Background
Stroke is one of the leading causes of mortality worldwide. Understanding the risk
factors associated with stroke mortality is important to improve patient management.
Few studies have examined long-term mortality and its associated predictive risk factors.
Methods
We examined long-term mortality in 1137 patients with acute stroke and compared it
to a geographically age- and sex-matched, stroke-free control group. We followed the
stroke patients for as long as 16.4 years. In 1018 of these patients we assessed the
effect of demographic, clinical, and hematological factors on mortality.
Results
At the end of the study period, 51.7% of the patients and 32.7% of the stroke-free
control individuals had died (hazard ratio 2.2, confidence interval 1.9-2.5, P < .001). A total of 72.5% of the patients and 53% of the controls with 12 years'
follow-up (n = 570) had died (P < .001). Regression analyses indicate that, in addition to known risk factors such
as age, diabetes, and stroke severity, both low cholesterol (P < .001) and hemoglobin (P < .002), hyperhomocysteinemia (P = .005), and elevated serum creatinine (P < .001) at index stroke are associated with increased long-term mortality.
Conclusions
Stroke patients surviving the first year after stroke have a markedly increased mortality
rate as seen in long-term follow-up. Furthermore, the results from this study indicate
that changes in creatinine, homocysteine, and hemoglobin should be followed more carefully
as standard practice after acute stroke.
Key Words
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Article info
Publication history
Published online: December 28, 2015
Accepted:
November 25,
2015
Received in revised form:
November 18,
2015
Received:
April 24,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.039
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
