Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort

Alessandra C Goulart,Paulo A Lotufo,Itamar S Santos,Airlane P Alencar,Tiotrefis G Fernandes,Isabela M Bensenor

doi:10.1186/1471-2377-13-51

Alessandra C Goulart, Paulo A Lotufo + Show 4 more

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https://doi.org/10.1186/1471-2377-13-51

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Abstract

BackgroundFew studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis.MethodsWe prospectively ascertained 665 consecutive first-ever ischemic and hemorrhagic stroke cases from “The Study of Stroke Mortality and Morbidity” (The EMMA Study) in a community hospital in São Paulo, Brazil. We evaluated cardiovascular risk factors and sociodemographic characteristics (age, gender, race and educational level).ResultsWe found a lower survival rate among hemorrhagic cases compared to ischemic stroke cases at the end of 4 years of follow-up (52% vs. 44%, p = 0.04). The risk of death was two times higher among people with ischemic stroke without formal education. Also, we found consistently higher risk of death for diabetics with ischemic stroke (HR = 1.45; 95% CI = 1.07-1.97) compared to no diabetics. As expected, age equally influenced on the high risk of poor survival, regardless of stroke subtype.ConclusionsFor ischemic stroke, the lack of formal education and diabetes were significant independent predictors of poor long-term survival.

Highlights

Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival
Written informed consent was obtained from all potential stroke patients admitted to the hospital who agreed to participate in this study, and each subject received a copy of the consent form
From 665 cases diagnosed as first-ever stroke enrolled in the EMMA cohort, 545 (82.6%) were identified as ischemic stroke (IS) and 116 (17.4%) as hemorrhagic stroke (HS) during 4-year follow-up

Summary

Introduction

Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis. Pathologic mechanisms for ischemic and hemorrhagic stroke are clearly distinct, most previous studies have failed to compare long-term prognosis including both ischemic and hemorrhagic stroke [1,2,3,4,5]. Despite the importance of investigating stroke survival, in developing countries as Brazil that has one of the highest rates of hemorrhagic. We sought to investigate long-term survival and predictors that could influence adversely ischemic and hemorrhagic first-ever stroke prognosis along 4 years of follow-up

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