Acute stroke in very old people: clinical features and predictors of in-hospital mortality.

OBJECTIVES

To examine demographic characteristics, clinical features, neuroimaging data, and outcome of all acute stroke events occurring in individuals aged 85 years or older.

DESIGN

Collection of data from a prospective hospital-based stroke registry.

SETTING

Between January 1986 and December 1995, the data was collected of 2,000 stroke patients admitted consecutively to the department of neurology ( having 25 beds and an acute stroke unit) of Sagrat Cor-L'Alianza Hospital of Barcelona (an acute care, 350-bed teaching hospital serving a population of approximately 250,000).

PARTICIPANTS AND MEASUREMENTS

For the purpose of this study, very old patients (aged 85 years or older) were selected (n = 262). The data of very old stroke patients were compared with the data of patients younger than 85 years of age (n = 1738). Predictors of in-hospital mortality based on clinical and neuroimaging variables were recorded within 48 hours of stroke onset, and outcome variables (medical complications that developed during hospitalization) were assessed by multiple regression analysis.

RESULTS

The very old patients showed a significantly greater frequency of atherothrombotic (27.5% vs. 21.9%, P<.05) and cardioembolic infarctions (24.4% vs. 26.3%, P<.001) and a lesser frequency of stroke of unusual cause. Acute stroke in the very old patients was more severe than in patients younger than 85 years of age, with greater rates of in-hospital mortality (27% vs. 13.5%, P<.001), longer duration of hospital stay (22.03+/-29.6 vs. 17.5+/-21.5 days, P<.001), and lesser frequency of absence of neurologic deficit at the time of hospital discharge (21.4% vs. 33.1%, P<.001). Altered consciousness, limb weakness, sensory symptoms, involvement of the parietal lobe and temporal lobe, involvement of the internal capsule (with a protective effect), intraventricular hemorrhage, cardiac events, and respiratory events were selected as independent predictors of in-hospital mortality in the multivariate analysis.

CONCLUSIONS

Very old patients with acute stroke showed a differential clinical profile, different frequency of stroke subtypes, and a poorer outcome compared with stroke patients who were younger than 85 years of age. Clinical and neuroimaging factors that are indicative of the severity of stroke and that were available at the time of the initial diagnosis and at the time of the development of cardiac and respiratory complications showed a predominant influence on in-hospital mortality and may help clinicians to establish prognosis more accurately.