Department of Anaesthesiology and Intensive Care Medicine, Critical Care Department, ZOL-Genk, Schiepse Bos 6, B-3600, Genk, Belgium.
Department of Anaesthesiology, University Hospital Antwerp, Antwerp, Belgium.
Acta Neurol Belg. 2022 Oct;122(5):1281-1287. doi: 10.1007/s13760-022-01977-2. Epub 2022 Jun 30.
Acute ischaemic stroke is associated with important mortality, morbidity, and healthcare-related costs. Age, pre-stroke functionality and stroke severity are important contributors to functional outcome. Stroke patients also risk developing infections during hospitalization. We sought to explore possible predictors of post-stroke infections and the relationship of post-stroke infection with healthcare-related costs and functional outcome.
This single-centre retrospective study included 530 patients treated for ischaemic stroke between January 2017 and February 2019. Antibiotics' administration was used as a proxy for post-stroke infection. Functional outcome at 90 days was assessed by the modified Rankin Scale (mRS). Total healthcare-related costs were recorded for the index hospital stay. Multivariable analysis for post-stroke infection was done with the independent factors sex, age, pre-stroke mRS, National Institutes of Health Stroke Scale (NIHSS) and diabetes mellitus.
Twenty percent of patients had a post-stroke infection. NIHSS (OR 1.10, 95%CI 1.06-1.13, p < 0.0001) and diabetes mellitus (OR 2.18, 95%CI 1.28-3.71, p = 0.0042) were independent predictors for post-stroke infection. Mean total healthcare-related costs were 15,374 euro (SD 19,968; IQR 3,380-18,165), with a mean of 31,061 euro (SD 29,995; IQR 12,584-42,843) in patients with infection, compared to 11,406 euro (SD 13,987; IQR 3,083-12,726) in patients without (p < 0.0001). Median 90-days mRS was 5 (IQR 3-6) in patients with infection versus 1 (IQR 0-3.5) in patients without (p < 0.0001).
In patients, admitted for acute ischaemic stroke, stroke severity and diabetes mellitus were identified as the main predictors for post-stroke infection. Hospital-acquired infections were associated with increased costs and worse functional outcome.
急性缺血性脑卒中与较高的死亡率、发病率和医疗相关费用有关。年龄、卒中前的功能状态和卒中严重程度是影响功能结局的重要因素。卒中患者在住院期间也有发生感染的风险。我们旨在探讨卒中后感染的可能预测因素，以及卒中后感染与医疗相关费用和功能结局的关系。
这项单中心回顾性研究纳入了 2017 年 1 月至 2019 年 2 月期间因缺血性卒中接受治疗的 530 例患者。抗生素的使用被用作卒中后感染的替代指标。90 天时的功能结局通过改良 Rankin 量表（mRS）进行评估。记录了索引住院期间的总医疗相关费用。多变量分析用于确定卒中后感染的独立因素，包括性别、年龄、卒中前 mRS、美国国立卫生研究院卒中量表（NIHSS）和糖尿病。
20%的患者发生了卒中后感染。NIHSS（比值比 1.10，95%置信区间 1.06-1.13，p<0.0001）和糖尿病（比值比 2.18，95%置信区间 1.28-3.71，p=0.0042）是卒中后感染的独立预测因素。总医疗相关费用的平均值为 15374 欧元（标准差 19968；四分位距 3380-18165），感染患者的平均费用为 31061 欧元（标准差 29995；四分位距 12584-42843），而未感染患者的平均费用为 11406 欧元（标准差 13987；四分位距 3083-12726）（p<0.0001）。感染患者 90 天时的 mRS 中位数为 5（四分位距 3-6），而未感染患者的 mRS 中位数为 1（四分位距 0-3.5）（p<0.0001）。
在因急性缺血性卒中入院的患者中，卒中严重程度和糖尿病被确定为卒中后感染的主要预测因素。医院获得性感染与费用增加和功能结局恶化有关。
