Poststroke Mortality Research Articles

Posthypoxic behavioral impairment and mortality of Drosophila melanogaster are associated with high temperatures, enhanced predeath activity and oxidative stress

Hypoxia is an underlying pathophysiological condition of a variety of devastating diseases, including acute ischemic stroke (AIS). We are faced with limited therapeutic options for AIS patients, and even after successful restoration of cerebral blood flow, the poststroke mortality is still high. More basic research is needed to explain mortality after reperfusion and to develop adjunct neuroprotective therapies. Drosophila melanogaster (D.m.) is a suitable model to analyze hypoxia; however, little is known about the impacts of hypoxia and especially of the subsequent reperfusion injury on the behavior and survival of D.m. To address this knowledge gap, we subjected two wild-type D.m. strains (Canton-S and Oregon-R) to severe hypoxia (<0.3% O2) under standardized environmental conditions in a well-constructed hypoxia chamber. During posthypoxic reperfusion (21% O2), we assessed fly activity (evoked and spontaneous) and analyzed molecular characteristics (oxidative stress marker abundance, reactive oxygen species (ROS) production, and metabolic activity) at various timepoints during reperfusion. First, we established standard conditions to induce hypoxia in D.m. to guarantee stable and reproducible experiments. Exposure to severe hypoxia under defined conditions impaired the climbing ability and reduced the overall activity of both D.m. strains. Furthermore, a majority of the flies died during the early reperfusion phase (up to 24 h). Interestingly, the flies that died early exhibited elevated activity before death compared to that of the flies that survived the entire reperfusion period. Additionally, we detected increases in ROS and stress marker (Catalase, Superoxide Dismutase and Heat Shock Protein 70) levels as well as reductions in metabolic activity in the reperfusion phase. Finally, we found that changes in environmental conditions impacted the mortality rate. In particular, decreasing the temperature during hypoxia or the reperfusion phase displayed a protective effect. In conclusion, our data suggest that reperfusion-dependent death might be associated with elevated temperatures, predeath activity, and oxidative stress.

The Independent Association of Prestroke Psychiatric Symptoms and Acute Phase Delirium with Poststroke Mortality at One Year in Nigeria

BackgroundUndetected acute phase delirium contributes to high poststroke mortality in sub-Saharan Africa (SSA). The present study adds to existing literature by examining the association of prestroke psychiatric symptoms with poststroke mortality at 3 and 12 months in Nigeria. MethodsA prospective observational study with repeated delirium assessments conducted using the Confusion Assessment Method (CAM). Delirium was characterised in participants meeting criteria in the Fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-V) as well as in those with ≥two core delirium features. Prestroke psychiatric symptoms were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Information on mortality was obtained by research supervisors during medical follow-up. Associations were investigated using multivariate logistic regression analyses and presented as odds ratios (O.R) within 95% confidence intervals (C.I). ResultsForty-five (30%) of 150 participants who provided data in the first week of stroke died by one-year follow-up. Those who died were more likely to have had a prestroke psychiatric symptom (64.4%, p=0.005) and delirium in the acute phase (60.0%, p=0.002). In analyses adjusting for the effect of age, education, tobacco smoking and stroke severity, prestroke psychiatric symptoms (O.R=3.3, 95% C.I=1.3,8.2; O.R=2.2, 95% C.I=1.0,4.6) and acute phase delirium (O.R=3.1, 95% C.I= 1.2,7.6; O.R=3.4, 95% C.I=1.5, 7.6) predicted mortality at 3 and 12 months poststroke, respectively. ConclusionThis study found that prestroke psychiatric symptoms and acute phase delirium independently predicted post-stroke mortality at 3- and 12 months. Detection and treatment of mental health conditions in the population at increased risk of stroke may help reduce poststroke mortality in SSA.

Prevalence, predictors, and prognoses of prestroke neuropsychiatric symptoms at 3 months poststroke.

Prior neuropsychiatric disturbances are risk factors for stroke. There is a knowledge gap on the predictors of prestroke psychopathology, as well as their association with stroke outcomes in survivors living in low- and middle-income countries (LMICs). We estimated prevalence, predictors, and association of prestroke neuropsychiatric symptoms with poststroke depression (PSD), disability, and mortality. Prospective observation. Nigeria. Adult ischemic and hemorrhagic stroke survivors. Prestroke psychopathology were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Outcomes were assessed using validated tools, including the Centre for Epidemiologic Studies - Depression Scale (CES-D 10) and modified Rankin scale (mRS). Independent associations were investigated using regression models with Bonferroni corrections, and presented as standardized mean differences (SMD) and odds ratios (OR) within 95% confidence intervals (CI). Among 150 participants, prestroke neuropsychiatric symptoms were found in 78 (52%). In multivariate logistic regression analyses, prestroke sleep disturbance was associated with systemic hypertension (OR = 5.39, 95% CI = 1.70-17.08). Prestroke neuropsychiatric symptoms independently predicted worse motor disability scores (SMD = 0.92, 95% CI = 0.21-1.62) and greater odds of poststroke mortality (OR = 2.7, 95% CI = 1.1-7.0) at 3 months. However, prestroke depression was not significantly associated with PSD. Prestroke sleep disturbances was associated with systemic hypertension, a key index of high cardiovascular risk profile and stroke. The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with sleep symptoms who have multiple, additional, risks of stroke.

Association Between Use of Statins and Survival After Stroke: Real-World Data from The Australian Stroke Clinical Registry

IntroductionDespite being recommended in clinical guidelines for secondary prevention of stroke, there are limited real-world data on outcomes associated with use of statins post-stroke.&#x0D; Objectives and ApproachWe aimed to investigate the association between statin use and cardiovascular mortality post-stroke. We conducted a retrospective cohort study using prospectively collected data from the Australian Stroke Clinical Registry (2010-2014), linked with national medication dispensing and mortality data. We observed adult patients with first-ever ischaemic stroke or transient ischaemic attack (TIA) for 1-year following hospital discharge, or until their date of death, whichever occurred first. Statin use, defined as having an available statin dispensing, was assessed daily and treated as a time-varying exposure to account for patients who discontinued or reinitiated statins during follow-up. Multivariable, competing-risks regression, with non-cardiovascular death as the competing risk, was used to investigate the association between statin use and 1-year cardiovascular mortality.&#x0D; ResultsAmong 8363 patients discharged following first-ever ischaemic stroke or TIA (48% aged ≥75 years, 45% female, 20% TIA, median length-of-stay 5 days), 945 died within 1 year, with 763 deaths being cardiovascular-related. The proportion of statin users was 65% at 90 days, 64% at 180 days, and 62% at 1 year. Groups least likely to be statin users at 1-year were women (odds ratio [OR]: 0.75; 95% CI: 0.67-0.85), patients aged &lt;65 years (OR: 0.80; 95% CI: 0.69-0.92), and those discharged directly home (OR: 0.77; 95% CI: 0.67-0.88). Compared to non-use, use of statins was associated with a reduced risk of cardiovascular mortality within 1 year overall (sub-distribution hazard ratio [SHR]: 0.40; 95% CI: 0.34-0.46), and in sub-groups of patients with TIA, severe stroke, and advanced age.&#x0D; Conclusion / Implications:Our preliminary data provide evidence of survival benefits associated with post-stroke statin use. Interventions to improve medication adherence may assist in reducing post-stroke mortality.

MiR-10a, 27a, 34b/c, and 300 Polymorphisms are Associated with Ischemic Stroke Susceptibility and Post-Stroke Mortality.

A recent study of the ischemic stroke described the roles played by miRNAs in the downregulation of specific cell-cycle gene expression and it is thought to require the development of biomarkers for the prognostic of ischemic stroke. Here, we hypothesized that four miRNA polymorphisms (miR-10a, miR-27a, miR-34b/c, and miR-300) may affect stroke susceptibility and mortality. Blood samples were collected from 530 patients and 403 controls. Genetic polymorphisms were detected by polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis and real-time PCR. We found that the miR-300 rs12894467 TC genotype and the dominant model (AOR: 2.069, p-value: 0.017; AOR: 1.931, p-value: 0.027) were significantly associated with an increased risk for the ischemic stroke subtype. In Cox proportional hazard regression models, the miR-10a rs3809783 A>T and miR-34b/c rs4938723 T>C polymorphisms were associated with the mortality rates among ischemic stroke patients. We found that a miR-300 polymorphism was associated with increased ischemic stroke susceptibility among the Korean population. Additionally, polymorphisms in miR-10a and miR-34b/c were associated with the increased or decreased mortality of ischemic stroke patients. This study marks the first report of an association between ischemic stroke and miRNA polymorphisms (miR-10aA>T, miR-27aT>C, miR-34b/cT>C, and miR-300T>C) in the Korean population.

MPG and NPRL3 Polymorphisms are Associated with Ischemic Stroke Susceptibility and Post-Stroke Mortality.

Ischemic stroke is a complicated disease which is affected by environmental factors and genetic factors. In this field, various studies using whole-exome sequencing (WES) have focused on novel and linkage variants in diverse diseases. Thus, we have investigated the various novel variants, which focused on their linkages to each other, in ischemic stroke. Specifically, we analyzed the N-methylpurine DNA glycosylase (MPG) gene, which plays an initiating role in DNA repair, and the nitrogen permease regulator-like 3 (NPRL3) gene, which is involved in regulating the mammalian target of rapamycin pathway. We took blood samples of 519 ischemic stroke patients and 417 controls. Genetic polymorphisms were detected by polymerase chain reaction (PCR), real-time PCR, and restriction fragment length polymorphism (RFLP) analysis. We found that two NPRL3 polymorphisms (rs2541618 C>T and rs75187722 G>A), as well as the MPG rs2562162 C>T polymorphism, were significantly associated with ischemic stroke. In Cox proportional hazard regression models, the MPG rs2562162 was associated with the survival of small-vessel disease patients in ischemic stroke. Our study showed that NPRL3 and MPG polymorphisms are associated with ischemic stroke prevalence and ischemic stroke survival. Taken together, these findings suggest that NPRL3 and MPG genotypes may be useful clinical biomarkers for ischemic stroke development and prognosis.

Long-Term Effect of Income Level on Mortality after Stroke: A Nationwide Cohort Study in South Korea

We investigated whether income level has long-term effects on mortality rate in stroke patients and whether this varies with time after the first stroke event, using the National Health Insurance Service National Sample Cohort data from 2002 to 2015 in South Korea. The study population was new-onset stroke patients ≥18 years of age. Patients were categorized into Category (1) insured employees and Category (2) insured self-employed/Medical Aid beneficiaries. Each category was divided into three and four income level groups, retrospectively. The study population comprised of 11,668 patients. Among the Category 1 patients (n = 7720), the low-income group’s post-stroke mortality was 1.15-fold higher than the high-income group. Among the Category 2 patients (n = 3948), the lower income groups had higher post-stroke mortality than the high-income group (middle-income, aOR (adjusted odds ratio) 1.29; low-income, aOR 1.70; Medical Aid beneficiaries, aOR 2.19). In this category, the lower income groups’ post-stroke mortality risks compared to the high-income group were highest at 13–36 months after the first stroke event(middle-income, aOR 1.52; low-income, aOR 2.31; Medical Aid beneficiaries, aOR 2.53). Medical Aid beneficiaries had a significantly higher post-stroke mortality risk than the high-income group at all time points.

Long-Term Risk of Stroke and Poststroke Outcomes in Patients with Heart Failure: Two Nationwide Studies.

ObjectiveTo evaluate the long-term risk of stroke and poststroke adverse outcomes in patients with heart failure (HF).MethodsWe used research data from Taiwan’s National Health Insurance Program from 2000 to 2005 and identified 20,072 adults aged ≥30 years who were newly diagnosed with HF. Frequency matching based on age and sex was used to select a comparison cohort consisting of 80,288 adults without HF. Events of incident stroke were identified from medical claims during the 2000–2013 follow-up period. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the association of stroke with HF were calculated with a multiple Cox proportional hazard model. Another nested stroke cohort study of 480,604 hospitalized stroke patients determined the adjusted odds ratios (ORs) and 95% CIs for adverse events after stroke in patients with and without HF between 2000 and 2009.ResultsCompared with the non-HF cohort, HF patients had an increased risk of stroke (HR 2.32, 95% CI 2.21–2.43), including ischemic stroke and hemorrhagic stroke. The association between HF and stroke was significant in both sexes and in patients in all age groups and with various medical conditions. Previous HF was associated with poststroke mortality (OR 1.40, 95% CI 1.31–1.50), pneumonia (OR 1.33, 95% CI 1.28–1.38), and septicemia (OR 1.30, 95% CI 1.23–1.37).ConclusionHF was associated with a higher risk of stroke, and patients with HF had more complications and greater mortality after stroke.

Intracranial Arterial Calcification Relates to Long-Term Risk of Recurrent Stroke and Post-stroke Mortality.

Background: Intracranial arterial calcification (IAC) is highly prevalent in ischemic stroke patients. However, data on the association of IAC with stroke recurrence and mortality remains limited. We examined the effect of IAC on the long-term recurrence of stroke and the risk of post-stroke mortality.Methods: Using a prospective stroke registry, we recruited 694 patients (mean age 71.6 ± 12.4; male sex 50.3%) since December 2004. IAC was visualized using the computed tomography exam that was made at hospital admission and was quantified with the Agatston method. All patients were regularly followed up till July 2016. The impacts of IAC on stroke recurrence and mortality were assessed using Cox-regression models with adjustments for age, sex, and relevant cardiovascular risk factors.Results: During a median follow-up period of 8.8 years, 156 patients (22.5%) suffered a recurrent stroke and 84 died (12.1%). We found that a higher IAC Agatston score related to a higher risk of stroke recurrence (HR per 1-SD increase in IAC: 1.30; 95% CI, 1.08–1.56, p = 0.005) and a higher risk of post-stroke mortality (HR per 1-SD increase, 1.44; 95% CI, 1.06–1.96, p = 0.019). After investigating etiology-specific risks of stroke-recurrence, we found that a higher IAC Agatston score specifically associated with small-vessel occlusive stroke.Conclusions: IAC is a strong risk factor for recurrent stroke and post-stroke mortality. Among stroke subtypes, IAC relates to higher risk of stroke recurrence among patients with small-vessel disease, which indicates chronic calcification detected in large cerebral arteries may have potential effects on the cerebrovascular beds extending to small vessels.

Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: A hospital-based prospective study.

Although obesity is an established risk factor of primary stroke, the association between obesity and post-stroke mortality remains unclear. The aim of this study was to investigate the association between dynamic obesity status and mortality in survivors of their first stroke in China.Of 775 patients with first-ever ischemic stroke included in a longitudinal study, 754 patients were included in this study and categorized into 4 categories of body mass index (BMI) (underweight, normal weight, overweight, and obese) and 2 categories of waist circumference (WC) (normal WC and abdominal obesity) according to standard Chinese criteria. The mortality information and obesity status were obtained via telephone follow-up every 3 months, beginning in 2010 through 2016. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for the relationship between all-cause mortality and dynamic obesity status.Of 754 patients, 60.87% were male, and the overall mean age was 61.45 years. After adjusting for possible confounders, significant inverse associations were identified between BMI and WC and all-cause mortality. Compared with those with normal BMI or WC, those with abdominal obesity or overweight had a significantly lower risk of all-cause mortality (HR and 95% confidence intervals [CI]: .521 [.303–.897] and 0.545 [.352–.845], respectively), whereas patients with underweight had the highest risk and those with obesity had lower risk of mortality, though it was not statistically significant (1.241 [.691–2.226] and .486 [.192–1.231], respectively).Overweight and abdominal obesity were paradoxically associated with reduced risk of mortality in patients who survived their first-ever ischemic stroke in China. Future prospective studies must look at evaluating the role of obesity in different stroke subtypes and devise appropriate weight-management strategies for optimal prognoses in secondary prevention in these survivors.

Post-stroke epilepsy and mortality: an observational study on healthcare administrative database

Abstract Background Post-stroke epilepsy (PSE) has been associated with hospitalization and increased mortality risk. So far, evidence on PSE and mortality risk is lacking. Therefore, this study aimed to evaluate the association between PSE and mortality in different type of stroke. Methods A retrospective observational study was conducted using healthcare administrative databases of Lombardy, a northern Italian region (16.4% of the Italian population). Patients aged 40 years or older admitted to the hospital between 1/1/2004 and 31/12/2008 with diagnosis of hemorrhagic (HS)- or ischemic (IS)- stroke were included. Diagnosis of seizure/epilepsy was identified by using discharge ICD9-CM codes, exemption code or use of antiepileptic drugs. This date was considered the index date. For each stroke cohort case of PSE was matched with 2 non post-stroke epileptic (PNS) individuals. Demographic and clinical characteristics were compared between PSE and PSN among the stroke cohorts. Cox proportional regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (95%CI) of mortality. Results In the observed period, 13,749 of patients (4,583 PSE Vs 9,166 PSN) had IS and 4,875 (1,625 PSE Vs 3,250 PNS) had HS. Individuals were ≥75-year-old with no difference among cohorts (p value &amp;gt;0.9). Similarly, no differences were observed for gender (p = 1.00) and Charlson'comorbidity index (p = 1.00). Early seizure occurred in 15% of ischemic cohort and 20% of hemorrhagic one. Differences in antithrombotic drug use were observed among PSE and PSN in IS (p = 0.009) and HS cohort (p = 0.03). In ischemic cohort PSE was positively associated with increased mortality risk (HRadj: 1.67; 95%CI: 1.57-1.79), whereas no significant result was observed in hemorrhagic cohort (1.06; 0.94-1.20). Conclusions This study demonstrated a twofold increased risk of mortality in IS cohort. Further studies need to deeply characterize possible association between PSE and mortality in HS individuals. Key messages Occurrence of seizure/epilepsy in ischemic post-stroke patients represents a risk factor for morality. New studies need to clarify the contrasting result observed for hemorrhagic PSE patients.

Predictive value of monocyte to HDL cholesterol ratio for stroke-associated pneumonia in patients with acute ischemic stroke.

Prior studies had reported monocyte to high-density lipoprotein cholesterol ratio (MHR) as a new inflammation marker and stroke-associated pneumonia (SAP) is common after stroke. We investigated the predictive value of MHR for SAP in patients with acute ischemic stroke (AIS). A total of 803 AIS patients within 72h after stroke were enrolled from April 2012 to January 2016 in Zhangjiagang TCM Hospital affiliated to the Nanjing University of Chinese Medicine. MHR measurement within 24h of hospital admission was divided into quartiles: Q1 (< 0.21), Q2 (0.21-0.30), Q3 (0.30-0.45), and Q4 (≥ 0.45). Monocyte count was also divided into categories. Clinical outcomes were post-stroke SAP and 3-month mortality. 121 patients (15.1%) experienced SAP during hospitalization, and 109 patients (13.6%) died from all causes within 3months after AIS. Compared to the lowest quartile, having admission MHR level in the highest quartile was associated with SAP [adjusted odds ratio (aOR) 2.79, 95% confidence interval (CI) 1.44-5.42; P trend = 0.003]. Compared with the lowest category of monocyte, the highest category was associated with a 2.60-fold increase in the odds of SAP (aOR 2.60, 95% CI 1.28-5.30; P trend = 0.005). However, there was no significant association between MHR (P trend = 0.514) and monocyte count (P trend = 0.684) and all-cause mortality at 3months. We demonstrated that both higher MHR and higher monocyte count at admission predicted SAP in patients with AIS.

Galectin-3 protects against ischemic stroke by promoting neuro-angiogenesis via apoptosis inhibition and Akt/Caspase regulation

Post-stroke neurological deficits and mortality are often associated with vascular disruption and neuronal apoptosis. Galectin-3 (Gal3) is a potent pro-survival and angiogenic factor. However, little is known about its protective role in the cerebral ischemia/reperfusion (I/R) injury. We have previously shown significant up-regulation of Gal3 in the post-stroke rat brain, and that blocking of Gal3 with neutralizing antibody decreases the cerebral blood vessel density. Our current study demonstrates that intracerebral local delivery of the Gal3 into rat brain at the time of reperfusion exerts neuroprotection. Ischemic lesion volume and neuronal cell death were significantly reduced as compared with the vehicle-treated MCAO rat brains. Gal3 increased vessel density and neuronal survival after I/R in rat brains. Importantly, Gal3-treated groups showed significant improvement in motor and sensory functional recovery. Gal3 increased neuronal cell viability under in vitro oxygen–glucose deprivation conditions in association with increased phosphorylated-Akt, decreased phosphorylated-ERK1/2, and reduced caspase-3 activity. Gene expression analysis showed down regulation of pro-apoptotic and inflammatory genes including Fas-ligand, and upregulation of pro-survival and pro-angiogenic genes including Bcl-2, PECAM, and occludin. These results indicate a key role for Gal3 in neuro-vascular protection and functional recovery following ischemic stroke through modulation of angiogenic and apoptotic pathways.

Does frailty predict post stroke mortality?

Stroke care is continually improving. Improvements in primary prevention, rapid diagnosis and treatment have been associated with national reductions in stroke mortality. Increasing availability of intravenous thrombolysis and mechanical thrombectomy has brought the discussion back to one of the most fundamental management questions in Geriatrics: “Is this the right decision for this particular patient?” The understanding of frailty as a syndrome of reduced physiological reserve has been widely adopted. Research across many specialities has identified frailty as an influencing factor in mortality and functional recovery, notably with: emergency surgery, intensive care admission and mechanical thrombectomy in acute stroke. The exact mechanisms through which frailty influences these outcomes is under investigation, though it has been suggested that it may be the result of cumulative deficits over time prior to the event rather than the response to the event itself.

T78. MORTALITY IN PATIENTS WITH SCHIZOPHRENIA ADMITTED FOR INCIDENT ISCHEMIC STROKE: A POPULATION-BASED COHORT STUDY

BackgroundEvidence shows that schizophrenia is associated with increased incidence of cardiovascular diseases (CVD), including stroke. The relationship between schizophrenia and post-stroke mortality was understudied, and mixed findings were observed. Of note, none of these studies specifically explored the association of schizophrenia with short-term mortality after incident ischemic stroke. One of them specifically examined short-term mortality following ischemic stroke in schizophrenia patients, but it did not address potential confounding by patients who had past history of stroke. The only study which included solely incident stroke patients indicated that patients with psychotic disorders experienced higher short-term mortality ensuing incident stroke.MethodsWe conducted a retrospective cohort study to investigate short-term mortality of schizophrenia patients after incident ischemic stroke. All individuals admitted for incident ischemic stroke between 2006 and 2016 in Hong Kong were identified using a territory-wide electronic health record database. 817 patients with an ICD-10 diagnosis of schizophrenia (F20) or schizoaffective disorder (F25) (termed schizophrenia henceforth) prior to index admission constituted the study group. The comparison group comprised 8170 patients (10:1 matched to schizophrenia patients on age, sex, treatment sites and calendar-period for index admission) without any non-affective psychoses, mania or bipolar disorder (F20, F22-25, F28-31).ResultsMultivariate logistic regression revealed that schizophrenia patients had higher 1-year (OR [95% CI] = 1.51 [1.22 – 1.85]) and marginally higher 30-day (OR [95% CI] = 1.34 [1.00 – 1.79]) mortality following incident ischemic stroke, after adjusting for medical comorbidities, including hypertension, diabetes, hyperlipidemia, alcohol and substance use disorders and other comorbidities quantified by Charlson-Deyo comorbidity index. Additional age- (<65 years and ≥65 years) and gender-stratified analyses revealed similar results. Elevated 1-year mortality was exhibited by all schizophrenia subgroups, being more pronounced in younger patients (OR [95% CI] = 2.02 [1.38 – 2.96]). Increase in 30-day mortality was only seen in younger (OR [95% CI] = 1.75 [1.04 – 2.95]) and male (OR [95% CI] = 1.63 [1.06 – 2.50]) schizophrenia patients.DiscussionOur results of heightened short-term post-stroke mortality in schizophrenia were in line with the only previous study which compared short-term mortality ensuing incident stroke in patients with and without psychotic disorders. This intuitive result may be explained by some studies which demonstrated that schizophrenic stroke patients were less likely to receive reperfusion treatments and prophylactic medications. The absence of data on lifestyle factors, antipsychotic treatment and post-stroke management is a major limitation in our study. In conclusion, our results indicated that schizophrenia is associated with increased short-term mortality after incident ischemic stroke. Further research is warranted to clarify the contribution of possible risk factors to post-stroke mortality in schizophrenia patients.

Post-stroke Complications and Mortality in Burkinabè Hospitals: Relationships with Deglutition Disorders and Nutritional Status.

Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional parameters were assessed at baseline (D0) and on Days 8 (D8) and 14 (D14). Complications and mortality were recorded up to D14. Factors associated with complications and mortality were investigated using multivariate analysis. Of the 222 patients included, 81.5% developed at least one complication, and mortality was 17.1%. At D0, D8, and D14, the rate of deglutition disorders was 37.4%, 28.4%, and 15.8%, respectively, and that of undernourishment 25.2%, 29.4%, and 31.0%, respectively. In multivariate analysis, only the presence of deglutition disorders was a risk factor for developing at least one complication (OR = 5.47, 95% CI 1.81-16.51). Factors predicting death were the presence of deglutition disorders at D0 (OR = 7.19, 95% CI 3.10-16.66), and at least one seizure during follow-up (OR = 3.69, 95% CI 1.63-8.36). After stroke, the rates of complications, death, and undernourishment were high compared to Western countries. Prevention and management of deglutition disorders, and specific follow-up of patients with seizures could reduce post-stroke mortality.

Racial and Ethnic Disparities in Mortality in US Veterans Following an Incident Subarachnoid Hemorrhage

Background Blacks and Hispanics have been shown to have higher stroke mortality than Whites. However, few studies have investigated health disparities in post-stroke mortality for specific stroke types, such as subarachnoid hemorrhage (SAH). We analyzed risk of mortality by race/ethnicity after incident SAH in a national sample of stroke patients from the Veteran's Health Administration (VHA). Methods We included 742 patients (98% male, mean age 63±13 years) with a first occurrence of an inpatient SAH in a VHA hospital between 2002-2007. SAH was determined by ICD-9 code 430. We categorized patients as non-Hispanic White, non-Hispanic Black, or Hispanic. Veterans with a prior definite stroke type (including TIA) were excluded. We constructed a piecewise multivariate survival model for post event all-cause mortality, separated according to 1 year post admission follow-up intervals. We then looked at 30-day mortality for vascular and stroke specific deaths. Results The proportion of White, Black, and Hispanic patients was 66%, 23%, and 11% respectively. Total mortality at 30 days, 90 days, 1 year, and end of follow up was 22%, 27%, 33% and 54% respectively. Compared to Whites, Hispanics had higher mortality in the first 30 days post stroke (HR=1.67 95% CI=1.08-2.30), while Blacks and Whites experienced similar mortality (HR=1.02 95% CI=0.68, 1.54). Both Blacks and Hispanics had worse vascular (Black vs White HR=1.59 95% CI=0.95-2.66; Hispanic vs White HR=2.04 95% CI=1.13-3.66) and stroke-specific (Black vs White HR=1.47 95% CI=0.81-2.67; Hispanic vs White HR=2.12 95% CI=1.16-4.22) mortality (“case-fatality”) than Whites in the first 30 days. Conclusion Survivorship following subarachnoid hemorrhage varies in Veterans according to race and ethnicity. Further research into the severity of the stroke as well as risk factor control before and after stroke could help to improve our understanding of these differences.

The Effect of Race on Stroke Incidence and Post-Stroke Mortality - The Stroke Paradox in LVAD Patients

Stroke is considered one of the major hurdles in applying Left Ventricular Assist Device (LVAD) technology to a broader population, and remains a leading cause of mortality and morbidity despite advances in both technology and management. In the general population, incidence of stroke in African Americans (AA) has been reported to be twice that of their Caucasian counterparts, and the mortality following stroke higher in AA. We sought to assess the effect of race on both rate of stroke, as well as post stroke survival in the LVAD population. Using the publically available NIH INTERMACS data, we identified and assessed stroke rates in a total of 14,573 patients support by continuous flow durable LVAD (cf-LVAD). We performed a univariate analysis based on gender and race, followed by a stepwise multivariate analysis adjusting for 20 commonly reported risk factors for stroke. We also applied Bayesian analyses to determine the significant variables impacting stroke in patients with and without self-reported Black ancestry RESULTS: There were 3916 patients with AA ancestry (26.8 %) and 3139 Females (21.5%). The overall stroke rate was 14.9%. There was no difference in the stroke rates between the AA and Caucasian CF-LVAD patients (15.3% vs. 14.7%, p=0.37), but there was an improved stroke free survival in the AA population (Figure 1,p < 0.001). Female patients were found to have an increased risk of stroke when compared to males (HR, 1.30, 95%CI, 1.19-1.43, p<0.01), without any heterogeneity by ethnicity. Post Stroke mortality was higher in the Caucasian population (Figure 2, p = 0.001). This study shows that patients with self-reported AA ancestry appears to be protected in regards to the time to first stroke, even when adjusted for gender. After a stroke occurs, AA patients also appear to have better survival when compared to Caucasians. This is paradoxical when compared to the non cf-LVAD population merits and avenue of further investigation into the mechanisms of stroke cf-LVAD patients.

Statin effects on post-stroke epilepsy and mortality – Taiwan population-based study

ABSTRACT Objectives: Statins have anti–inflammatory effects on several neurological diseases. However, their effects on post-stroke epilepsy and mortality have not been well studied. Method: This is a retrospective cohort study, based on the one-million random data from National Health Insurance Research Database (NHIRD) of Taiwan. We identified stroke inpatients during 2000–2009. They were grouped into statin users and non-users, and followed up to 2010. Excluded were those with in-hospital mortality, in-hospital seizure(s), epileptic history, antiepileptic drug use before admission, or age under 45. The hazard ratios of statin-associated epilepsy and mortality were analyzed separately. Results: There were 16,711 statin non-users and 2246 users. There was no significant differences between the two groups in terms of epilepsy (13.3 vs. 15.7 per 1000 person-years, p = 0.728) and overall mortality (66.3 vs. 104.6 per 1000 person-years, p = 0.351). Subgroup analysis of male patients showed that statin-users had lower mortality risk compared with non-users (60.2 vs. 113.0 per 1000 person-years, p = 0.032). Conclusion: Statins have a modest but non-significant effect in preventing post-apoplectic epilepsy in Taiwan. Statins decrease post-stroke mortality only in men. Further studies are needed to depict their exact roles in these issues.

Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.