Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
J Neurol. 2018 Feb;265(2):370-375. doi: 10.1007/s00415-017-8714-6. Epub 2017 Dec 16.
Stroke-associated infection (SAI) is a common and serious complication of stroke. This study aimed to assess the effects of SAI on patient mortality and functional outcome at 3 months after stroke onset. We retrospectively analyzed 809 consecutive patients with acute stroke (517 men and 292 women; median age, 72 years) who were admitted to our department between September 2014 and June 2016. SAI was defined as an infection diagnosed during the hospitalization period. Poor outcome was defined as a modified Rankin Scale (mRS) score of 3-5 or death (mRS score of 6). The effect of SAI on functional outcome was evaluated using a multivariate logistic regression analysis. SAI occurred in 169 patients (20.9%); of these, 106 (62.7%) had pneumonia, 23 (13.6%) had a urinary-tract infection, and 40 (23.7%) had other types of infection. Patients with SAI were older, more likely to be female, had lower body mass indices, had higher stroke severity, and were more likely to have atrial fibrillation and a history of ischemic heart disease than patients without SAI. Poor functional outcome and mortality were more common in patients with SAI than in patients without SAI (poor functional outcome 41.8 vs. 4.8%, mortality 24.3 vs. 3.9%, respectively). After adjusting for age, sex, stroke severity, and various comorbidities, SAI was independently associated with poor functional outcome [odds ratio (OR) 6.88; 95% confidence interval (CI) 3.72-12.73] and mortality (OR 4.45, 95% CI 2.27-8.72) at 3 months after stroke onset. Our results suggest that SAI during the hospitalization period is independently associated with 3-month poor functional outcome and mortality.
卒中相关性感染（SAI）是卒中的常见且严重的并发症。本研究旨在评估 SAI 对卒中发病后 3 个月患者死亡率和功能结局的影响。我们回顾性分析了 2014 年 9 月至 2016 年 6 月期间我院收治的 809 例连续急性卒中患者（517 名男性和 292 名女性；中位年龄 72 岁）。SAI 定义为住院期间诊断的感染。预后不良定义为改良 Rankin 量表（mRS）评分 3-5 或死亡（mRS 评分 6）。使用多变量逻辑回归分析评估 SAI 对功能结局的影响。169 例患者（20.9%）发生 SAI，其中 106 例（62.7%）患有肺炎，23 例（13.6%）患有尿路感染，40 例（23.7%）患有其他类型的感染。与无 SAI 患者相比，发生 SAI 的患者年龄更大、更可能为女性、体质量指数更低、卒中严重程度更高、更可能患有心房颤动和缺血性心脏病史。与无 SAI 患者相比，发生 SAI 的患者功能结局不良和死亡率更高（功能结局不良 41.8% vs. 4.8%，死亡率 24.3% vs. 3.9%）。在调整年龄、性别、卒中严重程度和各种合并症后，SAI 与不良功能结局独立相关（比值比[OR] 6.88；95%置信区间[CI] 3.72-12.73）和卒中发病后 3 个月的死亡率（OR 4.45，95%CI 2.27-8.72）。我们的结果表明，住院期间发生的 SAI 与 3 个月时的不良功能结局和死亡率独立相关。
