI: 1.25, 3.05). Chest infection afforded a greater hazard of death at 90 days (HR: 1.42, 95% CI 1.04, 1.93). This was reduced for those admitted to a stroke unit (HR: 1.31, 95% CI 0.99, 1.75). Conclusion: Results emphasize the need for active prevention and highlight the importance of stroke unit care in mitigating risk and improving survival in those with stroke-related chest infections.
| Original language | English |
|---|---|
| Number of pages | 9 |
| Journal | International Journal of Stroke |
| DOIs | |
| Publication status | Accepted/In press - 1 Jan 2019 |
Keywords
- chest infection
- data linkage
- mortality
- Stroke
- stroke unit care
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Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care : Analysis using linked data from the Australian Stroke Clinical Registry. / Chapman, Chantelle; Cadilhac, Dominique A.; Morgan, Prue; Kilkenny, Monique F.; Grimley, Rohan; Sundararajan, Vijaya; Purvis, Tara; Johnston, Trisha; Lannin, Natasha A.; Andrew, Nadine E.; On behalf of the Stroke123 investigators and AuSCR Consortium.
In: International Journal of Stroke, 01.01.2019.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care
T2 - Analysis using linked data from the Australian Stroke Clinical Registry
AU - Chapman, Chantelle
AU - Cadilhac, Dominique A.
AU - Morgan, Prue
AU - Kilkenny, Monique F.
AU - Grimley, Rohan
AU - Sundararajan, Vijaya
AU - Purvis, Tara
AU - Johnston, Trisha
AU - Lannin, Natasha A.
AU - Andrew, Nadine E.
AU - On behalf of the Stroke123 investigators and AuSCR Consortium
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Introduction: Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. Methods: Patient-level data from the Australian Stroke Clinical Registry (2010–13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. Results: Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% developed a chest infection within 30 days. Associated factors included: admission to intensive care (OR: 8.26, 95% CI: 4.07, 16.76); and urinary tract infection (OR: 3.09, 95% CI: 1.89, 5.04). Patients not treated in stroke units had a two-fold greater odds of chest infections (OR: 1.96, 95% CI: 1.25, 3.05). Chest infection afforded a greater hazard of death at 90 days (HR: 1.42, 95% CI 1.04, 1.93). This was reduced for those admitted to a stroke unit (HR: 1.31, 95% CI 0.99, 1.75). Conclusion: Results emphasize the need for active prevention and highlight the importance of stroke unit care in mitigating risk and improving survival in those with stroke-related chest infections.
AB - Introduction: Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. Methods: Patient-level data from the Australian Stroke Clinical Registry (2010–13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. Results: Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% developed a chest infection within 30 days. Associated factors included: admission to intensive care (OR: 8.26, 95% CI: 4.07, 16.76); and urinary tract infection (OR: 3.09, 95% CI: 1.89, 5.04). Patients not treated in stroke units had a two-fold greater odds of chest infections (OR: 1.96, 95% CI: 1.25, 3.05). Chest infection afforded a greater hazard of death at 90 days (HR: 1.42, 95% CI 1.04, 1.93). This was reduced for those admitted to a stroke unit (HR: 1.31, 95% CI 0.99, 1.75). Conclusion: Results emphasize the need for active prevention and highlight the importance of stroke unit care in mitigating risk and improving survival in those with stroke-related chest infections.
KW - chest infection
KW - data linkage
KW - mortality
KW - Stroke
KW - stroke unit care
UR - http://www.scopus.com/inward/record.url?scp=85061964898&partnerID=8YFLogxK
U2 - 10.1177/1747493019833008
DO - 10.1177/1747493019833008
M3 - Article
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
ER -