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

Chantelle Chapman, Dominique A. Cadilhac, Prue Morgan, Monique F. Kilkenny, Rohan Grimley, Vijaya Sundararajan, Tara Purvis, Trisha Johnston, Natasha A. Lannin, Nadine E. Andrew, On behalf of the Stroke123 investigators and AuSCR Consortium

Research output: Contribution to journalArticleResearchpeer-review

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 languageEnglish
Number of pages9
JournalInternational Journal of Stroke
DOIs
Publication statusAccepted/In press - 1 Jan 2019

Keywords

  • chest infection
  • data linkage
  • mortality
  • Stroke
  • stroke unit care

Cite this

@article{473ba5855c50481688017ec645ff4129,
title = "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",
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.",
keywords = "chest infection, data linkage, mortality, Stroke, stroke unit care",
author = "Chantelle Chapman and Cadilhac, {Dominique A.} and Prue Morgan and Kilkenny, {Monique F.} and Rohan Grimley and Vijaya Sundararajan and Tara Purvis and Trisha Johnston and Lannin, {Natasha A.} and Andrew, {Nadine E.} and {On behalf of the Stroke123 investigators and AuSCR Consortium}",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/1747493019833008",
language = "English",
journal = "International Journal of Stroke",
issn = "1747-4930",
publisher = "Wiley-Blackwell",

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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 journalArticleResearchpeer-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

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DO - 10.1177/1747493019833008

M3 - Article

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

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