Three-year survival after first-ever ischemic stroke is predicted by initial stroke severity: A hospital-based study

Chang, Ku-Chou; Lee, Hsuei-Chen; Tseng, Mei-Chiun; Huang, Yu-Ching

doi:10.1016/j.clineuro.2009.12.016

« Previous Next »Clinical Neurology and Neurosurgery
Volume 112, Issue 4 , Pages 296-301, May 2010

Three-year survival after first-ever ischemic stroke is predicted by initial stroke severity: A hospital-based study

Ku-Chou Chang
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Discharge Planning Service Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
Hsuei-Chen Lee
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
- Department of Research and Education, Taipei City Hospital, Taipei, Taiwan
- Corresponding author at: Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec. 2, Li-Nong Street, Pei-Tou District, Taipei 11221, Taiwan, ROC. Tel.: +886 2 28267000/5006; fax: +886 2 28201841.
Mei-Chiun Tseng
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
Yu-Ching Huang
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Received 20 April 2009; received in revised form 2 December 2009; accepted 23 December 2009.

Abstract

Objective

We aimed to report 3-year survival and causes of death of first-ever ischemic stroke stratified by initial stroke severity.

Study design and setting

From September 1998 to October 1999, 360 acute first-ever ischemic stroke patients consecutively admitted were followed up prospectively. Patients’ vital status and causes of death were identified from the National Death Registry, till December 31, 2002. Potential prognostic factors available at admission were evaluated using Cox proportional hazards regression analysis with bootstrap validation.

Results

Three hundred and sixty patients, 58% males with age 64.9 years on average, were followed up for 43.4 months with no lost follow-up. Ninety-two (25.6%) patients died, 25 in the first month. The cumulative case–fatality rates were 12.2%, 15.8%, 20.5% and 25.6% for years 1–4. The proportion of vascular deaths was 84% during the first 30 days and 71% for the subsequent 5 months. The hazard ratio (95% CI) was 1.08 (1.05–1.11) for age (1-year increment), 335.90 (20.72–5446.23) for NIHSS 16–38, 2.48 (1.39–4.42) for NIHSS 7–15, and 0.95 (0.91–0.99) for an interaction term of age and NIHSS 16–38.

Conclusion

This study confirmed that the initial stroke severity and age were early prognostic factors for 3-year survival after first-ever ischemic stroke, and further demonstrated that the influence of age on survival time was slightly lower in patients with severe stroke.

Keywords: Ischemic stroke, Stroke severity, Survival, Prognostic factors, Taiwan