Predictors of hospital readmission 1year after ischemic stroke.

Abstract

Predictors of short-term readmission after ischemic stroke have been previously identified, but few studies analyzed predictors of long-term readmission, namely early imaging findings and treatment with intravenous thrombolysis (IVT). To characterize predictors of hospital readmission during the first year after hospitalization for ischemic stroke. The study consists of a retrospective cohort of consecutive ischemic stroke patients admitted in a Portuguese university hospital during 2013, who survived index hospitalization. We collected clinical and imaging information using the electronical clinical record. Information concerning 1-year unplanned hospital readmissions was assessed using the Portuguese electronic Health Data Platform. Descriptive and univariate analyses, Kaplan-Meier survival curve and multivariate survival analysis with Cox regression model were used. We included 480 patients, 50.6% women, median age 79years (interquartile range=68-85). One-year hospital readmissions occurred in 165 patients [34.4%, 95% confidence interval (95% CI) 30.2-38.7]. The main causes for readmission were infectious diseases (43.8%), ischemic stroke or transient ischemic attack recurrence (13.2%) and cardiac diseases (6.4%). In-hospital mortality associated with readmission was 23.0%. The independent predictors of 1-year hospital readmission after ischemic stroke were admission mini-National Institute of Health Stoke Scale [hazards ratio (HR) 1.05, 95% CI 1.02-1.08, p=0.002], and mild or absent early signs of ischemia on admission computed tomography (CT) (HR 0.54, 95% CI 0.32-0.91, p=0.021) and IVT (HR 0.11, 95% CI 0.01-0.80, p=0.029). Hospital readmission during the first year after ischemic stroke occurs in 1/3 of patients and is associated with high in-hospital mortality. Clinical stroke severity, early signs of ischemia on admission CT, and treatment with IVT are independent predictors of 1-year hospital readmission.