Abstract WP181: Trends In Ischemic Stroke Patients With Central Nervous System Infections: A Propensity Score Matched 20-year Analysis Of The National Inpatient Sample

Abstract

Introduction: Infection of the central nervous system (CNS) - including meningitis, encephalitis and brain abscess - is a feared complication in hospitalized patients. Studies of CNS infection in patients with acute ischemic stroke (AIS) are scarce. We aimed to characterize AIS patients with CNS infections and assess their clinical outcomes over a 20-year period. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 434.01, 434.11, 434.91, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of CNS infections on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3. Results: Total of 10,415,286 patients with AIS were included; 74,731 (0.7%) had CNS infection. Infected patients had higher Elixhauser Comorbidity Score (12.02 ± 9.24 vs. 9.75 ± 8.82; p<0.001) and NIH Stroke Score (8.78 ± 8.86 vs. 6.65 ± 7.29; p<0.001). After propensity matching, these patients had lower rates of smoking, COPD and CKD, and higher rates of systemic inflammatory disease and burr hole drainage (p<0.001). Infected patients had longer hospital stay (3.88 days; 95% CI: 3.45-4.3), higher hospital charges ($49633.46; 95% CI: $44199.59-55067.33) and were less likely to be discharged home or short-term hospital (0.78; 95% CI: 0.74-0.82)(all p<0.001). Conclusion: In this 20 year nationally representative propensity matched analysis of patients with AIS, those with concomitant CNS infections had higher rates of comorbidities and had higher NIHSS. In addition to having longer and more expensive hospital stays, these patients were less likely to have good functional outcomes.